Abstracts

Rationale: Elderly individuals (aged at least 65 years) represent a rapidly growing segment of the population. Numerous factors related to aging, including physiological changes, medical comorbidities, and co-medications raise concerns about the appropriate choice of antiepileptic drug (AED) in the elderly with epilepsy. The primary goal of our systematic review is to evaluate the efficacy and tolerability of AEDs in elderly individuals with epilepsy. Methods: We searched the following electronic databases: Ovid MEDLINE, Ovid EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials. Published and unpublished randomized or quasi-randomized trials reporting the use of AEDs in the elderly with epilepsy were eligible for inclusion. Two review authors independently screened each title and abstract, selected articles for inclusion, extracted the data, and assessed risk of bias. All disagreements were resolved by consensus. Synthesis of the data is underway. We will meta-analyze study-level data using random-effect models. If there is substantial interstudy heterogeneity, we will provide a descriptive summary of the results. Results: 3925 abstracts and titles were identified and reviewed, resulting in 256 full-text articles. Amongst these, ten trials, encompassing at total of 938 subjects and evaluating eight AEDs, met our inclusion criteria.Lamotrigine trended towards being better tolerated than carbamazepine regular and sustained-released in two small-scale studies, while one large-scale study showed statistically significant better tolerability and seizure-freedom for lamotrigine. Individuals receiving levetiracetam were more likely to be seizure-free as compared to lamotrigine but also trended towards suffering from more side effects. Elderly patients with dementia treated with levetiracetam demonstrated improved cognitive performance when compared with phenobarbital which occasioned significant negative cognitive effects. Topiramate used as an adjunctive for uncontrolled focal seizures was effective and well-tolerated, as compared to baseline AED treatment. In subgroup analyses of phase III studies, brivaracetam and perampanel demonstrated comparable efficacy and tolerability to the general adult population. In an unpublished study of elderly subjects with focal refractory epilepsy, zonisamide was possibly more effective (effect not statistically significant) than placebo but also possibly associated with more side effects.For the majority of risk of bias criteria, most of our included studies were judged to have unclear (due to insufficient data reported) or high risks of bias. Conclusions: There is some evidence that lamotrigine and levetiracetam have similar efficacy and better tolerability in the elderly when compared with older AEDs such as carbamazepine. Evidence exists to support the use of brivaracetam, perampanel, and topiramate. More data is required to better inform optimal treatment of epilepsy in the elderly. Funding: No funding.