Epilepsy in the Elderly – AED Choice — SCE Neurology MCQ

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EasyEpilepsy & Seizure DisordersEpilepsy in the Elderly – AED ChoiceSCE Neurology

A 78-year-old man with no prior seizure history presents with a first focal to bilateral tonic-clonic seizure. CT head shows a chronic subdural haematoma. He is started on levetiracetam. Which antiseizure medication should generally be avoided as first-line in elderly patients due to its side-effect profile?

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Correct answer: B — Carbamazepine

Carbamazepine should be used cautiously in the elderly due to its enzyme-inducing properties (drug interactions with warfarin, statins, antihypertensives), risk of hyponatraemia (SIADH — more common in older patients), cardiac conduction effects, and narrow therapeutic index. NICE NG217 recommends lamotrigine and levetiracetam as preferred first-line options for focal seizures in the elderly. A: Levetiracetam is well-tolerated in the elderly. B: Lamotrigine is well-tolerated. D: Gabapentin has a favourable profile. E: Lacosamide is reasonable with ECG monitoring.

Reference: NICE NG217 (2025); SANAD II Trial