Brodie Martin J, Elder Andrew T, Kwan Patrick
Epilepsy Unit, Western Infirmary, Scotland, UK.
Lancet Neurol. 2009 Nov;8(11):1019-30. doi: 10.1016/S1474-4422(09)70240-6. Epub 2009 Oct 1.
Epilepsy is most likely to develop in later life. The burden of this disorder on health-care resources will rise further as the world's population continues to age. Making a secure diagnosis can be challenging because the clinical manifestations of seizures and the differential diagnoses and causes of epilepsy can be different in older individuals compared with younger individuals. Obtaining a reliable account of the events for accurate assessment is particularly important in guiding the appropriate choice and interpretation of investigations to arrive at the correct diagnosis. In older age, unique pharmacokinetic and pharmacodynamic changes occur. The use and selection of antiepileptic drugs is often further complicated by the presence of comorbidities, polypharmacy, and concomitant functional impairment, but there is a paucity of high-level clinical evidence on the effects of these factors as well as on the choice of treatment in the elderly. A comprehensive model of care should combine expertise in the diagnosis and treatment of epilepsy with effective assessment and management of the psychosocial effects to improve the prognosis in this vulnerable and poorly studied group of patients.
癫痫最有可能在晚年发病。随着世界人口持续老龄化,这种疾病对医疗资源的负担将进一步加重。做出确切诊断可能具有挑战性,因为与年轻人相比,老年人癫痫发作的临床表现、鉴别诊断及病因可能有所不同。获取关于这些事件的可靠描述以进行准确评估,对于指导恰当选择和解读检查以得出正确诊断尤为重要。在老年人群中,会出现独特的药代动力学和药效学变化。抗癫痫药物的使用和选择常常因合并症、多种药物治疗及伴随的功能损害而更加复杂,但关于这些因素的影响以及老年患者治疗选择的高水平临床证据却很匮乏。一个全面的护理模式应将癫痫诊断和治疗方面的专业知识与对心理社会影响的有效评估及管理相结合,以改善这一脆弱且研究不足的患者群体的预后。