Cloyd J, Hauser W, Towne A, Ramsay R, Mattson R, Gilliam F, Walczak T
College of Pharmacy, University of Minnesota, 308 Harvard St. SE, Minneapolis, MN 55455-0353, USA.
Epilepsy Res. 2006 Jan;68 Suppl 1:S39-48. doi: 10.1016/j.eplepsyres.2005.07.016. Epub 2005 Dec 27.
Both the incidence and prevalence of epilepsy are high among the elderly. Cerebrovascular disease is the most common underlying cause, although as many as 25-40% of new epilepsy cases in the elderly have no obvious underlying etiology. Status epilepticus appears to occur more frequently in individuals greater than 60 years, and the morbidity and mortality of status epilepticus are significantly greater in this age group. Elderly patients with seizures, particularly complex partial seizures, present differently than younger adults, which can lead to misdiagnosis. Post-ictal confusion may last as long as 1-2 weeks in an elderly patient, as opposed to minutes in younger individuals. Adverse events are similar in symptomatology, but are more common in elderly patients and occur at lower doses and plasma drug concentrations. Neuropsychiatric disorders, such as depression and anxiety, are common in elderly patients with epilepsy, although often under-diagnosed and inadequately treated. The risk of osteoporosis is high among elderly women taking antiepileptic drugs, which underscores the importance of assessing bone health and treatment in this group. Management of the older patient with epilepsy requires an understanding of the etiologies and the medical and psychological aspects unique to this age group.
癫痫在老年人中的发病率和患病率都很高。脑血管疾病是最常见的潜在病因，不过在老年人中，多达25%至40%的新发癫痫病例没有明显的潜在病因。癫痫持续状态似乎在60岁以上的人群中更频繁发生，且该年龄组癫痫持续状态的发病率和死亡率显著更高。老年癫痫患者，尤其是复杂部分性发作患者，其表现与年轻成年人不同，这可能导致误诊。老年患者发作后的意识模糊可能会持续长达1至2周，而年轻个体则仅持续几分钟。不良事件在症状学上相似，但在老年患者中更常见，且在较低剂量和血浆药物浓度时就会发生。神经精神障碍，如抑郁和焦虑，在老年癫痫患者中很常见，尽管常常诊断不足且治疗不充分。服用抗癫痫药物的老年女性患骨质疏松症的风险很高，这凸显了评估该群体骨骼健康和进行治疗的重要性。对老年癫痫患者的管理需要了解病因以及该年龄组特有的医学和心理方面的情况。
