A 68-year-old man presents to clinic for routine follow-up. His seizures are fairly well controlled on carbamazepine monotherapy. There have been no trials of other antiepileptic drugs (AEDs), so therapeutic alternatives are numerous. However, there are unique issues that must be addressed in elderly patients with epilepsy. Agespecific issues include the effect of treatment on bone health, the tolerability of AEDs, and changes in AED pharmacokinetics and pharmacodynamics. Obtaining maximal seizure control must be balanced with drug effects on mood, quality of life, independence, and cognitive and behavioral disorders. Although there is no single best AED for this patient, there are several options that meet the majority of the treatment characteristics that would be beneficial. The addition of a new agent to carbamazepine with the hope of eventually tapering the patient off carbamazepine is a reasonable approach. The patient should also receive supplemental calcium and vitamin D.
Answer the following questions and provide your sources to your answers
Symptoms; List two pertinent signs and symptoms,
Recommended Drugs: Provide list of recommended drugs as indicated for this diagnosis,
Drug Categories and Subcategories: Identify the category of each recommended drug
Rationale: Provide rationale, clinical guidelines, or evidence for the selected drug of choice
Contraindications and/ or Risks, as appropriate: Identify contraindications and risks as appropriate
What Patients Must Understand: Identify at least three appropriate teaching points for the patient and/or family