Our objective of this study is to compare the response rate and management of epilepsy in the elderly compared to younger age group.

The management of epilepsy is challenging in elderly patients due to physiologic effects of aging on pharmacokinetics of antiseizure drugs (ASD), variable pharmacodynamic effects and potential drug interactions.

As part of development of an epilepsy database, we retrospectively reviewed the medical records of patients with a diagnosis of epilepsy. Elderly patients were defined as > 60 years of age and those younger patients with epilepsy served as controls. Statistical analysis was performed and p-value <0.05 was considered as significant.

Our study group includes 418(25.10%) elderly patients and 1247(74.89%) controls. Focal epilepsy was present in 59.5%of the elderly and 75.8%of control whereas generalized epilepsy was only present in 5% of the elderly as compared to the 12.1%of the controls. Epilepsy was intractable in 29.18% of the elderly and 36.08% of the controls (p<0.05) whereas the seizure-free status was seen in 23.7% of the elderly and 19.8% of the controls (p >0.05). In the elderly group, 72.77%achieved seizure-free status on monotherapy and 27.27% on polytherapy compared to controls which has the seizure-free status of 67.6%on monotherapy and 32.8%on polytherapy (NS). Lamotrigine monotherapy was associated with a greater likelihood of being seizure-free in the elderly compared to controls (41.19%% vs 31.88%, p> 0.05). Levetiracetam was not associated with any significant difference in outcomes (p>0.05)

Older patients with epilepsy are more likely to respond to the first line antiseizure medication with higher likelihood of being seizure free compared to younger patients. Levetiracetam, Lamotrigine and Lacosamide were the most commonly utilized ASDs in the elderly patients. Lamotrigine monotherapy was most often associated with seizure free state.