The EDGAR study (Elderly with epilepsy DruG AppRopriateness)

The incidence of epilepsy over the past 40 years has more than tripled among the elderly, far outpacing that among younger individuals. Treating epilepsy in the elderly is complicated by various factors related to aging. Appropriate antiepileptic drug (AED) therapy for this population has therefore been identified as a “major knowledge gap” by The International League Against Epilepsy.  We hypothesize that newer AEDs will be more effective in the elderly, as compared to older AEDs, as well as better tolerated and, by extension, associated with greater adherence.

About the project

Epilepsy, defined as recurrent and unprovoked seizures, is common and can be debilitating. 70 million people worldwide suffer from epilepsy. Drugs that prevent seizures, called Antiepileptic drugs (AEDs), are central to achieving seizure-freedom. Epilepsy may begin in the young but occurs more often in the elderly. More than 20 AEDs are available but there is little evidence to guide which are best suited for the treatment of epilepsy in the elderly, and none which evaluates the importance of frailty. The EDGAR study (Elderly with epilepsy DruG AppRopriateness) is a pan-Canadian study that will provide the highest quality evidence to guide future AED choices in the elderly, taking into account frailty status. The current proposal will lay the ground work for the EDGAR study with two objectives: 1) to use an existing research database of 10 million people to begin our examination of the best AEDs for the treatment of epilepsy in the elderly and study how this may be impacted by frailty; 2) to carry out a feasibility study in four Canadian epilepsy hospital centres, to confirm the rate at which we can recruit study participants, and provide us a chance to refine our data collection tools, including frailty scales for which there is no standard in epilepsy. The EDGAR study is an exciting chance to lead the way in the treatment of epilepsy among older adults, guided by frailty status. The current proposal is the first step to help realize this long-term goal.

Project Team

Principal Investigators:

Mark Keezer, MDCM, MSc, CFCN, FRCP(C), Chercheur Investigateur Ciblé, Professeur Adjoint Clinique de Neurosciences, Centre de recherche du Centre hospitalier de l’Université de Montréal

Colin Josephson, MD, CFCN, FRCP(C), Assistant Professor of Neurology and Community Health Sciences, University of Calgary Department of Clinical Neurosciences


Marie-Pierre Sylvestre, PhD, Chercheur Investigateur Ciblé, Professeur Adjoint de Biostatistiques, Centre de recherche du Centre hospitalier de l’Université de Montréal/University of Montreal School of Public Health

Tolulope Sajobi, PhD, Assistant Professor of Biostatistics, University of Calgary Department of Community Health Sciences

Samuel Wiebe, MD, MSc, FRCP(C), Professor of Neurology, Community Health Sciences, and Pediatrics, University of Calgary Department of Clinical Neurosciences

Jayna Holroyd-Leduc, MD, FRCPC, University of Calgary Geriatric Medicine Section Head and Associate Professor; Medical Director of AHS Calgary zone Specialized Geriatric Services, University of Calgary, Department of Medicine (Section of Geriatric Medicine) and Community Health Sciences; Alberta Health Services


Spiros Denaxas, PhD, Senior Lecturer in Clinical Epidemiology, University College London, Farr Institute of Health Informatics Research

Arturo Gonzalez-Izquierdo, PhD, Research Associate, University College London, Farr Institute of Health Informatics Research

Jorge Burneo, MD, MSPH, FRCP(C), Professor of Neurology and Epidemiology, Schulich School of Medicine, Western University

Jose Teller-Zenteno, MD, CSCN, PhD, FRCP(C), Professor of Neurology, Department of Medicine, University of Saskatchewan

Jordan Engbers, PhD, Founder, Chief Scientist, Desid Labs Inc.

Knowledge Users:

Barbara Liu, MD, Associate Professor of Geriatrics, University of Toronto, Department of Medicine, Division of Geriatrics and Division of Clinical Pharmacology

Josemir (Ley) Sander, MD, PhD, FRCP, Professor of Neurology, UCL Institute of Neurology

Nathalie Jetté, MD, MSc, FRCP(C), Professor of Neurology and Population Health Science and Policy, Vice Chair of Neurology Clinical Research, and Chief of the Division of Health Outcomes and Knowledge Translation Research, Mount Sinai Icahn School of Medicine

Project contact: Mark Keezer —


Keywords: Epilepsy; Anticonvulsants; Geriatrics; Dementia; Stroke