Critical issues in the treatment of epilepsy in older adults: Can lacosamide be a therapeutic option?

Epilepsy is a major neurological illness among the elderly, with the highest prevalence rates reported in those aged over 65 years, particularly rising in those over 80. Challenges in treating epilepsy in older individuals include age-related changes in pharmacokinetics, polypharmacy due to comorbid conditions, and heightened vulnerability to adverse drug reactions. Stroke, trauma, and intracranial neoplasms are the acquired causes for epilepsy, also considered as predominant etiological factors. It is challenging to identify suitable antiseizure medications (ASMs) with lesser chances of cognitive side effects, a low chance of drug interactions, and favourable pharmacokinetic profiles. Lacosamide has emerged as a feasible, well-accepted treatment option for elderly patients. It offers various benefits, including a low threat of cognitive impairment and low potential for drug–drug interactions. Lacosamide is considered easier to tolerate and can be acclimatised to each case's requirements compared to older antiseizure medications such as carbamazepine, phenytoin, and valproate. This positions lacosamide as an viable therapeutic option for managing epilepsy in old age, which improves overall quality of life.Purpose: This review provides a scientific evaluation of epilepsy management in the elderly, elucidating the complexities of age-related pharmacokinetic changes, polypharmacy, and comorbidities, while highlighting the clinical efficacy and tolerability of lacosamide, which has a low risk of cognitive adverse effects and a low potential for drug-drug interactions.