Ilo E. Leppik, MD MINCEP Epilepsy Care, 7500 Western Avenue, Golden Valley, MN 55427, USA.
Curr Treat Options Neurol. 2008 Jul;10(4):239-45. doi: 10.1007/s11940-008-0026-9.
The elderly are the most rapidly growing segment of the population, and the incidence of epilepsy in persons over 65 is higher than in any other age group. In nursing homes, its incidence is even higher than in community-dwelling persons of similar ages. About 10% of nursing home residents are being treated with antiepileptic drugs (AEDs), with an "epilepsy/seizure" indication reported for about 7.7% of this use. Almost all elderly patients are being treated with AEDs introduced before 1978--phenytoin, carbamazepine, valproate, and barbiturates. However, age-related changes in protein binding, decreases in hepatic and renal clearance, alterations in gastrointestinal absorption, and interactions with drugs used for other conditions make the choice of the best AED difficult. AEDs that do not interact with other drugs, are not metabolized by the liver, and are readily absorbed may offer benefits for the elderly. To complicate matters, the elderly are not a homogeneous population. Today there are many AEDs to choose from, and some of the newer AEDs have more favorable characteristics than the older ones. Choice of an AED should be made on an individual basis, considering the cost of the drug, the cost of consequences of drug-drug interactions, and expenses associated with acute and chronic adverse effects. In other words, clinical skills rather than formulaic approaches are needed to match detailed knowledge of each patient's characteristics with the properties of the various AEDs.
老年人是人口中增长最快的群体，65 岁以上人群的癫痫发病率高于其他任何年龄段。在养老院中，其发病率甚至高于年龄相仿的社区居住者。约有 10%的养老院居民正在接受抗癫痫药物（AED）治疗，其中约 7.7%的患者有“癫痫/发作”的用药指征。几乎所有老年患者都在使用 1978 年以前引入的 AED 治疗，包括苯妥英钠、卡马西平、丙戊酸钠和巴比妥类药物。然而，与年龄相关的蛋白结合变化、肝肾功能清除率下降、胃肠道吸收改变以及与用于治疗其他疾病的药物相互作用，使得选择最佳 AED 变得困难。那些与其他药物无相互作用、不经肝脏代谢且易于吸收的 AED 可能对老年人有益。更复杂的是，老年人并不是一个同质的群体。如今有许多 AED 可供选择，一些较新的 AED 具有比旧 AED 更有利的特性。AED 的选择应根据个体情况进行，考虑药物的成本、药物相互作用的后果成本以及与急性和慢性不良反应相关的费用。换句话说，需要临床技能而不是公式化方法，将每位患者特征的详细知识与各种 AED 的特性相匹配。
