Antiseizure Medications in Older Adults with Epilepsy: Considerations in Pharmac...

연구 요약

Antiseizure Medications in Older Adults with Epilepsy: Considerations in Pharmacology, Safety, Tolerability, and Effectiveness of Newer Agents.

Drugs & aging 학술지에 발표된 이 연구는 McCarthy LM, Boylan KA, Sarkis RA 외 연구팀이 수행하였습니다.

이 연구는 'Antiseizure Medications in Older Adults with Epilepsy: Considerations in Pharmacology, Safety, Tolerability, and Effectiveness of Newer Agents.'에 대한 과학적 분석을 제공합니다.

핵심 내용

Older adults represent one of the fastest-growing populations living with epilepsy, yet they remain underrepresented in clinical trials. In this age group, antiseizure medication selection is frequently complicated by multimorbidity, polypharmacy, age-related changes in renal and hepatic function, and vulnerability to adverse effects such as falls and cognitive impairment. Because many antiseizure medications demonstrate comparable efficacy for seizure control, medication tolerability and quality-of-life considerations often play a decisive role in treatment selection for older adults. This narrative review synthesizes available evidence on the tolerability of commonly used antiseizure medications in adults aged 65 years and older, with a focus on adverse-effect profiles, treatment retention, and clinical considerations unique to aging populations. Data from previous trials are reviewed for established agents (including levetiracetam, lamotrigine, carbamazepine, gabapentin, and pregabalin) as well as newer antiseizure medications such as lacosamide, brivaracetam, cenobamate, eslicarbazepine acetate, and perampanel. Emerging evidence suggests that newer agents demonstrate favorable efficacy and tolerability at lower doses in older adults, though falls, dizziness, and neuropsychiatric effects can be dose limiting. Newer intranasal benzodiazepine rescue therapies offer practical advantages for seizure clusters, but data specific to older adults remain limited. The review also addresses tolerability considerations related to renal and hepatic impairment, osteoporosis, anticoagulation, chemotherapy, and special populations including individuals with dementia, post-stroke epilepsy, tumor-related epilepsy, and depression. Overall, existing evidence supports the use of lower starting doses, slower titration schedules, and avoidance of enzyme-inducing antiseizure medications when possible in older adults. The heterogeneity of this population highlights the need for future studies stratified by frailty, cognitive status, and the living environment to better inform individualized tolerability-focused epilepsy care in later life.

일반인을 위한 해석

구체적인 실천 사항은 담당 의사 또는 약사와 상담하시기 바랍니다.

실천 사항

• 현재 복용 중인 약물이나 영양제에 대해 궁금한 점이 있다면 담당 의사 또는 약사와 상담하시기 바랍니다
• 약물이나 영양제의 용법·용량을 임의로 변경하지 마세요
• 이상 반응이 나타나면 즉시 전문가에게 문의하세요

의사/약사의 전문적 판단을 대체하지 않습니다 (PMID: 41706289)