Pirgit Meritam Larsen, Beniczky Sándor
Department of Clinical Neurophysiology, Danish Epilepsy Centre*, Visbys Allé 5, 4293 Dianalund, Denmark.
Department of Clinical Neurophysiology, Danish Epilepsy Centre*, Visbys Allé 5, 4293 Dianalund, Denmark; Department of Clinical Neurophysiology, Aarhus University Hospital*, and Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark.
Seizure. 2025 May;128:90-121. doi: 10.1016/j.seizure.2024.09.003. Epub 2024 Sep 7.
The prevalence and incidence of epileptic seizures and epilepsy increases among the elderly. Epileptic seizures in older people remain often unreported and undiagnosed, contributing to incorrect or delayed treatment. The goal of our review paper is to increase awareness of seizures in the elderly, to improve the diagnostic process in this growing population.
We present a systematic review of the literature on EEG findings and seizure semiology among the elderly according to the PRISMA statement. One hundred and two original studies were included and findings were divided in four groups: EEG among elderly without seizures, EEG among elderly with seizures or epilepsy, semiology, and status epilepticus.
EEG abnormalities are found in approximately half of the geriatric population referred to routine EEG. Slowing (both focal and diffuse) is the most common finding among seniors with and without seizures. Interictal epileptiform discharges (IEDs) are likewise seen among healthy seniors, which reduces their specificity as biomarker for epilepsy. Focal onset seizures prevail among the aged. Generalized seizures are uncommon, starting usually earlier in life but exacerbating in later years. Motor phenomena are less frequently seen than among younger individuals. Seizures are mainly characterized by impairment of awareness, disturbed cognition and confusion, both ictally and postictally. Unresponsiveness may occur during non-epileptic events too, which further challenges seizure recognition. Epilepsy and dementia are bi-directionally related: dementia carries an increased risk of developing epilepsy and vice versa. Up to 45 % of the aged with new onset seizures present with status epilepticus (SE). SE among the elderly is more often focal motor; non-convulsive status epilepticus (NSCE) constitutes 10-25 %.
癫痫发作及癫痫在老年人中的患病率和发病率呈上升趋势。老年人的癫痫发作常常未被报告和诊断，导致治疗不当或延误。我们这篇综述文章的目的是提高对老年人癫痫发作的认识，改善这一不断增长人群的诊断过程。
我们根据PRISMA声明对有关老年人脑电图（EEG）结果及发作症状学的文献进行了系统综述。纳入了102项原创研究，研究结果分为四组：无癫痫发作老年人的EEG、有癫痫发作或癫痫老年人的EEG、症状学以及癫痫持续状态。
在接受常规EEG检查的老年人群中，约一半存在EEG异常。慢波（局灶性和弥漫性）是有癫痫发作和无癫痫发作老年人中最常见的表现。发作间期癫痫样放电（IEDs）在健康老年人中也可见，这降低了其作为癫痫生物标志物的特异性。局灶性发作在老年人中占主导。全身性发作不常见，通常在生命早期开始，但在晚年加重。与年轻人相比，运动现象较少见。癫痫发作主要表现为发作期和发作后期意识障碍、认知紊乱和精神错乱。在非癫痫事件期间也可能出现无反应性，这进一步增加了癫痫发作识别的难度。癫痫与痴呆双向相关：痴呆会增加患癫痫的风险，反之亦然。新发癫痫发作的老年人中，高达45%会出现癫痫持续状态（SE）。老年人中的SE更常为局灶性运动性发作；非惊厥性癫痫持续状态（NSCE）占10 - 25%。
