Epilepsy Care in Older Adults

This issue of Practical Neurology considers approaches to the care of older adults with epilepsy, from diagnosis and pharmacology to surgical management and considerations for quality of life. The concise, informative articles included in this issue are intended to equip neurologists with important concepts based on current research findings that can be integrated into their clinical practice.

Dr. Elder and Harley Mocker begin the issue with an overview of diagnostic considerations for epilepsy in people aged 60 years or older. This vulnerable population is at an increased risk of neurologic disorders, with epilepsy ranking as the third most common disorder behind stroke and dementia, both of which are also risk factors for epilepsy. The authors note that early recognition and accurate diagnosis are critical for managing epilepsy for these patients.

Next, Drs. Nguyen, Bainbridge, and Dergalust discuss a detailed landscape of antiseizure medications available for the treatment of epilepsy in older adults, including preferred and nonpreferred options. Special considerations for each antiseizure medication are discussed, including their pharmacokinetic and pharmacodynamic properties, adverse events, and drug–disease and drug–drug interactions.

For older adults with drug-resistant epilepsy, surgical procedures and neuromodulatory devices present unique challenges. Dr. Gururangan presents an overview of surgical management for this population, with a focus on neurostimulation and neuromodulatory approaches including vagus nerve stimulation, deep brain stimulation, and brain-responsive neurostimulation, as well as resective and ablative surgery.

Finally, Dr. Pellinen covers important aspects of health, well-being, and quality of life to consider when treating older adults with epilepsy. These factors include severity of epilepsy and underlying etiologies, treatments and their side effects, as well as living environment, social engagement, and available local and personal resources. Dr. Pellinen identifies how these factors combine with natural aging to impact quality of life, resulting in complex individual experiences and perspectives.

Each of these review articles provide relevant, insightful commentary that can be leveraged to enhance approaches to care for older adults with epilepsy. I extend my gratitude to each of the authors for sharing their knowledge and expertise.