Tuesday, April 25, 2017

Blog #81: Elderly Adults with New-Onset Epilepsy Are Often Prescribed Older, Less Effective Anti-Epilepsy Drugs

            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 scarsa 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.