According to results of a systematic review presented at the AES Annual Meeting 2017, lamotrigine and levetiracetam are not only as effective as other antiepileptic drugs (AEDs) for the treatment of epilepsy in elderly patients, but were also found to be better tolerated as well.
To assess the safety and efficacy of AEDs in elderly epileptic patients, the study authors used various electronic databases to search for studies that were randomized or quasi-randomized. A total of 3,925 abstracts and titles were identified and screened. After review, 10 trials were found to meet inclusion criteria, which analyzed and evaluated a total of 938 patients and 8 AEDs.
The study authors reported, “Lamotrigine trended towards being better tolerated than carbamazepine regular and sustained-released in two small-scale studies.” Another, larger study found statistically significant better tolerability and seizure-freedom for lamotrigine.
When compared to lamotrigine, levetiracetam was found to increase seizure-freedom, however, it was also associated with an increased risk of side effects. Additionally, levetiracetam was found to improve cognitive performance in elderly patients with dementia, compared to phenobarbital, which demonstrated an association with negative cognitive effects.
Results of the study also observed topiramate to be an effective and well-tolerated adjunctive medication for the treatment of uncontrolled focal seizures when compared to baseline AED therapy.
Data from subgroup analyses of Phase 3 studies demonstrated that the safety and efficacy of brivaracetam and perampanel were similar in elderly patients when compared to the general adult population.
The authors noted, “For the majority of risk of bias criteria, most of our included studies were judged to have unclear (due to insufficient data reported) or high risks of bias.”
In elderly patients with epilepsy, lamotrigine and levetiracetam may be effective and better tolerated treatment options compared to older AEDs. Additionally, some evidence may support the use of brivaracetam, perampanel, and topiramate. The researchers concluded, “More data is required to better inform optimal treatment of epilepsy in the elderly.”
Lezaic N, Josephson C, Wiebe S, Jette N and Keezer M. The medical treatment of epilepsy in the elderly: A systematic review and meta-analysis. Presented at AES annual meeting in Washington, DC. Abstract: 3.272.