Dupont S, Verny M, Harston S, Cartz-Piver L, Puisieux F, Benetos A, Vespignani H, Marchal C, Derambure P
clinique Paul-Castaigne, hôpital Pitié-Salpêtrière, AP-HP, université Pierre-et-Marie-Curie, Paris, France.
Rev Neurol (Paris). 2009 Oct;165(10):803-11. doi: 10.1016/j.neurol.2008.10.028. Epub 2009 Jan 17.
Diagnosis of epileptic seizure may be difficult in older patients because seizure manifestations are often unusual: confusion, paresis... and because there are multiple differential diagnoses (syncope, transient ischemic attack, transient global amnesia...). To promote and facilitate the diagnosis of seizures in the elderly, neurologists and gerontologists must work together and focus their strategy on two points: firstly, the knowledge of the specific presentation of seizures in elderly patients, and secondly, the adoption of a reasoning based on seizures and not epileptic syndromes. A multidisciplinary group worked on epilepsy of the elderly to elaborate an electro-clinical score which aims to help establish the diagnosis of epilepsy in elderly patients in different clinical settings. This electro-clinical score is based on a systematic review of scientific literature and the recommendations are explicitly linked to supporting evidence. Further, clinical validation of the electro-clinical score is required.
老年患者癫痫发作的诊断可能较为困难,因为发作表现往往不寻常,如意识模糊、轻瘫等,且存在多种鉴别诊断(晕厥、短暂性脑缺血发作、短暂性全面性遗忘症等)。为了促进和便利老年患者癫痫发作的诊断,神经科医生和老年病专家必须共同努力,并将策略重点放在两点上:其一,了解老年患者癫痫发作的具体表现;其二,采用基于癫痫发作而非癫痫综合征的推理方法。一个多学科小组致力于老年癫痫研究,制定了一个电临床评分系统,旨在帮助在不同临床环境中对老年患者进行癫痫诊断。该电临床评分系统基于对科学文献的系统综述,其建议与支持证据明确相关。此外,还需要对该电临床评分系统进行临床验证。