(phenytoin, carbamazepine, phenobarbital). Antidepressants ... Lifestyle factors. Against the background of having to manage the epilepsy itself is the patient's ... Galimberti, C., et al., Antiepileptic drug use and epileptic seizures in elderly ..... Ferrendelli, J., et al., Use of levetiracetam in a population of patients aged. 65 years ...
Table
5.
Drugs
whose
serum
concentrations
are
lowered
by
enzyme‐inducing
drugs
(phenytoin,
carbamazepine,
phenobarbital)
Antidepressants
Amitriptyline,
bupropion,
citalopram,
clomipramine,
desipramine,
doxepin,
imipramine,
mianserin,
mirtazapine,
nefazodone,
nortriptyline,
paroxetine
Antimicrobials
Albendazole,
doxycycline,
griseofulvin,
indinavir,
itraconazole,
metronidazole,
praziquantel
Antineoplastics
Busulfan,
cyclophosphamide,
etoposide,
irinotecan,
methotrexate,
nitroureas,
paclitaxel,
procarbazine,
tamoxifen,
tenoposide,
vinca
alkaloids
Antipsychotics
Chlorpromazine,
clozapine,
haloperidol,
olanazapine,
quetiapine,
risperidone,
ziprasidone
Benzodiazepines
Alprazolam,
clobazam,
clonazepam,
diazepam,
midazolam
Cardiovascular
Amiodarone,
atorvastatin,
warfarin,
digoxin,
felodipine,
metoprolol,
mexiletine,
nifedipine,
nimodipine,
propranolol,
quinidine,
simvastatin,
verapamil
Immunosuppressants
Cyclosporine,
sirolimus,
tacrolimus
Steroids
Cortisol,
dexamethasone,
hydrocortisone,
methylprednisolone,
prednisolone,
oral
contraceptives
Miscellaneous
Fentanyl,
methadone,
paracetamol,
pethidine,
theophylline,
thyroxine,
vecuronium
6. Lifestyle
factors
Against
the
background
of
having
to
manage
the
epilepsy
itself
is
the
patient’s
own
complex
psychosocial
milieu.
Few
studies
have
been
conducted
on
the
impact
of
epilepsy
on
the
morbidity
of
elderly
patients.
However,
it
is
clear
that
the
effect
of
epilepsy
and
the
medications
used
to
treat
it
can
pose
a
threat
to
the
independence
of
the
elderly
patient.
There
is
significant
potential
for
social
isolation
caused
by
falls,
confusion
and
amnesia,
which
can
be
further
enhanced
by
the
driving
restrictions
that
are
imposed
following
a
seizure.
Furthermore,
there
is
a
higher
prevalence
of
depression,
anxiety
and
poor
sleep
compared
to
age‐matched
controls
[96],
which
may
be
worsened
by
the
stigma
towards
the
disease.
Together,
these
issues
have
the
potential
to
contribute
to
a
poorer
overall
quality
of
life,
and
the
physician
needs
to
be
vigilant
to
advocate
for
independence
with
spouses,
family
and
regulating
bodies.
7. Conclusions
Overall,
the
care
of
the
elderly
patient
with
epilepsy
poses
special
challenges
to
the
modern
neurologist.
Similar
to
other
age
groups,
the
cornerstone
of
management
remains
diagnostic
rigeur,
especially
as
seizures
present
commonly,
and
sometimes
atypically
in
this
population.
However,
this
must
always
be
balanced
against
the
alternative
likelihood
of
seizure
‘mimickers’.
Comorbidities,
including
cerebrovascular
risk
factors
and
cognitive
impairment
should
be
sought,
as
the
impact
of
treatment
should
not
risk
overall
mordidity
and
mortality.
Close
attention
to
anticonvulsant
impact
on
patient’s
physical
status,
comorbidities
and
concomitant
medications
is
critical
if
these
ideals
are
to
be
realized.
It
is
important
for
physicians
to
have
an
understanding
of
the
patient’s
social
environment
and
the
potential
impact
of
any
future
seizures
on
individual
safety
and
independence,
which
may
require
a
more
multidisciplinary
perspective.
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