This protocol applies to adults aged 60 and older who present with focal (partial) seizures — seizures that originate within networks limited to one hemisphere. These may involve subjective features (aura), motor signs, autonomic changes, or dyscognitive features.
Age is a key factor in this population. Tolerability and drug interactions carry greater weight in selecting an approach for patients 60 and older than in younger adults.
For this population, guidelines support initiating treatment with a single antiepileptic agent — monotherapy — rather than combination therapy. The specific agent selected depends on the patient's concurrent medications and individual tolerability considerations.