The medical treatment of epilepsy in the elderly: A systematic review and meta-analysis
Nastasija Lezaic
Research Centre of the University of Montreal Hospital Centre, Montreal, Quebec, Canada
Department of Neurosciences, University of Montreal, Montreal, Quebec, Canada
Search for more papers by this authorGeneviève Gore
Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Quebec, Canada
Search for more papers by this authorColin B. Josephson
Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
Search for more papers by this authorSamuel Wiebe
Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
Search for more papers by this authorNathalie Jetté
Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
Search for more papers by this authorCorresponding Author
Mark R. Keezer
Research Centre of the University of Montreal Hospital Centre, Montreal, Quebec, Canada
Department of Neurosciences, University of Montreal, Montreal, Quebec, Canada
Department of Social and Preventative Medicine, University of Montreal, Montreal, Quebec, Canada
Correspondence
Mark R. Keezer, Centre Hospitalier de l'Université de Montréal, Pavillon R R04-700 1000, rue Saint-Denis, Montréal, QC H2X 0C1, Canada.
Email: [email protected]
Search for more papers by this authorNastasija Lezaic
Research Centre of the University of Montreal Hospital Centre, Montreal, Quebec, Canada
Department of Neurosciences, University of Montreal, Montreal, Quebec, Canada
Search for more papers by this authorGeneviève Gore
Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Quebec, Canada
Search for more papers by this authorColin B. Josephson
Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
Search for more papers by this authorSamuel Wiebe
Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
Search for more papers by this authorNathalie Jetté
Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
Search for more papers by this authorCorresponding Author
Mark R. Keezer
Research Centre of the University of Montreal Hospital Centre, Montreal, Quebec, Canada
Department of Neurosciences, University of Montreal, Montreal, Quebec, Canada
Department of Social and Preventative Medicine, University of Montreal, Montreal, Quebec, Canada
Correspondence
Mark R. Keezer, Centre Hospitalier de l'Université de Montréal, Pavillon R R04-700 1000, rue Saint-Denis, Montréal, QC H2X 0C1, Canada.
Email: [email protected]
Search for more papers by this authorAbstract
Objective
To evaluate the efficacy and tolerability of antiepileptic drugs (AEDs) in elderly individuals with epilepsy.
Methods
We searched four electronic databases as well as bibliographies and conference abstracts. Published and unpublished, randomized, or quasirandomized trials reporting the use of AEDs in people aged at least 60 years with epilepsy were eligible for inclusion. Two authors independently carried out each stage of the review. Meta-analyses were performed using random-effects models.
Results
Three thousand four hundred seventeen titles and abstracts were reviewed. Eighteen studies evaluating 12 AEDs met all eligibility criteria. Ten studies, comprising 1999 subjects, were suitable for meta-analysis. Among the elderly with epilepsy, lamotrigine (LTG) is better tolerated relative to carbamazepine (pooled weighted risk ratio [RR] of experiencing withdrawal due to adverse events = 1.83, 95% confidence interval [CI] = 1.23-2.43). There is a higher probability, although with a 95% CI of borderline importance, of seizure freedom when comparing levetiracetam to LTG (RR = 0.83, 95% CI = 0.68-0.97). Single studies provide evidence for the efficacy and/or tolerability of other AEDs in the elderly, including brivaracetam, gabapentin, lacosamide, perampanel, and topiramate. The risk of bias of the included studies was frequently low or unclear, although there was on occasion a high risk of bias (especially with regard to selective reporting).
Significance
There is some evidence for AED use in the elderly with epilepsy. More evidence is required, comparing newer AEDs to prior generations as well as examining the effects of determinants such as frailty, to guide clinicians when treating this rapidly growing patient population.
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