0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
ARTICLE |

Seizures and Epilepsy in the Elderly

Robert J. Thomas, MD
Arch Intern Med. 1997;157(6):605-617. doi:10.1001/archinte.1997.00440270035003.
Text Size: A A A
Published online

Seizures and epilepsy in the elderly are an important and increasingly common clinical problem. Major known causes include cerebrovascular disease, brain tumor, degenerative disorders such as Alzheimer disease and cerebral amyloid angiopathy, and toxic-metabolic syndromes such as nonketotic hyperglycemia, postcardiac arrest, and drug-induced seizures. Recognition of seizures may be complicated by relatively unique clinical presentations and differential diagnosis. Nonconvulsive status epilepticus may present as recurrent episodes of confusion. The electroencephalogram is less useful than in the pediatric age group, but has a role in the evaluation of a first seizure and may rarely show characteristic patterns, such as poststroke periodic lateralized epileptiform discharges. Convulsive status, especially that associated with drug toxicity, is associated with increased mortality in the elderly. Pharmacological treatment is complicated by age-related changes in pharmacokinetics and pharmacodynamics and drug-drug and drug-disease interactions. Some of the new antiepileptic drugs may offer advantages for use in the elderly. Oxcarbazepine has fewer drug interactions than carbamazepine, and gabapentin has one, a reduction of felbamate renal elimination. Vigabatrin causes little cognitive dysfunction, while drugs that reduce excitatory amino acid neurotransmission, such as lamotrigine and felbamate, have potentially protective effects in patients with ischemic cerebrovascular disease. The use of barbiturates, primidone, the benzodiazepine clobazam, and the calcium blockers flunarizine and cinnarizine should preferably be avoided in the elderly.

Arch Intern Med. 1997;157:605-617

Topics

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 56

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Jobs
brightcove.createExperiences();