Gerontologic considerations drug therapy for seizure

Gerontologic Considerations
Drug Therapy for Seizure Disorders
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Seizure disorders are high among older adults
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because the liver metabolizes phenytoin, its use can be a problem for older patients with
compromised liver function
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Age-related changes in liver enzymes decrease the liver's ability to metabolize drugs
Created 7/2016

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Phenobarbital, carbamazepine, and primidone have potential effects on cognitive function, so
their use may be less desirable for the older adult
Surgical Therapy
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The most common surgical intervention is an anterior temporal lobe resection
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Surgical candidates must meet three requirements:
o
a confirmed diagnosis of epilepsy
o
an adequate trial with drug therapy without satisfactory results
o
a defined electroclinical syndrome (type of seizure disorder)
Other Therapies
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Vagal nerve stimulation is used as an adjunct to medications when surgery is not feasible
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A surgically implanted electrode in the neck is programmed to deliver the electrical impulse to
the vagus nerve
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The patient can activate it with a magnet when he or she senses a seizure is imminent
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Vagal nerve stimulation can cause adverse effects such as coughing, hoarseness, dyspnea, and
tingling in the neck
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Battery replacement is required via surgery about every 5 years
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The ketogenic diet is a special high-fat, low-carbohydrate diet that has been used to control
seizures in some people with epilepsy

When a person is on this diet, ketones are produced and pass into the brain and replace glucose
as an energy source
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The diet may be effective for some patients with drug-resistant epilepsy

Biofeedback to control seizures is aimed at teaching the patient to maintain a certain brain wave
frequency that is refractory to seizure activity
Safety Alert
During a seizure, you should do the following:

Maintain a patent airway for the patient.
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Protect the patient's head, turn the patient to the side, loosen constrictive clothing, ease patient to the floor (if
seated).

Do not restrain the patient.
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Do not place any objects in the patient's mouth.
Restless Leg Syndrome
Etiology and Pathophysiology

Also called Willis-Ekbom disease, is a relatively common condition characterized by unpleasant
sensory (paresthesia’s) and motor abnormalities of one or both legs

It is more common in older adults
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More common in women
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There are two distinct types of RLS: primary (idiopathic) and secondary
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The majority of cases are primary, and many patients with this type of RLS report a positive family
history
Created 7/2016

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Secondary RLS can occur with metabolic abnormalities associated with iron deficiency, renal failure,
hypertension, diabetes mellitus, or rheumatoid arthritis
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Conditions such as anemia, pregnancy, and certain medications can cause or worsen symptoms
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It is believed that RLS is related to a dysfunction in the brain’s basal ganglia circuits that use the
neurotransmitter dopamine, which controls movement
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