Department of Psychiatry, Stanford University School of Medicine, Stanford, California 94305-5723, USA.
Clin Interv Aging. 2010 Apr 26;5:89-99. doi: 10.2147/cia.s3785.
Individuals over 65 years of age experience the new onset of seizures at a prevalence rate of roughly twice that of younger adults. Differences in physiology, need of concomitant medications, and liability for cognitive deficits in this population, make the choice of anticonvulsant drugs especially important. This paper reviews topiramate (TPM), a treatment for many types of seizures, with the above risks in mind. In particular, we discuss efficacy and pharmacokinetics with emphasis on the older patient, and adverse events in both the younger and older adult. With most studies of TPM-induced cognitive deficits having been performed in younger adults and volunteers, we discuss the implications for the older adult. Even in studies of younger individuals, up to 50% discontinue TPM because of intolerable cognitive deficits. Most studies find specific declines in working memory and verbal fluency. In conclusion, we give recommendations for use of this antiepileptic drug in this population.
65 岁以上人群癫痫发作的新发病率大约是年轻人的两倍。生理差异、同时需要服用的药物以及认知缺陷的风险，使得抗癫痫药物的选择尤为重要。本文回顾了托吡酯（TPM），一种可治疗多种类型癫痫发作的药物，同时考虑了上述风险。特别是，我们讨论了该药在老年患者中的疗效和药代动力学，以及在年轻和老年患者中的不良反应。由于 TPM 引起认知缺陷的大多数研究都是在年轻人和志愿者中进行的，我们讨论了这些研究对老年患者的意义。即使在针对年轻人的研究中，也有高达 50%的患者因无法忍受的认知缺陷而停止使用 TPM。大多数研究发现工作记忆和语言流畅性有特定程度的下降。总之，我们针对该人群使用这种抗癫痫药物提出了建议。
