DOI: https://doi.org/10.22141/2224-0713.16.3.2020.203450

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

T.A. Litovchenko, I.M. Pasyura

Abstract


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.


Keywords


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

References


Baftiu A., Feet S.A., Larsson P.G. et al. Utilisation and polypharmacy aspects of antiepileptic drugs in elderly versus younger patients with epilepsy: A pharmacoepidemiological study of CNS-active drugs in Norway, 2004–2015. Epilepsy Res. 2018 Jan. 139. 35-42.

Bergey G.K. Initial treatment of epilepsy: special issues in trea­ting the elderly. Neurology. 2004. 63(Suppl. 4). S40-8.

Bourdet S.V., Gidal B.E., Alldredge B.K. Pharmacologic mana­gement of epilepsy in the elderly. J. Am. Pharm. Assoc. (Wash.). 2001. 41(3). 421-36.

Brodie M.J., Overstall P.W., Giorgi L. Epilepsy Res. 1999. 37. 81–87. PubMed: 10515178.

Chen B., Choi H., Hirsch L.J., Katz A., Legge A., Buchsbaum R., Detyniecki K. Psychiatric and behavioral side effects of antiepileptic drugs in adults with epilepsy. Epilepsy Behav. 2017. 76. 24-31.

Cramer J.A., Leppik I.E., Rue K.D., Edrich P., Kramer G. Epilepsy Res. 2003. 56. 135-145. PubMed: 14642998.

De la Court A., Breteler M.M., Meinardi H., Hauser W.A., Hofman A. Epilepsia. 1996. 37. 141-147. PubMed: 8635424.

Fisher R.S., Acevedo C., Arzimanoglou A., Bogacz A. et al. A practical clinical definition of epilepsy. Epilepsia. 2014. 55(4). 475-482.

Graham N.S., Crichton S., Koutroumanidis M., Wolfe C.D., Rudd A.G. Incidence and associations of poststroke epilepsy: the prospective South London Stroke Register. Stroke. 2013.

Greenblatt D.J. J. Am. Geriatr. Soc. 1979. 27. 20-22. PubMed: 759470.

Gupta S.R., Naheedy M.H., Elias D., Rubino F.A. Stroke. 1988. 19. 1477-1481. PubMed: 3201504.

Hаuser W., Hesdorffer D. Epilepsy, Frequency, Causes and Consequences. New York, NY: Demos Publications, 1990.

Hauser W.A., Annegers J.F., Rocca W.A. Mayo Clin. Proc. 1996. 71. 576-586. PubMed: 8642887.

Hermann B.P., Sager M.A., Koscik R.L., Young K., Nakamura K. Vascular, inflammatory, and metabolic factors associated with cognition in aging persons with chronic epilepsy. Epilepsia. 2017 Nov. 58(11). e152-e156.

Hernández-Ronquillo L., Adams S., Ballendine S., Téllez-Zenteno J.F. Epilepsy in an elderly population: Classification, etiology and drug resistance. Epilepsy Res. 2018. 140. 90-94.

Hesdorffer D.C. et al., 2011; Olafsson E. et al., 2005; Leppik I.E. et al., 2010; Wallace H., Shorvon S., Tallis R., 1998; Faught E., Richman J., Martin R. et al., 2012; Ghosh S., Jehi L.E., 2014; Pugh M.J., Knoefel J.E., Mortensen E.M. et al., 2009.

Holmes G. Clin. Electroencephalogr. 1980. 11. 83-86.

Hussein Z., Posner J. Br. J. Clin. Pharmacol. 1997. 43. 457-465. PubMed: 9159559.

Ip Q., Malone D.C., Chong J., Harris R.B., Labiner D.M. An update on the prevalence and incidence of epilepsy among older adults. Epilepsy Res. 2018. 139. 107-112.

Leppik I.E., Birnbaum A.K. Epilepsy in the Elderly. Ann. NY Acad. Sci. 2010. 1184. 208-224.

Leppik I.E., Brodie M.J., Saetre E.R., Rowan A.J., Ramsay R.E., Macias F., Jacobs M.P. Epilepsy Res. 2006. (Suppl. 1). S71-S76. PubMed: 16413171.

Liu J., Wang L., Wu L., Wang Y. Treatment of epilepsy for people with Alzheimer’s disease. Cochrane Database of Systematic Reviews. 2016. Issue 11. Art. No.: CD011922.

Martin R., Vogtle L., Gilliam F., Faught E. Health-related quality of life in senior adults with epilepsy: what we know from randomized clinical trials and suggestions for future research. Epilepsy and Behavior. 2003. 4(6). 626-634.

May T.W., Pfäfflin M., Brandt C., Füratsch N. et al. Epilepsy in the elderly: restrictions, fears, and quality of life. Acta Neurol. Scand. 2015. 131(3). 176-86.

Moore S.A. Teal T.W. Proceedings of the Drug Information Association Workshop Geriatric Drug Use: Clinical and Social Perspectives. Washington, DC: Pergamon Press, 1985. Adverse drug reaction surveillance in the geriatric population: a preliminary review.

Morrell M.J., Leppik I., French J., Ferrendelli J., Han J., Magnus L. Epilepsy Res. 2003. 54. 153-161. PubMed: 12837566.

Nicastro N., Assal F., Seek M. From here to epilepsy: the risk of seizure in patients with Alzheimer’s disease. Epileptic Disord. 2016. 18 (1). 1-12.

Patsalos P.N., Sander J.W. Drug Saf. 1994. 11. 37-67. PubMed: 7917080; French J. Epilepsia. 2001. 42(Suppl. 4). 40-43. PubMed: 11564125.

Peck A.W. Epilepsia. 1991. 32(Suppl. 2). S9-S12. PubMed: 1773780.

Perucca E., Berlowitz D., Birnbaum A. et al. Pharmacological and clinical aspects of antiepileptic drug use in the elderly. Epilepsy Res. 2006 Jan. 68 (Suppl. 1). S49-63.

Reddy D.S., Bhimani A., Kuruba R., Park M.J., Sohrabji F. Prospects of Modeling Post-Stroke Epileptogenesis. J. Neurosci. Res. 2017. 95(4). 1000-1016.

Richens A. Clinical pharmacokinetics of gabapentin. London, England: Royal Society of Medicine Services, 1993.

Rowan A., Ramsay R., Collins J. et al. Neurology. 2005. 64. 1868-1873. PubMed: 15955935.

Scheffer I.E., Berkovic S., Capovilla G., Connolly M.B. et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017. 58(4). 512-521.

Sillanpaa M., Kalviainen R., Klaukka T., Helenius H., Shinnar S. Epilepsy Res. 2006. 71. 206-215. PubMed: 16876984.

Stefan H., May T.W., Pfäfflin M., Brandt C. et al. Epilepsy in the elderly: comparing clinical characteristics with younger patients. Acta Neurol. Scand. 2014. 129(5). 283-93.

Verbeeck R.K., Cardinal J.A., Wallace S.M. Eur. J. Clin. Pharmacol. 1984. 27. 91-97. PubMed: 6489431.

Wallace S., Verbeeck R. Clin. Pharmacokinet. 1987. 12. 91-97.

Wynne H.A., Cope L.H., Mutch E., Rawlins M.D., Woodhouse K.W., James O.F. Hepatology. 1989. 9. 297-301. PubMed: 2643548.

Yang H., Rajah G., Guo A., Wang Y., Wang Q. Pathogenesis of epileptic seizures and epilepsy after stroke. Neurol. Res. 2018 Apr. 21. 1-7.




Copyright (c) 2020 INTERNATIONAL NEUROLOGICAL JOURNAL

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2020

 

   Seo анализ сайта