By COLLEEN CREAMER
For VerusMed
Seizures are common among elderly individuals, and their diagnosis and management require an approach tailored to the geriatric patient, according to experts.
Twenty-five percent to 50 percent of new-onset seizures occur in elderly patients, said Dr. Eugene Ramsay, a professor in the departments of neurology and psychiatry at the University of Miami School of Medicine. The underlying cause of such seizures is often vascular disease, which is common among older patients.
Of the many challenges in managing seizures in the aging population, one is an accurate diagnosis. Physicians are frequently unable to determine that these patients are presenting with a new disorder, Ramsay noted.
“There is a delay in the diagnosis of these patients, and patients that have the longest delay are the people that have active brain or heart disease. Somehow their symptoms get lumped in with one disease,” he said.
Because of changes in the aging brain, imaging studies are of little value, according to Ramsay, as are laboratory tests. As a result, patient history becomes a valuable diagnostic tool.
Richard Marasco, president of Pharmaceutical Care & Management Services in Valdosta, Ga., added that what might look like agitation to a health care provider or family member, might actually be an epileptic episode.
“Here we are thinking they might need an antipsychotic or something that will stop that acting out or that aggression,” Marasco said.
With respect to the treatment of seizures in older patients, Ramsay explained that drug tolerability is an important consideration.
“As it turns out in this age group, efficacy is not the primary differential as far as being able to treat someone well,” Ramsay noted. “It’s the tolerability of the drug.”
And though many antiepileptic drugs cause adverse events, the newer drugs, such as gabapentin, lamotrigine, levetiracetam, Pfizer Inc.’s Lyrica (pregabalin), Cephalon Inc.’s Gabitril (tiagabine hydrochloride), Johnson & Johnson’s Topamax (topiramate), and zonisamide, appear to be less problematic in this population, Marasco added.
Ramsay and Marasco advised physicians to be particularly cautious when prescribing an antiepileptic drug that causes weight gain, which can exacerbate comorbidities in elderly patients who are already overweight.
“Obesity is a major problem for people in nursing homes who may not be moving around. It’s very easy to make them more overweight, adding to many of their other medical problems,” said Ramsay.
Long-term providers need to not only develop a care plan based on the type of seizure, but must be able to determine when to switch medications and when and how to reduce or discontinue therapy.
