Special issues in the management of young children, older adults, and the developmentally disabled

The very young, the very old, and those with developmental disability have an increased risk of both epilepsy and prolonged and repetitive seizures. The special issues that affect their management are reviewed. Polypharmacy that occurs because of comorbid illnesses requiring chronic medication can result in dangerous drug-drug interactions. The antiepileptic drug's pharmacokinetic profile must be factored when treating young children and older adults. Patients who have taken an older enzyme-inducing antiepileptic drug for years may have a markedly induced hepatic enzyme system that may alter drug metabolism. Overdose or toxicity may occur in older adults who may metabolize and clear antiepileptic drugs more slowly than younger patients. Benzodiazepines are the most rapidly effective acute therapy for repetitive or prolonged seizures. It is important to have a plan for management of prolonged and repetitive seizures. Long-term therapy should be managed in a manner that will eliminate the need for rescue therapies and visits to the emergency department.