Abstracts

Rationale: It is generally recognized that seizures in elderly onset epilepsy without apparent symptomatic etiology are easily controlled with antiepileptic drugs(AEDs). However, there is little evidence as to which drug is the most reliable to achieve long-term seizure freedom. Methods: The subjects were 119 patients fulfilling the following criteria; no evidence of apparent symptomatic etiology, the first visit to our hospital between Feb.2008 and Feb.2017 , onset of epilepsy above 50 years of age, follow-up period longer than one year. Follow up periods ranged from 1.0 to 9.9 years (mean 4.0 years). Medical records were retrospectively reviewed to evaluate the efficacy and tolerability of four frequently used drugs, namely carbamazepine(CBZ), levetiracetam(LEV), lamotrigine(LTG) and valproate(VPA). One-year complete seizure freedom was a marker for efficacy and discontinuation of a drug for tolerability. Results: CBZ was prescribed for 90 patients, and VPA for 45, LEV for 37, LTG for 22. The proportion of patients achieving one-year seizure freedom to all patients to whom a certain drug was prescribed was 77% in LTG, 61% in CBZ, 32% in LEV, and 20% in VPA. On the contrary, the proportion of patients who discontinued a drug was 62% in VPA, 54% in LEV, 31% in CBZ and 18% in LTG. Chief reason for discontinuation was ineffectiveness or aggravation of seizures in 51% in VPA, and 32% in LEV. Furthermore, additional 24% of patients stopped LEV due to sleepiness or psychiatric problems. On the other hand, allergic skin reaction was the main reason for discontinuation in 22% in CBZ and 9% in LTG, while only 1.1% in CBZ and none in LTG showed ineffectiveness or aggravation of seizures, which means that CBZ and LTG would be highly probable to reach one-year seizure freedom if tolerated. Conclusions: LTG is the drug of choice for elderly onset epilepsy without apparent symptomatic etiology in terms of efficacy and tolerability. Funding: Nothing