Oxford Epilepsy Research Group, National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
Departments of Neurology and Population Health Sciences & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Lancet. 2020 Feb 29;395(10225):735-748. doi: 10.1016/S0140-6736(19)33064-8.
Globally, as populations age there will be challenges and opportunities to deliver optimal health care to senior citizens. Epilepsy, a condition characterised by spontaneous recurrent seizures, is common in older adults (aged >65 years) and yet has received comparatively little attention in this age group. In this Review, we evaluate the underlying causes of epilepsy in older people, explore difficulties in establishing a diagnosis of epilepsy in this population, discuss appropriate antiseizure medications, and evaluate potential surgical treatment options. We consider cognitive, psychological, and psychosocial comorbidities and the effect that epilepsy might have on an older person's broader social or care network in high-income versus middle-income and low-income countries. We emphasise the need for clinical trials to be more inclusive of older people with epilepsy to help inform therapeutic decision making and discuss whether measures to improve vascular risk factors might be an important strategy to reduce the probability of developing epilepsy.
在全球范围内，随着人口老龄化，为老年人提供最佳医疗保健将面临挑战和机遇。癫痫是一种以自发性反复发作性癫痫发作为特征的疾病，在老年人（年龄>65 岁）中很常见，但在该年龄组中受到的关注相对较少。在这篇综述中，我们评估了老年人癫痫的潜在病因，探讨了在这一人群中确定癫痫诊断的困难，讨论了适当的抗癫痫药物，并评估了潜在的手术治疗选择。我们考虑了认知、心理和社会心理合并症，以及癫痫可能对高收入、中等收入和低收入国家老年人更广泛的社会或护理网络产生的影响。我们强调需要进行更多的临床试验，使患有癫痫的老年人更具包容性，以帮助为治疗决策提供信息，并讨论改善血管危险因素的措施是否可能是降低癫痫发病概率的重要策略。
