Management of epilepsy in older adults: A critical review by the ILAE Task Force on Epilepsy in the elderly

Loretta Piccenna, Rebecca O'Dwyer, Ilo Leppik, Ettore Beghi, Giorgia Giussani, Cinzia Costa, Jacopo C. DiFrancesco, Monica B. Dhakar, Naoki Akamatsu, Benjamin Cretin, Günter Krämer, Edward Faught, Patrick Kwan

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Older adults represent a highly heterogeneous population, with multiple diverse subgroups. Therefore, an individualized approach to treatment is essential to meet the needs of each unique subgroup. Most comparative studies focusing on treatment of epilepsy in older adults have found that levetiracetam has the best chance of long-term seizure freedom. However, there is a lack of studies investigating other newer generation antiseizure medications (ASMs). Although a number of randomized clinical trials have been performed on older adults with epilepsy, the number of participants studied was generally small, and they only investigated short-term efficacy and tolerability. Quality of life as an outcome is often missing but is necessary to understand the effectiveness and possible side effects of treatment. Prognosis needs to move beyond the focus on seizure control to long-term patient-centered outcomes. Dosing studies with newer generation ASMs are needed to understand which treatments are the best in the older adults with different comorbidities. In particular, more high-level evidence is required for older adults with Alzheimer's disease with epilepsy and status epilepticus. Future treatment studies should use greater homogeneity in the inclusion criteria to allow for clearer findings that can be comparable with other studies to build the existing treatment evidence base.

Original languageEnglish (US)
Pages (from-to)567-585
Number of pages19
Issue number3
StatePublished - Mar 2023

Bibliographical note

Funding Information:
We would like to thank Tianrui Ren and Yingtong Li, Monash University, for their assistance in the preparation of Tables 1 and 2 . P.K. is supported by a Medical Research Future Fund Practitioner Fellowship (MRF1136427).

Publisher Copyright:
© 2022 The Authors. Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.


  • antiseizure medications
  • older adults
  • treatment

PubMed: MeSH publication types

  • Review
  • Journal Article
  • Research Support, Non-U.S. Gov't


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