What has shown to be the most effective medication/treatment for a 60+ man suddenly suffering seizures

The short version: a seizure lasting minutes is a medical emergency, and the best-proven first drug is a benzodiazepine, not any of the newer antiseizure drugs.

Sudden seizures in a man over 60 are usually either a one-off caused by something else (a bleed, a stroke, an infection, a drug reaction) or the start of epilepsy. The retrieval is thin on this exact population: most of these records are pediatric or status-epilepticus trials, and none is a trial of long-term treatment for a newly diagnosed 60-year-old. The one record that directly addresses older adults is about nonconvulsive status, where urgent EEG is the key step because the seizure is invisible [6].

For stopping a seizure that is happening now, the best evidence is a benzodiazepine first. In adults with generalized status, lorazepam stopped seizures within 20 minutes in about 65 in 100 patients, versus about 44 in 100 with phenytoin alone [2]. If a second drug is needed, the large ESETT trial found levetiracetam, fosphenytoin, and valproate roughly equal, with no significant difference by age group [1]. A retrospective study found phenytoin/fosphenytoin notably weaker than other second-line options [4], and another found no significant difference among lacosamide, levetiracetam, valproate, and phenytoin [5]. Dosing matters: giving more benzodiazepine than the weight-based recommendation was linked to far more intubation, 45 in 100 versus 8 in 100 [3].

For the long-term drug after the emergency, the retrieval does not answer it for this age group. The closest is a trial in elderly patients with newly diagnosed seizures, where lamotrigine was better tolerated than carbamazepine, with 71 in 100 staying on treatment versus 42 in 100 [7]. That is a tolerability result, not proof it controls seizures better.

My call: for the acute seizure, a weight-dosed benzodiazepine is the best-supported treatment, with levetiracetam or valproate as a reasonable second-line choice; for the long-term drug in a 60-plus man, the evidence here is too thin to name a winner, and the cause of the seizure needs to be found first. Confidence: moderate on the acute treatment, low on the long-term choice.