Epilepsy in elderly people: management issues.

Epilepsy in elderly people is far more common than many doctors realise. The prevalence and incidence are frequently underestimated due to underdiagnosis or misdiagnosis of the condition. As the proportion of older people in the population grows, the management of epilepsy in this population will become increasingly important. Elderly people are especially susceptible to the consequences of seizures, particularly loss of self-confidence, decreased independence, and "falls" resulting in physical injury. Establishing the diagnosis of epilepsy in old age can be more difficult than in younger patients due to the extensive range of differential diagnoses and a far higher prevalence of concomitant disease. Treatment strategies are demanding; they must allow for the complexities of co-morbidity, co-medication, alterations in drug handling, and drug effects on an aging body. Together with a growing array of antiepileptic medication from which to choose, these factors make the management of epilepsy in elderly people particularly challenging.