Abstracts

Rationale: The optimal treatment of epilepsy in older adults remains understudied and uncertain. Comorbidities, polypharmacy and frailty are all factors that add to the complexity of treating epilepsy in in this population (generally defined as aged at least 65 years).

Methods: A literary review on surveys with epilepsy as its central subject and physicians as responders was first conducted. The questionnaires were analyzed and used as models to create our own survey. We surveyed geriatricians and neurologists (those with and without specialty training in epilepsy) from across Canada. Our online survey (using SurveyMonkey) included 15 questionnaire items on medical and surgical opinions and medical practices for older adults with epilepsy. We transmitted a link to our online survey by facsimile to all geriatricians and neurologists listed in the Scott’s Medical Directory (which includes the majority of Canada-registered physicians). After 3 facsimile attempts, an additional invitation (with a paper copy of the survey) was mailed to the initial non-respondents. We used descriptive statistics to map these responses. To test the reliability of the survey, an email asking to complete the survey for a second time was sent to the 18 participants of the pilot test two weeks after completing the survey.

Results: 182 geriatricians, neurologists and epileptologists responded to our survey (response rate of 15%). Levetiracetam and lamotrigine were the preferred antiseizure medication (ASM) to prescribe in 75% or more of older adult patients among surveyed geriatricians. These two medications and lacosamide were the preferred prescribed ASM among surveyed neurologists without epilepsy training. Compared to the other two physician groups, more epileptologists prescribed lacosamide. Most neurologists, epileptologists and geriatricians ranked control of seizure as the highest priority when prescribing an ASM to an older adult with new focal-onset. ASM tolerability was generally ranked third by the respondents. 30.8% and 31.8% of epileptologists and geriatricians, respectively, are ”likely” to propose surgery to treat someone with bilateral tonic-clonic seizures at least once per month if they are aged 60-69 years old. This number went up to 38.8% among neurologists without epilepsy training. All 3 physician groups were more likely to propose surgery to patients aged 40-49 years as compared to individuals aged 60 years and above.

Conclusions: Our study establishes that there are important differences in opinion and treatment practices between physician groups. Our surveyed geriatricians and neurologists (with and without epilepsy training) differed in their approach to ASM choice as well as surgical treatments. This may relate to the lack of clear and accepted clinical practice guidelines. This may also point to the need for more robust evidence. We hope this study will motivate further interest in the treatment of epilepsy in older adults.

Funding: Please list any funding that was received in support of this abstract.: None.