Spécificités de la prise en charge de l'épilepsie chez le sujet âgé

Epilepsy increases in frequency with age, above 60, with consequences in terms of independence. Stroke and dementia are the most frequent etiologies. Clinical diagnostic of epileptic seizure is challenging at this age, and a clinical algorithm is proposed. Sleep EEG during one hour seems to be the most useful exam. Interictal and critical discharges can be seen during sleep in dementia ; relation between hyperexcitability and evolution of cognition has to be precised in this pathology. In a therapeutical point of view, it is necessary to bear in mind the pharmacological consequences of aging, polytherapies, and the frequency of adverse events in this age group. Two molecules, lamotrigine and levetiracetam are recommended as first line treatment. Pronostic is good, as the majority of patients are seizure-free in monotherapy.