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 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.

Blog #46: Uncontrolled Epilepsy: New Explanation and Treatment

(This blog was originally posted on May 27, 2014)

 

Almost one-third of people who have epilepsy cannot satisfactorily control their seizures, even when they take several anti-epilepsy drugs simultaneously.

A new treatment has come to light that some of these epilepsy patients respond to drugs that reduce inflammation in the brain. Toledano, et. al, reported that immunotherapy can improve seizure control (Neurology; 82:1578-86, May 6, 2014). How can this work?

Patients’ own natural defenses can cause disease. This type of disease mechanism is known as an autoimmune process. For various, and poorly understood reasons, the body creates chemical substances called antibodies that react with, and battle against, itself. Antibodies normally are produced to fight against disease-bearing germs, such as those causing infections, and against foreign bodies. Examples of FOREIGN BODIES are livers and kidneys transplanted from one person into another. But sometimes the body uses the immune system to harm itself. Examples of AUTOIMMUNE illnesses include rheumatoid arthritis, lupus, myasthenia gravis and multiple sclerosis.

Various inflammations of the brain are also caused by autoimmune antibody mechanisms. Autoimmune diseases are treated with medications that minimize the effect of autoimmune antibodies. Steroids (prednisone, methylprednisolone, and cortisol) are examples of such medications. Other treatments involve “washing” these deleterious antibodies out of the blood by plasmapheresis, or by infusing intravenously human immune globulin (IVIG) blood products. The precise mechanism by which IVIG suppresses harmful inflammation has not been definitively established.

Testing for various known antibodies working against nervous system tissue can be considered in those patients with epilepsy whose epilepsy has no identifiable cause and is poorly controlled. Research has shown that, when appropriate, treating with a trial of immunotherapy as discussed above has been effective.

 

 

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.