Leppik Ilo E
University of Minnesota, College of Pharmacy, Minneapolis, Minnesota 55455, USA.
Epilepsia. 2006;47 Suppl 1:65-70. doi: 10.1111/j.1528-1167.2006.00664.x.
The elderly are the most rapidly growing segment of the population and the incidence of epilepsy is higher in the elderly than in any other age group. They have been subdivided into the "young old," 65-74 years, "middle old" 75-84 years, and the "old old," 85 years or older. But further subdivisions are needed: persons with only epilepsy, those with epilepsy and multiple medical problems, and the frail elderly. Thus, when considering therapy, one must tailor the interventions to nine categories: young old healthy, young old with medical problems, frail young old, old healthy, old with medical problems, frail old, old old healthy, old old with medical problems, and frail old old. The prevalence of antiepileptic drug (AED) use in community dwelling elderly is 1.5%; in the nursing home population it is 10%. Surprisingly, 3% have an AED newly prescribed after admission. Overall, 6.2% were using phenytoin, 1.8% carbamazepine, 0.9% valproic acid, 1.7% phenobarbital, and others combined, 1.2%. AEDs rank fifth among all drug categories as a cause of adverse reactions. There are very few data regarding the clinical use of AEDs in the elderly. The paucity of information makes it very difficult to recommend specific AEDs with any confidence that the outcomes will be optimal. An appropriate for elderly healthy may not be appropriate for elderly with multiple medical problems, and in frail elderly variable absorption may be a major problem. One of the major advantages of some newer AEDs is lack of drug interactions. Cost is an advantage of the older AEDs. Regardless of the AED chosen, one must use doses appropriate to the clearance of the drug, and AED levels, especially unbound (free) levels, must be monitored. The elderly nursing home resident may be more frail, be taking many medications, and have several concomitant illnesses, making them difficult to treat. The most commonly used AED, phenytoin, may not be the easiest or safest AED to prescribe in the elderly with multiple medical problems or the frail elderly.
老年人是人口中增长最快的群体，癫痫在老年人中的发病率高于其他任何年龄组。他们被细分为“年轻老人”（65 - 74岁）、“中年老人”（75 - 84岁）和“高龄老人”（85岁及以上）。但还需要进一步细分：仅患有癫痫的人、患有癫痫且有多种医疗问题的人以及体弱的老年人。因此，在考虑治疗时，必须将干预措施针对九个类别进行调整：健康的年轻老人、有医疗问题的年轻老人、体弱的年轻老人、健康的老年人、有医疗问题的老年人、体弱的老年人、健康的高龄老人、有医疗问题的高龄老人以及体弱的高龄老人。社区居住老年人中抗癫痫药物（AED）的使用率为1.5%；在养老院人群中为10%。令人惊讶的是，3%的人在入院后新开具了AED。总体而言，6.2%的人使用苯妥英，1.8%使用卡马西平，0.9%使用丙戊酸，1.7%使用苯巴比妥，其他药物组合使用的占1.2%。AED在所有药物类别中作为不良反应的原因排名第五。关于AED在老年人中的临床使用数据非常少。信息匮乏使得很难有信心推荐特定的AED并确保结果是最佳的。适合健康老年人的药物可能不适合有多种医疗问题的老年人，而在体弱的老年人中，药物吸收变化可能是一个主要问题。一些新型AED的主要优点之一是缺乏药物相互作用。成本是 older AED的一个优点。无论选择哪种AED，都必须使用适合药物清除率的剂量，并且必须监测AED水平，尤其是未结合（游离）水平。养老院中的老年居民可能更体弱，服用多种药物，并且患有多种伴发疾病，这使得他们难以治疗。最常用的AED苯妥英，在有多种医疗问题的老年人或体弱的老年人中可能不是最容易或最安全开具的AED。
