Melbourne Brain Centre at the Royal Melbourne Hospital; Departments of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, 3050, Australia.
Departments of Neuroscience and Neurology, Central Clinical School, Monash University, The Alfred Hospital, Melbourne, Victoria, 3004, Australia.
Br J Clin Pharmacol. 2018 Oct;84(10):2208-2217. doi: 10.1111/bcp.13653. Epub 2018 Jul 28.
People who are 60 years old and older have the highest incidence of developing new-onset epilepsy. The increase of the ageing population has resulted in a greater number of patients with new-onset epilepsy or at risk of developing the condition. Previously published review articles regarding epilepsy in older patients have had a broad focus, including people who were diagnosed with epilepsy in their childhood or middle age. The present review focuses on the causes, treatment, prognosis and psychosocial impact of new-onset epilepsy in people aged ≥60 years. Following a search of the medical electronic databases and relevant references, we identified 22 studies overall that met the inclusion criteria. Only four randomized clinical trials (RCTs) were identified that compared different antiepileptic drug treatments in this population, demonstrating that newer-generation antiepileptic drugs (e.g. lamotrigine and levetiracetam) were generally better tolerated. One uncontrolled study provided promising evidence of good outcomes and safety for surgical resection as a treatment for people with uncontrolled seizures. Five studies reported that people ≥60 years with new-onset epilepsy have significant cognitive impairments (e.g. memory loss) and psychological issues including depression, anxiety and fatigue. We found that there is limited evidence to guide treatment in people with Alzheimer's disease and epilepsy. The specific features of new-onset epilepsy in this target population significantly influences the choice of treatment. Cognitive and psychiatric screening before treatment may be useful for management. Two studies with proposed guidelines were identified but no formal clinical practice guidelines exist for this special population to assist with appropriate management. There is a need for more RCTs that investigate effective treatments with limited side effects. More research studies on the psychosocial effects of new-onset epilepsy, and long-term outcomes, for people aged ≥60 years are also required.
60 岁及以上人群新发癫痫的发病率最高。随着人口老龄化，新发癫痫或有癫痫发病风险的患者人数有所增加。先前发表的关于老年患者癫痫的综述文章广泛关注了包括在儿童或中年期被诊断为癫痫的人群。本综述重点关注≥60 岁人群新发癫痫的病因、治疗、预后和社会心理影响。通过对医学电子数据库和相关参考文献进行检索，共确定了 22 项符合纳入标准的研究。仅发现了 4 项比较该人群中不同抗癫痫药物治疗的随机临床试验（RCT），这些试验表明新一代抗癫痫药物（如拉莫三嗪和左乙拉西坦）通常具有更好的耐受性。一项非对照研究为手术切除作为治疗未控制癫痫患者的方法提供了良好结局和安全性的有前景的证据。有 5 项研究报告称≥60 岁新发癫痫患者存在明显的认知障碍（如记忆力减退）和心理问题，包括抑郁、焦虑和疲劳。我们发现，对于伴有阿尔茨海默病和癫痫的患者，治疗的指导证据有限。该目标人群中新发癫痫的具体特征显著影响治疗选择。治疗前进行认知和精神筛查可能有助于管理。确定了两项提出指南的研究，但该特殊人群尚无正式的临床实践指南来协助进行适当的管理。需要更多的 RCT 来研究具有有限副作用的有效治疗方法。还需要更多关于≥60 岁人群新发癫痫的社会心理影响和长期结局的研究。
