A 75-year-old woman, 1 month post-stroke, has small focal seizures. What is the most appropriate treatment for her?

The most appropriate treatment for small focal seizures in a 75-year-old woman who is one month post-stroke is leviracetam. This medication is often favored in elderly patients for several reasons.

Levetiracetam has a favorable side effect profile and is less likely to cause cognitive impairment compared to other antiepileptic drugs, which is particularly important in older adults who may already be dealing with cognitive issues or are at risk for them. Additionally, levetiracetam does not have significant drug interactions, which is an important consideration when managing older patients who may be on multiple medications for comorbid conditions.

In the context of her recent stroke, choosing an antiepileptic drug that minimizes the risk of side effects and allows for easier management is crucial. This aligns well with the current recommendations for treating seizures in older adults, prioritizing medications that provide effective seizure control while minimizing adverse effects.