Yaşlılarda Epilepsi

Öz

Nöbetler etiyoloji, klinik bulgular ve prognoz açısından yaşlı ve genç hastalar arasında önemli farklılıklar gösterir. Yaşlılarda epilepsi insidans ve prevalansı genç erişkinlerden ve çocuklardan belirgin olarak daha yüksektir. Yaşlılarda en sık görülen nöbet nedenleri serebrovasküler olaylar, nörodejeneratif hastalıklar, travma ve metabolik ensefalopatilerdir. Yaşlı bir hastada epilepsi tanısı atipik klinik bulguların sık görülmesi nedeniyle zorlaşabilmektedir. Antiepileptik ilaç tedavisi yaşlanmayla ilişkili fi zyolojik farmakokinetik ve farmakodinamik değişiklikler nedeniyle doz ayarlamaları gerektirir

Anahtar Kelimeler

• Yaşlı, Epilepsi, Nöbet

Epilepsy in the Elderly

Abstract

Seizures differ signifi cantly between the elderly and younger patients according to the etiology, clinical fi ndings and prognosis. The incidence and prevalence of epilepsy is signifi cantly higher in the elderly than in young adults and children. The most common causes of seizures in the elderly are cerebrovascular events, neuro-degenerative diseases, trauma and metabolic encephalopathies. The diagnosis of epilepsy in older patients is usually diffi cult due to the commonly encountered atypical clinical fi ndings. Antiepileptic drug therapy requires dose adjustments due to the physiological pharmacokinetic and pharmacodynamic changes associated with aging

Keywords

• Elderly, Epilepsy, Seizure

References

1. Pugh MJV, Knoefel JE, Mortensen EM, Amuan ME, Berlowitz DR,van Cott AC. New-onset epilepsy risk factors in older veterans. J Am Geriat Soc 2009; 57: 237– 42.
2. Hauser WA. Epidemiology of seizures in the elderly. In: Rowan Aj, Ramsay RE, eds. Seizures and epilepsy in the elderly. Boston: Butterworth-Heinemann,1997:7-20.
3. Lhatoo SD, Johnson AL, Goodridge DH, MacDonald BK, Sander JW, Shorvon SD. Mortality in epilepsy in the fi rst 11 to 14 years after diagnosis: Multivariate analysis of a long-term, prospective, population-based cohort. Ann Neurol 2001; 49: 336–44.
4. Brodie MJ, Adler AT, Kwan P. Epilepsy in later life. Lancet Neurology 2009:1019-30.
5. McBride AE, Shih TT, Hirsch LJ. Video-EEG monitoring in the elderly: A review of 94 patients. Epilepsia 2002; 43: 165–69.
6. Duncan JS, Sander JW, Sisodiya SM, Walker MC. Adult epilepsy. Lancet 2006; 367:1087–100.
7. Holmes G. Cognitive impairment in epilepsy: The role of network abnormalities. Epileptic Disord 2015. Epub ahead of print.
8. Sheth RD, Drazkowski JF, Sirven JI, Gidal BE, Hermann BP. Protracted ictal confusion in elderly patients. Arch Neurol 2006; 60: 529–32.

9. Crompton DE, Berkovic SF. The borderland of epilepsy: Clinical and molecular features of phenomena that mimic epileptic seizures. Lancet Neurol 2009; 8: 370–81.
10. Waterhouse E, Towne A. Seizures in the elderly. Cleveland Clinic J Med 2005; 72 Suppl 3: 26–37.
11. Beyenburg S, Elger CE, Reuber M. Acute confusion or altered mental state: Consider nonconvulsive status epilepticus. Gerontology 2007; 53: 388–96.
12. Scicchitano F, Constanti A, Citrano R, Sarro G, Russo E. Statins and epilepsy: Preclinical studies, Clinical trials and statin-anticonvulsant drug interactions. Curr Drug Targets. 2015 April 22 .Epub ahead of print.
13. Miskin C, Hasbani DM. Status epilepticus: Immunologic and infl Neurology 2014; 21(3):221-5.
14. Legido A, Katsetos CD. Experimental studies in epilepsy: Immunologic and infl ammatory mechanisms. Semin Pediatr Neurol 2014 Sep;21(3):197-206.
15. Wyllie E, Gupta A, Lachhwani DK. The Treatment of Epilepsy. 4th ed. Lippincott Williams & Wilkins, 2001.
16. Stephen LJ, Brodie MJ. Epilepsy in the elderly. Review. Lancet 2000; 355:1441-46.