26. Epilepsy After Sixty

  1. John W. Miller MD, PhD Director, UW Regional Epilepsy Center, Professor of Neurology and Neurological Surgery2 and
  2. Howard P. Goodkin MD, PhD The Shure Professor of Neurology and Pediatrics, Director, Division of Pediatric Neurology3
  1. Edward Faught

Published Online: 10 JAN 2014

DOI: 10.1002/9781118456989.ch26



How to Cite

Faught, E. (2014) Epilepsy After Sixty, in Epilepsy (eds J. W. Miller and H. P. Goodkin), John Wiley & Sons, Oxford. doi: 10.1002/9781118456989.ch26

Editor Information

  1. 2

    University of Washington, Seattle, WA, USA

  2. 3

    Department of Neurology, University of Virginia, Charlottesville, VA, USA

Author Information

  1. Department of Neurology, Emory University, Atlanta, GA, USA

Publication History

  1. Published Online: 10 JAN 2014
  2. Published Print: 14 FEB 2014

ISBN Information

Print ISBN: 9781118456941

Online ISBN: 9781118456989



  • epilepsy;
  • seizures;
  • elderly;
  • antiepileptic drugs


Epileptic seizures are extremely common after age 60. Most are complex partial or generalized tonic–clonic. Diagnosis may be difficult because of confusion with transient ischemic attacks or syncope. Clinical history is paramount because electroencephalograms (EEGs) are often negative. Cerebrovascular disease is the most common cause, but no etiology is identifiable in 50% of persons. Avoid enzyme-inducing drugs, especially phenytoin and barbiturates. Reasonable drug choices include levetiracetam, lamotrigine, oxcarbazepine, timed-release carbamazepine, valproate, and gabapentin. Starting and maintenance dosages should be one-half to two-thirds of those usual for younger adults, both because tolerability is lower and because efficacy of drugs is higher in older adults.