Gareri P, Gravina T, Ferreri G, De Sarro G
Department of Clinical and Experimental Medicine, University of Catanzaro, Italy.
Prog Neurobiol. 1999 Aug;58(5):389-407. doi: 10.1016/s0301-0082(98)00089-6.
Management of epilepsy in the elderly involves many challenges, including the presence of concomitant diseases, polypharmacy and changes in body physiology. Age-related changes in pharmacokinetics and pharmacodynamics have to be taken into account in order to avoid potentially severe adverse drug reactions in elderly people. The present study reviews the most commonly used antiepileptic drugs (AEDs) in the elderly. Because some AEDs may induce the metabolism of other agents and reduce the effectiveness of several drugs, the physicians have to carefully evaluate concomitant drugs being administered. Moreover, the main problems appear to be when beginning therapy, the first choice drug, the appropriate dosage and pharmacologic compliance. Elderly patients must be screened for hepatic and renal functions before beginning a treatment with an AED, carefully interviewed to reduce complaints for drug side-effects which may negatively influence compliance and monitored for total and free blood levels. Besides the 'classic' AEDs, such as phenytoin, phenobarbital, carbamazepine, valproic acid, primidone and benzodiazepines, the review shows the possible advantages of new AEDs, such as felbamate, gabapentin, lamotrigine, oxcarbazepine and gamma-vinyl-GABA, which may be used in the elderly too for their good tolerability. A careful control of drug assumption is requested in the elderly, especially when it is difficult to achieve seizure control.
老年人癫痫的管理面临诸多挑战，包括并存疾病、多种药物联用以及身体生理机能的变化。必须考虑到与年龄相关的药代动力学和药效学变化，以避免老年人出现潜在的严重药物不良反应。本研究回顾了老年人最常用的抗癫痫药物（AEDs）。由于某些AEDs可能诱导其他药物的代谢并降低多种药物的疗效，医生必须仔细评估正在使用的并存药物。此外，主要问题似乎出现在开始治疗时、首选药物、合适的剂量以及药物依从性方面。在开始使用AEDs治疗之前，必须对老年患者进行肝肾功能筛查，仔细询问以减少可能对依从性产生负面影响的药物副作用投诉，并监测总血药浓度和游离血药浓度。除了“经典”的AEDs，如苯妥英、苯巴比妥、卡马西平、丙戊酸、扑米酮和苯二氮䓬类药物外，该综述还显示了新型AEDs的潜在优势，如非氨酯、加巴喷丁、拉莫三嗪、奥卡西平和γ-乙烯基-GABA，由于它们良好的耐受性，也可用于老年人。在老年人中，尤其是在难以实现癫痫控制时，需要仔细控制药物的服用。
