About 35% of all newly diagnosed epileptic seizures in people older than
60 years are caused by stroke. The incidence of the early epileptic seizures is 2.4–5.4%, and for the late seizures 3–4.5%. Seizures after stroke are most often simple partial seizures with or without secondary generalization, and less often complex partial seizures. In early seizure these are acute biochemical cellular changes, and in late seizures gliosis. Althoung the risk for developing epilepsy was 17–35% after early seizures, the risk of developing epilepsy after late seizures increased to 65–90%. Combination of coronary heart disease,
hypertonia and cardiovascular disease occur in 65% of patients over 75 year old. Intrah spitalmortality in patients with stroke with epileptic seizures was 37.9% compared to patients without seizures (14.4%). Early seizures cause highermortality than late seizures which can be explained by sinergistic effect of of the damaged tissue due to the seizure and vascular ischaemia. European authors in 2007 indicate that lavetiracetam, lamotrigine and gabapentin were first line drugs, followed by topiramate and valproate in elderly patients.
Oxcarbazepine and carbamazepine were not highly recommended because of the associated hyponatremia, cardiac disorders and interaction potentials. The standard antiepileptic drug for focal epilepsy is still carbamazepine, and valproate is most commonly used for generalized epilepsy- even in older patients. Epidemiological studies on epilepsy treatment in the elderly show steady increase in the number of patients. Therefore, elderly patients require special attention. Monotherapy in lowdoses is often sufficient, enzyme inducing
drug are used too frequently
