Brodie Martin J, Stephen Linda J
Division of Cardiovascular and Medical Sciences, Western Infirmary, Glasgow, UK.
Int Rev Neurobiol. 2007;81:253-63. doi: 10.1016/S0074-7742(06)81016-0.
Epilepsy develops most commonly in the elderly. Seizures can severely affect a senior citizen's quality of life, and despite a growing elderly population with epilepsy, there is a paucity of good clinical data in this age group. To address some of the issues encountered by elderly patients with epilepsy, prospective information from elderly patients attending the Epilepsy Unit at the Western Infirmary in Glasgow, Scotland, was analyzed. Ninety patients, aged 65-93 years, were diagnosed with epilepsy and started on antiepileptic drug (AED) treatment. Neuroimaging was performed in 84 patients (93%), with 69 evaluated via computerized tomography and 15 via magnetic resonance imaging; abnormalities were found in 45 patients (54%). Sixty-eight patients underwent interictal electroencephalography, which revealed epileptiform discharges in 18 patients (26%). Fifty-eight of 90 patients (64%) became seizure free for at least 12 months on modest doses of the first prescribed AED. Seizures remained uncontrolled in 21 patients (23%), and the first AED was withdrawn in 11 patients (12%) because of adverse events. Following pharmacological manipulation, a total of 76 patients (84%) achieved seizure freedom. Patients starting treatment > or =2 years after their first seizure were less likely to achieve seizure control than patients who initiated treatment earlier. Newly diagnosed elderly patients were more likely to remain seizure free on AED treatment than newly diagnosed younger populations (p < 0.001). The majority of patients evaluated had partial-onset seizures, and underlying cerebral atrophy and infarcts were common. Treating an older person with initial AED therapy can be complicated; taking adequate time and communicating clearly are paramount. Although most of the patients evaluated had a positive outcome, all AEDs have some disadvantages in this population. Choice of drug may depend on comorbidity and comedication, among other factors. Initial dosing should be low with a slow titration schedule. A holistic approach to care helps optimize the outcome for elderly people with epilepsy.
癫痫在老年人中最为常见。癫痫发作会严重影响老年人的生活质量，尽管癫痫老年患者的数量不断增加，但该年龄组的高质量临床数据却很匮乏。为了解决老年癫痫患者遇到的一些问题，我们分析了苏格兰格拉斯哥西部医院癫痫科老年患者的前瞻性信息。90名年龄在65至93岁之间的患者被诊断为癫痫并开始接受抗癫痫药物（AED）治疗。84名患者（93%）进行了神经影像学检查，其中69名通过计算机断层扫描评估，15名通过磁共振成像评估；45名患者（54%）发现异常。68名患者进行了发作间期脑电图检查，其中18名患者（26%）显示有癫痫样放电。90名患者中有58名（64%）在服用首次处方的适量AED后至少12个月无癫痫发作。21名患者（23%）的癫痫发作仍未得到控制，11名患者（12%）因不良事件停用了第一种AED。经过药物调整，共有76名患者（84%）实现了无癫痫发作。首次发作后≥2年开始治疗的患者比早期开始治疗的患者更难实现癫痫控制。新诊断的老年患者比新诊断的年轻患者更有可能通过AED治疗保持无癫痫发作（p<0.001）。大多数接受评估的患者为部分性发作，潜在的脑萎缩和梗死很常见。用初始AED治疗老年人可能很复杂；充分的时间和清晰的沟通至关重要。尽管大多数接受评估的患者有积极的结果，但所有AED在该人群中都有一些缺点。药物的选择可能取决于合并症和联合用药等因素。初始剂量应较低，并采用缓慢滴定方案。整体护理方法有助于优化老年癫痫患者的治疗效果。
