Abstracts

Antiepileptic drug (AED) treatment in the elderly represents a challenge due to limited data on their efficacy and side effect profile in older patients, high incidence of co-morbidities, and age-related changes in protein binding, gastrointestinal absorption, renal and hepatic clearance. In the last decade new AEDs with improved tolerability and reduced interaction potential have been available. The aim of the study was to determine whether the increased availability of new AEDs has influenced our prescribing habits in elderly epilepsy patients., We identified new referrals to Henry Ford Hospital epilepsy clinics in the last 3 years by searching our electronic database. We included patients older than 60 with a confirmed diagnosis of epilepsy. We collected data on specialty of referring physician, age at epilepsy onset, etiology, AED upon initial evaluation, seizure control and calcium supplementation. Descriptive statistics and Fisher[apos]s exact test were used for the analysis., Of 349 new referrals, 49 (14%) were older than 60 (age range 60 to 91; females=20). Primary care physicians referred 23 (47%) patients. Community neurologists referred the remainder, except for two referred by neurosurgeons. Thirty four patients (69.4%) were taking either one old or combination of old AEDs. Nineteen patients (38.7%) were on phenytoin monotherapy and 10 (20.4%) on phenytoin polytherapy. Twelve patients (24.5%) were taking carbamazepine as mono or polytherapy while 9 patients (18.4%) were on phenobarbital combination therapy. Only 11 patients (32%) on old AEDs were seizure free. In our patient group only 4 patients (8%) were taking new AED monotherapy. Calcium supplementation was recommended in only 3 patients (6%). There was a trend for primary care physicians (PCP) to prescribe older AEDs (95% of PCP vs 74% of neuro-specialists, p = 0.09), Our study showed that almost 70% of elderly are still being prescribed phenytoin, phenobarbital and carbamazepine despite their potential of multiple drug interactions, sedative and cognitive side effects, increased neurotoxicity at [ldquo]therapeutic doses[rdquo] along with long term side effects such as osteoporosis. In our group, patients were maintained on old AEDs although they were effective in only 32% of them. Guidelines for calcium supplementation were not followed. Ten years after the approval of new AEDs, their use is still very limited in elderly for reasons that need to be further addressed.,