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Antiepileptic drugs in the elderly, pregnant women, children and in systemic disorders
Objective. To review the known pharmacokinetic and pharmacodynamic bases of current antiepileptic drugs in the elderly, pregnant and child populations, and in patients with systemic disorders so as to offer recommendations as to their use. Development. In the elderly it should be pointed out that there is a slower rate of metabolism of drugs due to poorer liver function and also slower renal clearance leading to slower elimination from the body. In children there is slower metabolism in the new-born, but metabolism increases as the child grows and becomes normal when he reaches adolescence. In childhood the adverse effects of antiepileptic drugs may have an important effect on the proper growth of the body. In pregnant women there are several reasons why the levels of antiepileptic drugs may drop, and following child-birth the risk of toxicity increase considerably. The terratogenic effect of antiepileptic drugs is well known and seems to be related to the level of antiepileptic drugs and of polytherapy. Early administration of folic acid may help to avoid some of the more serious malformations. Patients with chronic liver or kidney disease should be treated with drugs eliminated via the more healthy organ. Conclusions. Because of their specific pharmacological properties, the new antiepileptic drugs would seem to be the treatment of choice in the groups at risk which have been considered, although there is still insufficient experience to recommend their use in pregnant women.
Antiepileptic drugsChildrenElderlyPregnantSystemic disordersEpilepsias y síndromes epilépticosNeurogeriatríaNeuropediatría