The medical treatment of epilepsy in the elderly: A systematic review and meta‐analysis

• Published in: Epilepsia (Copenhagen) Vol. 60; no. 7; pp. 1325 - 1340
• Main Authors: Lezaic, Nastasija, Gore, Geneviève, Josephson, Colin B., Wiebe, Samuel, Jetté, Nathalie, Keezer, Mark R.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.07.2019
• Subjects: Age Factors; Aged; anticonvulsants; Anticonvulsants - adverse effects; Anticonvulsants - therapeutic use; Antiepileptic agents; Carbamazepine; Clinical trials; Drug Tolerance; Epilepsy; Epilepsy - drug therapy; Etiracetam; Gabapentin; Geriatrics; Humans; Lamotrigine; Meta-analysis; randomized controlled trials; Seizures; Systematic review; Topiramate; Treatment Outcome; aged; geriatrics; seizures; anticonvulsants; randomized controlled trials
• ISSN: 0013-9580; 1528-1167; 1528-1167
• DOI: 10.1111/epi.16068

Objective To evaluate the efficacy and tolerability of antiepileptic drugs (AEDs) in elderly individuals with epilepsy. Methods We searched four electronic databases as well as bibliographies and conference s. Published and unpublished, randomized, or quasirandomized trials reporting the use of AEDs in people aged at least 60 years with epilepsy were eligible for inclusion. Two authors independently carried out each stage of the review. Meta‐analyses were performed using random‐effects models. Results Three thousand four hundred seventeen titles and s were reviewed. Eighteen studies evaluating 12 AEDs met all eligibility criteria. Ten studies, comprising 1999 subjects, were suitable for meta‐analysis. Among the elderly with epilepsy, lamotrigine (LTG) is better tolerated relative to carbamazepine (pooled weighted risk ratio [RR] of experiencing withdrawal due to adverse events = 1.83, 95% confidence interval [CI] = 1.23‐2.43). There is a higher probability, although with a 95% CI of borderline importance, of seizure freedom when comparing levetiracetam to LTG (RR = 0.83, 95% CI = 0.68‐0.97). Single studies provide evidence for the efficacy and/or tolerability of other AEDs in the elderly, including brivaracetam, gabapentin, lacosamide, perampanel, and topiramate. The risk of bias of the included studies was frequently low or unclear, although there was on occasion a high risk of bias (especially with regard to selective reporting). Significance There is some evidence for AED use in the elderly with epilepsy. More evidence is required, comparing newer AEDs to prior generations as well as examining the effects of determinants such as frailty, to guide clinicians when treating this rapidly growing patient population.