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Generalized Tonic-clonic SeizureS* Senior Seizures CASE

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Generalized Tonic?clonic SeizureS* Senior Seizures




A 68-year-old man presents to clinic for routine follow-up. His seizures are fairly well controlled


on carbamazepine monotherapy. There have been no trials of other antiepileptic drugs (AEDs),


so therapeutic alternatives are numerous. However, there are unique issues that must be


addressed in elderly patients with epilepsy. Agespecific issues include the effect of treatment on


bone health, the tolerability of AEDs, and changes in AED pharmacokinetics and


pharmacodynamics. Obtaining maximal seizure control must be balanced with drug effects on


mood, quality of life, independence, and cognitive and behavioral disorders. Although there is


no single best AED for this patient, there are several options that meet the majority of the


treatment characteristics that would be beneficial. The addition of a new agent to


carbamazepine with the hope of eventually tapering the patient off carbamazepine is a


reasonable approach. The patient should also receive supplemental calcium and vitamin D.



Answer the following questions and provide your sources to your answers









Symptoms; List two pertinent signs and symptoms,


Recommended Drugs: Provide list of recommended drugs as indicated for


this diagnosis,


Drug Categories and Subcategories: Identify the category of each


recommended drug


Rationale: Provide rationale, clinical guidelines, or evidence for the selected


drug of choice


Contraindications and/ or Risks, as appropriate: Identify contraindications and


risks as appropriate


What Patients Must Understand: Identify at least three appropriate teaching


points for the patient and/or family




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