New-onset epilepsy in the elderly

Lily Chi Vu, Loretta Piccenna, Patrick Kwan, Terence J. O'Brien

Research output: Contribution to journalReview ArticleResearchpeer-review

Abstract

People who are 60 years old and older have the highest incidence of developing new-onset epilepsy. The increase of the ageing population has resulted in a greater number of patients with new-onset epilepsy or at risk of developing the condition. Previously published review articles regarding epilepsy in older patients have had a broad focus, including people who were diagnosed with epilepsy in their childhood or middle age. The present review focuses on the causes, treatment, prognosis and psychosocial impact of new-onset epilepsy in people aged ≥60 years. Following a search of the medical electronic databases and relevant references, we identified 22 studies overall that met the inclusion criteria. Only four randomized clinical trials (RCTs) were identified that compared different antiepileptic drug treatments in this population, demonstrating that newer-generation antiepileptic drugs (e.g. lamotrigine and levetiracetam) were generally better tolerated. One uncontrolled study provided promising evidence of good outcomes and safety for surgical resection as a treatment for people with uncontrolled seizures. Five studies reported that people ≥60 years with new-onset epilepsy have significant cognitive impairments (e.g. memory loss) and psychological issues including depression, anxiety and fatigue. We found that there is limited evidence to guide treatment in people with Alzheimer's disease and epilepsy. The specific features of new-onset epilepsy in this target population significantly influences the choice of treatment. Cognitive and psychiatric screening before treatment may be useful for management. Two studies with proposed guidelines were identified but no formal clinical practice guidelines exist for this special population to assist with appropriate management. There is a need for more RCTs that investigate effective treatments with limited side effects. More research studies on the psychosocial effects of new-onset epilepsy, and long-term outcomes, for people aged ≥60 years are also required.

Original languageEnglish
Pages (from-to)2208-2217
Number of pages10
JournalBritish Journal of Clinical Pharmacology
Volume84
Issue number10
DOIs
Publication statusPublished - 1 Oct 2018

Keywords

  • antiepileptic drugs
  • elderly
  • new-onset epilepsy
  • psychosocial
  • randomized controlled trials
  • treatment

Cite this

Vu, Lily Chi ; Piccenna, Loretta ; Kwan, Patrick ; O'Brien, Terence J. / New-onset epilepsy in the elderly. In: British Journal of Clinical Pharmacology. 2018 ; Vol. 84, No. 10. pp. 2208-2217.
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New-onset epilepsy in the elderly. / Vu, Lily Chi; Piccenna, Loretta; Kwan, Patrick; O'Brien, Terence J.

In: British Journal of Clinical Pharmacology, Vol. 84, No. 10, 01.10.2018, p. 2208-2217.

Research output: Contribution to journalReview ArticleResearchpeer-review

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T1 - New-onset epilepsy in the elderly

AU - Vu, Lily Chi

AU - Piccenna, Loretta

AU - Kwan, Patrick

AU - O'Brien, Terence J.

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