Approximately one percent of the population, or three million people, have epilepsy. Several decades ago the most prevalent age-group that developed epilepsy was children. Times have changed. Today, it’s the elderly who develop epilepsy just as often, if not more so. See my Blog # 15, December 14, 2011 on this website.
Health-care
has vastly improved over the past half-century resulting in people living
longer. However, longer longevity results in potentially more brain scars—a very common cause of epilepsy. Scars result
from strokes and “hardening” of the arteries, brain injuries, tumors, infections,
Alzheimer’s disease and other brain degenerations.
Older adults diagnosed
with new-onset epilepsy may not receive optimal treatment because they are too
often prescribed the older anti-epilepsy drugs (AEDs). Prime examples of these
are Dilantin (phenytoin), developed in the late 1930’s, and barbiturates
(phenobarbital), in use for over a century. Non-neurologist physicians (e.g., emergency
department doctors, and geriatricians), are often more familiar with these older
drugs than with newer ones; these are the physicians who usually evaluate and initiate
treatment of patients after their first seizure.
Older drugs’ common
side-effects include “brain fogginess” and drowsiness which can worsen
unsteadiness that may already afflict the elderly. Dilantin promotes bone
density loss more than newer AEDs. The newer AEDs developed over the past
twenty years, such as Keppra (levetiracetam), Lamictal (lamotrigine), and many
others are reasonably well-tolerated and can be more effective. Dilantin has
many drug interactions, too, including lowering the effectiveness of some cholesterol-controlling
medications. One key reason for using the older AEDs, however, can be that they
cost less than the newer ones.
I want this
information to prompt patients to discuss their AED choice with their primary physician.
Consider a neurologist consulting in their epilepsy care.
Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.
