Association Between Frailty and Antiseizure Medication Tolerability in Older Adults With Epilepsy

Frailty is an important aspect of biological aging, referring to the increased vulnerability of individuals with frailty to physical and psychological stressors. While older adults with epilepsy are an important and distinct clinical group, there are no data on frailty in this population. We hypothesize that frailty will correlate with the seizure frequency and especially the tolerability of antiseizure medications (ASMs) in older adults with epilepsy.We recruited individuals aged 60 years or older with active epilepsy from four Canadian hospital centers. We reported the seizure frequency in the three months preceding the interview, while ASM tolerability was quantified using the Liverpool Adverse Events Profile (LAEP). We applied three measures of frailty: grip strength as a measure of physical frailty, one self-reported score [Edmonton Frailty Score (EFS)], and one scale completed by a health-care professional [Clinical Frailty Scale (CFS)]. We also administered standardized questionnaires measuring levels of anxiety, depression, functional disability, and quality of life, and obtained relevant clinical and demographic data.43 women and 43 men aged 60-93 years were recruited, 87% of whom had focal epilepsy, with an average frequency of 3.4 seizures per month. Multiple linear regression and zero-inflated negative binomial regression models showed that EFS and CFS scores were associated with decreased ASM tolerability, each point increase leading to 1.83 (95% CI: 0.67, 4.30) and 2.49 (95% CI: 1.27, 2.39) point increases on the LAEP scale, respectively. Neither the EFS and CFS scores, nor grip strength were significantly associated with seizure frequency. The EFS was moderately correlated with depression, anxiety, quality of life and functional disability, demonstrating the best construct validity amongst the three tested measures of frailty.The EFS was significantly, both statistically and clinically, associated with ASM tolerability. It also showed multiple advantages in performance while assessing for frailty in older adults with epilepsy, as compared to the two other measures of frailty that we tested. Future studies must focus on what role the EFS at the time of epilepsy diagnosis may play in ASM selection among older adults with epilepsy.