Cerebrovascular diseases and dementia: modern views on the diagnosis and treatment of symptomatic epilepsy in the elderly

T.A. Litovchenko, I.M. Pasyura


Epilepsy is one of the most common diseases of the nervous system in the elderly, and ranks third after cerebrovascular diseases and dementias. It is estimated that by 2020, the number of cases of epilepsy in the elderly will account for a half of all new cases of epilepsy. New-onset epilepsy is mainly a consequence of accumulated brain damage and other secondary factors. The most common etiologies of epilepsy in the elderly include cerebrovascular diseases, neurodegenerative diseases with cognitive impairment, brain tumors and traumatic brain injuries. Stroke and other cerebrovascular diseases are the most important risk factors for the occurrence of epilepsy in the elderly, accounting for 30–50 % of all identified causes. Primary neurodege-nerative disorders account for ~10–20 % of all identified causes of epilepsy in the elderly. The first focal early epileptic seizure is optional for treatment. Late seizures after a cerebrovascular event, especially recurrent ones, are indicative for antiepileptic drug (AED) treatment, with a risk of recurrence of 71.5 %. In case of even single unprovoked seizures on the background of chronic cerebrovascular disease, AEDs are necessary. The first epileptic seizure due to Alzheimer’s disease and other primary neurodegenerations is an indication to start the treatment that not only significantly improves the prognosis of epilepsy but also slows the progression of cognitive impairment. It is recommended to use AEDs that do not inhibit cognitive function, do not affect lipid metabolism, weight, do not cause arrhythmias, minimally interact with other drugs. The drugs of choice for elderly patients, especially those with cognitive impairment (due to degenerative diseases, cerebrovascular diseases, etc.), should be levetiracetam (Levicitam) and lamotrigine (Lamotrine), pre-ferably as monotherapy.


epilepsy in the elderly; cerebrovascular diseases; Alzheimer’s disease; treatment


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