Acharya Jayant N, Acharya Vinita J
Department of Neurology, Penn State University Hershey Medical Center, Hershey, Pennsylvania, USA.
Ann Indian Acad Neurol. 2014 Mar;17(Suppl 1):S18-26. doi: 10.4103/0972-2327.128645.
The elderly are generally defined as those over 60 or 65 years old, but they are a heterogeneous group and may be subdivided into categories based on age and health status. The incidence of epilepsy is highest in the elderly. With a progressive increase in life expectancy, this is the fastest growing segment of patients with epilepsy. Older patients most often have focal seizures, with less prominent auras and automatisms, and longer duration of postictal confusion compared to younger patients. Status epilepticus is common and has a high mortality. The most common specific etiology is cerebrovascular disease, but the cause remains unknown in many patients. Diagnosis can be challenging because of several patient-related, physician-related and investigation-related factors. Over-diagnosis and under-diagnosis are common. Treatment is complicated by the presence of physiological changes related to aging, co-morbidities and cognitive problems as well as concerns regarding drug interactions and medication adherence. Seizures can be controlled in most patients with low doses of a single anti-epileptic drug (AED). Tolerability is an important factor in selection of an AED, as elderly patients tend to be highly sensitive to side effects. Drug-resistant epilepsy is uncommon. Epilepsy surgery, especially temporal lobectomy, can be performed in older patients with good results. More studies addressing the pathophysiological mechanisms of epilepsy in this age group, and greater inclusion of the elderly in clinical trials, as well as development of comprehensive care models are needed to provide optimal care to these patients.
老年人通常被定义为60岁或65岁以上的人群，但他们是一个异质性群体，可根据年龄和健康状况进一步细分。癫痫在老年人中的发病率最高。随着预期寿命的逐步增加，这是癫痫患者中增长最快的部分。与年轻患者相比，老年患者最常出现局灶性发作，先兆和自动症不那么明显，发作后意识模糊的持续时间更长。癫痫持续状态很常见，死亡率很高。最常见的具体病因是脑血管疾病，但许多患者的病因仍不明。由于一些与患者、医生和检查相关的因素，诊断可能具有挑战性。过度诊断和诊断不足很常见。由于存在与衰老、合并症和认知问题相关的生理变化，以及对药物相互作用和药物依从性的担忧，治疗变得复杂。大多数患者使用低剂量的单一抗癫痫药物（AED）就能控制癫痫发作。耐受性是选择AED的一个重要因素，因为老年患者往往对副作用高度敏感。耐药性癫痫并不常见。癫痫手术，尤其是颞叶切除术，可在老年患者中进行，效果良好。需要更多针对该年龄组癫痫病理生理机制的研究，让更多老年人参与临床试验，以及开发综合护理模式，以便为这些患者提供最佳护理。
