The medical treatment of epilepsy in the elderly: A systematic review and meta‐analysis

<jats:title>Abstract</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p>To evaluate the efficacy and tolerability of antiepileptic drugs (<jats:styled-content style="fixed-case">AED</jats:styled-content>s) in elderly individuals with epilepsy.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We searched four electronic databases as well as bibliographies and conference abstracts. Published and unpublished, randomized, or quasirandomized trials reporting the use of <jats:styled-content style="fixed-case">AED</jats:styled-content>s 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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Three thousand four hundred seventeen titles and abstracts were reviewed. Eighteen studies evaluating 12 <jats:styled-content style="fixed-case">AED</jats:styled-content>s met all eligibility criteria. Ten studies, comprising 1999 subjects, were suitable for meta‐analysis. Among the elderly with epilepsy, lamotrigine (<jats:styled-content style="fixed-case">LTG</jats:styled-content>) is better tolerated relative to carbamazepine (pooled weighted risk ratio [<jats:styled-content style="fixed-case">RR</jats:styled-content>] of experiencing withdrawal due to adverse events = 1.83, 95% confidence interval [<jats:styled-content style="fixed-case">CI</jats:styled-content>] = 1.23‐2.43). There is a higher probability, although with a 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> of borderline importance, of seizure freedom when comparing levetiracetam to <jats:styled-content style="fixed-case">LTG</jats:styled-content> (<jats:styled-content style="fixed-case">RR</jats:styled-content> = 0.83, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> = 0.68‐0.97). Single studies provide evidence for the efficacy and/or tolerability of other <jats:styled-content style="fixed-case">AED</jats:styled-content>s 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).</jats:p></jats:sec><jats:sec><jats:title>Significance</jats:title><jats:p>There is some evidence for <jats:styled-content style="fixed-case">AED</jats:styled-content> use in the elderly with epilepsy. More evidence is required, comparing newer <jats:styled-content style="fixed-case">AED</jats:styled-content>s to prior generations as well as examining the effects of determinants such as frailty, to guide clinicians when treating this rapidly growing patient population.</jats:p></jats:sec>