The significance of valproate in the therapy for epilepsy in the elderly -: Results of an expert meeting, Zurich, May 12 and 13, 2006

in German-speaking countries carbamazepine (CBZ) is by far the most frequently used antiepileptic drug (AED) in the therapy for epilepsy in the elderly in spite of several disadvantages. Although controlled randomised studies have documented an identical efficacy but better tolerability for the newer AEDs gabapentin (GBP) and lamotrigine (LTG), they are used rather reluctantly. Valproate (VPA) is a low-priced AED with several advantages, especially for elderly patients. Pharmacologically advantages are the absence of enzyme induction (in contrast to CBZ), the broad spectrum of efficacy against all seizure types and epilepsy syndromes (in contrast to CBZ and GBP) as well as the availability of a parenteral formulation (in contrast to CBZ, GPB and LTG). An additional advantage in comparison to LTG is the possibility of a rapid titration. The known disadvantages of VPA in the treatment of younger patients have not been described (e.g., hepatotoxicity) or are only rarely relevant (e.g. weight gain) for elderly patients. The possibility of an encephalopathy or drug interactions due to enzyme inhibition still have to be considered. Data of the evidence classes III and IV as well as the clinical experience of the authors argue for a more widespread use of VPA in elderly patients with epilepsy. We recommend an initial target dose of 250 to 300 mg b.i.d.