Seizures and epilepsy in older patients: Evaluation and management

Seizures and epilepsy in older patients are commonly caused by a previous stroke or other organic CNS insult. In patients who have 'spells,' the first step is to determine whether or not the events are epileptic. Rule out other potential causes of transient loss of consciousness with a careful history, physical exam, lab tests, and imaging studies. An EEG and CT or MRI of the brain are essential. Candidates for treatment with an antiepileptic drug include those with recurrent unprovoked seizures, those with onset of epilepsy presenting with status epilepticus, and those with a strong family history of epilepsy. Monotherapy with a drug known to work best for the type of seizure is preferred. Monitor patients closely for side effects and potential drug-drug interactions.