Greffard Sandrine, Barrou Zina, Godard Maxime, Verny Marc
Hôpital de La Pitié-Salpêtrière, centre de gériatrie, pavilion Marguerite-Bottard, 75013 Paris.
Rev Prat. 2011 Dec;61(10):1343-8.
Epilepsy is one of the most frequent neurological diseases in the elderly. Its incidence and associated-mortality rise in old age. Distinguishing epilepsy from paroxysmal non epileptic events can be a real challenge for physicians. Diagnosis of epilepsy relies on clinical examination but routine laboratory tests and cerebral imaging are warranted, especially for first-ever event. Electroencephalogram is important for the evaluation of seizures in elderly patients but it may show non specific changes associated with age. Clinical presentation in old age is often less-specific. Partial seizures are more common than generalized. Acute symptomatic seizures are very frequent most often due to metabolic abnormalities; infections or medications. Although the international classification of epilepsy is well known, its use is not easy in the elderly We favour a geriatric model of reasoning, which takes into account the effects of aging, chronic diseases and acute precipitating factors, because it is more beneficial to the patient. Based on this model, an electro-clinical scale has been created (but not yet validated) to help practitioners with the diagnosis. When initiating the treatment, monotherapy is always preferred. The choice of a molecule must be individualized. Efficacy, but also antiepileptic drug side-effects (alertness, cognitive effects), and interactions must be taken into account in this vulnerable population.
癫痫是老年人中最常见的神经系统疾病之一。其发病率和相关死亡率在老年时会上升。对于医生来说，将癫痫与阵发性非癫痫事件区分开来可能是一项真正的挑战。癫痫的诊断依赖于临床检查，但常规实验室检查和脑部影像学检查也是必要的，尤其是对于首次发作的情况。脑电图对于评估老年患者的癫痫发作很重要，但它可能显示与年龄相关的非特异性变化。老年患者的临床表现往往缺乏特异性。部分性发作比全身性发作更常见。急性症状性发作非常频繁，最常见的原因是代谢异常、感染或药物。尽管癫痫的国际分类广为人知，但在老年人中应用并不容易。我们倾向于采用一种老年医学推理模式，该模式考虑到衰老、慢性疾病和急性诱发因素的影响，因为这对患者更有益。基于这种模式，已经创建了一种电临床量表（但尚未经过验证）来帮助从业者进行诊断。在开始治疗时，总是首选单一疗法。药物的选择必须个体化。在这个脆弱的人群中，必须考虑药物的疗效，还有抗癫痫药物的副作用（警觉性、认知影响）以及相互作用。
