Konrad J Werhahn

‌Contrary to former views, the incidence rate of epilepsy after the age of 65 years is higher than in childhood and adolescence, and epileptic seizures are one of the most common neurological problems in the elderly. Given that the incidence of epilepsy increases with advancing age and is not accompanied by an increase in mortality and given that elderly people now live longer, the prevalence of epilepsy is increasing with older age. Antiepileptic drugs (AEDs) are the primary treatment for epilepsy, although they are prescribed for other conditions too. Among nursing home residents the prevalence of seizures or epilepsy is between 5 and 8%, while AEDs are taken by approximately 5–10%. It is unclear why AED use is inversely related to age in nursing home residents. AEDs may be of considerable risk for the elderly due to falls, cognitive side effects, other adverse events and drug interactions. In addition, inappropriate use of all medication (up to 40% of prescriptions) has a significant impact on public-health costs leading to increased hospitalization and mortality. Despite evidence from controlled clinical trials and expert recommendations, most AEDs used in nursing home residents are outdated. Efforts should therefore be made to improve the medical management of nursing facility residents receiving AEDs.