American Board of Internal Medicine (ABIM) Certification Practice Exam

Which antiepileptic drugs are considered the best choices for older patients?

1. Valproic acid, carbamazepine, and phenytoin

2. Lamotrigine, levetiracetam, and gabapentin

3. Phenobarbital, zonisamide, and ethosuximide

4. Benzodiazepines, topiramate, and clobazam

The correct answer is: Lamotrigine, levetiracetam, and gabapentin

The selection of lamotrigine, levetiracetam, and gabapentin for older patients is well-supported due to their favorable safety profiles and tolerability compared to other antiepileptic drugs. Lamotrigine is often preferred because it is effective for a variety of seizure types and has a low risk of causing cognitive impairment, which is particularly important in older patients who may already be vulnerable to such effects. Its side effects are generally mild, and monitoring for rare but serious skin reactions can be managed with careful titration. Levetiracetam is another excellent choice as it is effective for various seizures and has minimal interactions with other medications, making it suitable for older patients who are likely taking multiple drugs for comorbid conditions. Its side effects profile is relatively benign, although some patients may experience mood changes, which should be monitored. Gabapentin is helpful for partial seizures and is often well-tolerated in older adults. Its side effects typically include sedation and peripheral edema, which are generally manageable, and it has a lower risk for drug-drug interactions. Overall, these medications are selected for their efficacy combined with a lower risk of cognitive decline, sedation, and drug interactions, which are critical considerations when treating older patients with epilepsy.