Learning Objectives

Upon completion of this activity, participants should be able:

• Describe the differential diagnosis of epilepsy, including the role of imaging and other diagnostic methods in the geriatric patient
• Outline the mechanisms of seizure production and epilepsy syndromes in geriatric patients
• Cite the most recent data on both nonpharmacologic and pharmacologic approaches to the management of epilepsy in geriatric patients
• Describe the impact of a patient's age on the selection of anti-epileptic drugs (AEDs)
• Identify strategies to avoid interactions with the concurrent use of antibiotics, warfarin, other agents, and anti-epileptic drugs
• Create effective treatment regimens for different patient types

Statement of Need

The elderly are a substantial and rapidly increasing proportion of the population. Seizures are as common in this population as they are among children, with serious consequences. The most common seizure types in older persons are simple partial, complex partial, and secondarily generalized tonic clonic. To effectively manage elderly patients experiencing seizures, clinicians must recognize that a patient has had a seizure, determine the seizure type, calculate the risk ofseizure recurrence, and determine whether to initiate anticonvulsant therapy. These decisions are based on clinical, electroencephalographic, and neuroimaging findings. However, in the elderly, among whom dementia is common and memory function is declining, recognizing seizures and obtaining a clear history of the seizure-like event from the patient can be very difficult. Symptoms are subtle and can be identified only by a trained eye, or must be called to the attention of clinicians by relatives and caregivers. Elderly patients may hesitate to mention these episodes because they’re afraid they are “losing their minds”.

Accreditation

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Albert Einstein College of Medicine & Montefiore Medical Center, the University of Tennessee College of Pharmacy, the Epilepsy Foundation,and CME2, the educational division of Advanstar Communications Inc., publisher of Geriatrics. Albert Einstein College of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Albert Einstein College of Medicine designates this continuing medical education (CME) activity for a maximum of 1 category 1 credit toward the AMA Physician’s Recognition Award. Each phsician should claim only those credits that he/she actually spent in the educational activity.

• Review the means by which seizures are produced and presented in elderly patients
• Provide expert opinion and data regarding the most appropriate treatment and management options
• Recognize the special considerations that must be addressed regarding drug interactions and safety and tolerability of seizure management methods
• Discuss addressing epilepsy with loved ones and caregivers

Special Considerations in the Treatment of Geriatric Epilepsy

Currently, 1.5 million elderly people reside in nursing homes, therefore as many as 150,000 elderly patients in nursing homes may be taking AEDs. The widespread prevalence of epilepsy in this population indicates a need to educate the physicians who treat them. Upon completing t his program, physicians will be able to discuss the epidemiology of epilepsy in the elderly, review the means by which seizures are produced and presented in geriatric patients to better understand which treatment is most appropriate, and discuss the special considerations that must be addressed regarding drug interactions in these patients as well as new data regarding the safety and tolerability of pharmacologic and non-pharmacologic treatments in this population. CME Credit hour: 1.0

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