Landwehr Ralf, Liszka Robert
Zentrum für Ambulante Neurorehabilitation (ZANR), Europaallee 1, D-67657 Kaiserslautern. Germany.
Klinik fur Neurologie, Westpfalz-Klinikum, Hellmut-Hartert-Str. 1, D-67655 Kaiserslautern. Germany.
Curr Aging Sci. 2017;10(4):263-269. doi: 10.2174/1874609810666170413123317.
Acute symptomatic seizures and epileptic disorders are frequent health problems of elderly patients. An early and reliable distinction of the seizure etiology is important to ensure adequate treatment, and to prevent unwarranted diagnostic and therapeutic procedures.
We review the current literature based on a MEDLINE search, describe age-related problems in detail, with particular attention to clinical practice, discuss possible criteria and potential pitfalls for diagnostics, and provide a compilation of etiologic factors for acute symptomatic seizures.
The most common causes of acute symptomatic seizures - acute cerebrovascular disorders, metabolic disorders, traumatic brain injury, meningo-encephalitis, cerebral tumors, and withdrawal of alcohol and other central agents - are well-defined and seem to permit straightforward diagnostic and therapeutic strategies. The current classification of seizures and epileptic syndromes apparently provides clear definitions. However, multiple age-related risk factors, as well as a reduced discriminatory power of clinical and technical diagnostic criteria can make the distinction difficult.
Typical age-related problems are incomplete or missing medical history, dementia, oligosymptomatic seizures, inconclusive EEG and cerebral imaging results, multiple pathological findings and comorbidity with ambiguous significance, confounding sleep disorders, intake of proconvulsive drugs, and psychogenic seizures. All diagnostic and therapeutic decisions need to be based on an integrative and individual approach that includes diagnostic findings and risk factors, the intake of medications and other agents, and the social situation of the elderly patient.
急性症状性癫痫发作和癫痫性疾病是老年患者常见的健康问题。早期且可靠地区分癫痫发作的病因对于确保恰当治疗以及避免不必要的诊断和治疗程序至关重要。
我们基于医学文献数据库检索回顾当前文献，详细描述与年龄相关的问题，尤其关注临床实践，讨论诊断的可能标准和潜在陷阱，并提供急性症状性癫痫发作病因因素的汇总。
急性症状性癫痫发作最常见的病因——急性脑血管疾病、代谢紊乱、创伤性脑损伤、脑膜脑炎、脑肿瘤以及酒精和其他中枢性药物戒断——已明确界定，似乎允许采取直接的诊断和治疗策略。当前癫痫发作和癫痫综合征的分类显然提供了清晰的定义。然而，多种与年龄相关的风险因素，以及临床和技术诊断标准的鉴别力下降，可能使区分变得困难。
典型的与年龄相关的问题包括病史不完整或缺失、痴呆、症状轻微的癫痫发作、脑电图和脑成像结果不明确、多种病理发现以及意义不明确的合并症、混淆的睡眠障碍、促惊厥药物的摄入以及心因性癫痫发作。所有诊断和治疗决策都需要基于一种综合的个体化方法，该方法包括诊断结果和风险因素、药物及其他药物的摄入以及老年患者的社会状况。
