Special Issues in Epilepsy: The Elderly, the Immunocompromised, and Bone Health.

PURPOSE OF REVIEW: This article discusses targeted special issues in epilepsy, including epilepsy in the elderly and immuncompromised populations and bone health in epilepsy. Although this is a broad and diverse set of topics, common themes can be identified by focusing on elderly patients and patients who are immunocompromised that provide a valuable framework for other groups.

RECENT FINDINGS: An increasing incidence of epilepsy has been reported in patients 65 years of age and older. As people age, physiologic changes can alter antiepileptic drug metabolism, which can significantly impact dosing requirements and tolerability. Side effects of antiepileptic drugs may pose a significant challenge given the relatively high frequency of comorbid illnesses. When evaluating and treating immunocompromised patients, a broad range of potential etiologies for new-onset or worsening seizures must be considered. When choosing an antiepileptic drug, drug-drug interactions, the potential for increased side effects, and the overall impact of treatments on the underlying illness must be considered. The most recent findings and recommendations pertaining to bone health assessment and maintenance in various populations with epilepsy are summarized.

SUMMARY: Treating epilepsy and seizures in special populations requires taking a broad view of patients' overall health status, including potentially complex treatment regimens and a unique predisposition to adverse events.