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Gerontologic ConsiderationsDrug Therapy for Seizure DisordersSeizure disorders are high among older adults because the liver metabolizes phenytoin, its use can be a problem for older patients with compromised liver functionAge-related changes in liver enzymes decrease the liver's ability to metabolize drugsCreated 7/2016
Phenobarbital, carbamazepine, and primidone have potential effects on cognitive function, so their use may be less desirable for the older adultSurgical TherapyThe most common surgical intervention is an anterior temporal lobe resection Surgical candidates must meet three requirements:oa confirmed diagnosis of epilepsyoan adequate trial with drug therapy without satisfactory resultsoa defined electroclinical syndrome (type of seizure disorder)Other TherapiesVagal nerve stimulation is used as an adjunct to medications when surgery is not feasibleA surgically implanted electrode in the neck is programmed to deliver the electrical impulse to the vagus nerveThe patient can activate it with a magnet when he or she senses a seizure is imminentVagal nerve stimulation can cause adverse effects such as coughing, hoarseness, dyspnea, and tingling in the neckBattery replacement is required via surgery about every 5 yearsThe ketogenic diet is a special high-fat, low-carbohydrate diet that has been used to control seizures in some people with epilepsyWhen a person is on this diet, ketones are produced and pass into the brain and replace glucose as an energy sourceThe diet may be effective for some patients with drug-resistant epilepsyBiofeedback to control seizures is aimed at teaching the patient to maintain a certain brain wave frequency that is refractory to seizure activitySafety AlertDuring a seizure, you should do the following:Maintain a patent airway for the patient.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.Do not place any objects in the patient's mouth.Restless Leg SyndromeEtiology and PathophysiologyAlso called Willis-Ekbom disease, is a relatively common condition characterized by unpleasant sensory (paresthesia’s) and motor abnormalities of one or both legsIt is more common in older adults More common in womenThere are two distinct types of RLS: primary (idiopathic) and secondaryThe majority of cases are primary, and many patients with this type of RLS report a positive family historyCreated 7/2016
Secondary RLS can occur with metabolic abnormalities associated with iron deficiency, renal failure, hypertension, diabetes mellitus, or rheumatoid arthritisConditions such as anemia, pregnancy, and certain medications can cause or worsen symptomsIt is believed that RLS is related to a dysfunction in the brain’s basal ganglia circuits that use the neurotransmitter dopamine, which controls movement