Clinical Scenario

This protocol addresses epilepsy presenting as focal (partial) seizures in patients aged 60 years and older. These seizures originate within networks limited to one hemisphere and may involve subjective (aura), motor, autonomic, or dyscognitive features. Age-related factors shape how this population is evaluated and managed.

Treatment Approach (Overview — Partial)

For this population, when adequate seizure control is not achieved, the approach may include interventional or neuromodulatory strategies. Options depend on surgical candidacy and individual patient factors. The complete sequenced regimen — including specific indications and the criteria for escalation — is available through the full protocol.

Full regimen available below →

References

Seizure originating within networks limited to one hemisphere characterized by subjective (aura), motor, autonomic, and dyscognitive features
Older adults (60 years and older)
For patients with seizures that are not controlled with these agents, alternative treatments include surgical resection of the seizure focus, ketogenic diets, vagus nerve stimulators, and implantable brain neurostimulators.
Surgical resection of the seizure focus in appropriately selected patients often results in decreased frequency or elimination of seizures with improvement in quality of life.
The ketogenic diet, a high-fat, low-carbohydrate, and low-protein diet, induces ketone body formation.
Vagus nerve stimulation may increase seizure-free time in patients with medically refractory epilepsy who are not candidates for surgery or in whom surgery has been ineffective.
It is approved by the U.S. Food and Drug Administration for use in persons older than 12 years.
Responsive neurostimulation is another approach to treating medically refractory partial-onset seizures.

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Treatment of Epilepsy with Focal (Partial) Seizures in Adults 60 Years and Older

Clinical Scenario

Treatment Approach (Overview — Partial)

References