Werhahn K J
Klinik und Poliklinik für Neurologie, Universitätsmedizin Mainz, Mainz, Germany.
Nervenarzt. 2009 Apr;80(4):399-404. doi: 10.1007/s00115-008-2638-4.
Given current demographic trends, the prevalence of epilepsy in the elderly population will increase. This review summarizes the most relevant clinical and therapeutic findings in elderly patients with epilepsy. Guidelines, systematic reviews, and meta-analysis are lacking, and there are only three randomized controlled trials of epilepsy in the elderly. Clinically, seizures in the elderly may be overlooked since warning signs (auras) and seizure evolution into generalized tonic-clonic seizures are rarer in old people. Sudden loss of consciousness occurs more frequently with increasing age, challenging differential diagnosis. Therapy is more complex due to frequent comorbidities and multiple drug therapies, requiring a cautious approach. Especially drug interactions need to be considered. Epileptic seizures seem to be better controlled by drugs in the elderly than in young people. Therapy is hampered by side effects and drug interactions, making definite diagnosis indispensable and bringing on the need for newer-generation antiepileptic drugs.
鉴于当前的人口趋势，老年人群中癫痫的患病率将会上升。本综述总结了老年癫痫患者最相关的临床和治疗研究结果。目前缺乏相关指南、系统评价和荟萃分析，仅有三项针对老年人癫痫的随机对照试验。临床上，老年患者的癫痫发作可能会被忽视，因为先兆症状和癫痫发作演变为全面性强直阵挛发作在老年人中较为少见。随着年龄增长，意识突然丧失更为常见，这给鉴别诊断带来了挑战。由于频繁的合并症和多种药物治疗，治疗更为复杂，需要谨慎对待。尤其需要考虑药物相互作用。与年轻人相比，老年人的癫痫发作似乎更容易通过药物得到控制。副作用和药物相互作用阻碍了治疗，因此明确诊断必不可少，这也催生了对新一代抗癫痫药物的需求。
