RSS-Feed abonnieren
DOI: 10.1055/a-1844-8292
Epileptischer Anfall bei älteren Patienten
Epileptic seizure in the elderlyZUSAMMENFASSUNG
Die Inzidenz vorübergehender Bewusstseinsverluste steigt mit zunehmendem Alter an, dies gilt jedoch sowohl für Anfälle epileptischer Genese als auch für Bewusstseinsverluste nicht epileptischer Natur, insbesondere aus kardialer oder zerebrovaskulärer Ursache. Zur sicheren Differenzierung ist daher primär eine umfassende Anamnese sowohl der Semiologie des Ereignisses als auch möglicher Auslösefaktoren zu erheben und, je nach Ergebnis, eine gezielte apparative Diagnostik durchzuführen. Bei Diagnose einer Epilepsie muss im Rahmen der Therapie beachtet werden, dass im Alter aufgrund einer veränderten Pharmakodynamik und vielfacher Wechselwirkungen, eine medikamentöse Therapie oftmals durch nicht akzeptable unerwünschte Arzneimittelwirkungen erschwert wird. Weitere Therapiemöglichkeiten sind auch im höheren Lebensalter zu erwägen, wie die verschiedenen Möglichkeiten der Epilepsiechirurgie.
ABSTRACT
The incidence of transient losses of consciousness increases with age, on the one hand due to epileptic seizures, on the other hand because of diseases of non-epileptic nature, especially cardiac or cerebrovascular causes. For reliable differentiation, a comprehensive anamnesis of both the semiology of the event and possible triggering factors is necessary and, depending on the result, must be succeeded by targeted diagnostic investigations. When diagnosing epilepsy and therefore evaluating an antiseizure medication, it is important to consider that in older ages, due to changed pharmacodynamics and multiple drug interactions, this drug therapy is often difficult by unacceptable adverse drug effects. Also, in older ages other therapy strategies should be evaluated such as epilepsy surgery.
Publikationsverlauf
Artikel online veröffentlicht:
28. Juli 2022
© 2022. Thieme. All rights reserved.
© Georg Thieme Verlag KG Stuttgart · New York
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 Forsgren L, Bucht G, Eriksson S. et al Incidence and clinical characterization of unprovoked seizures in adults: a prospective population-based study. Epilepsia 1996; 37: 224-229 DOI: 10.1111/j.1528-1157.1996.tb00017.x.
- 2 Banerjee PN, Filippi D, Allen Hauser W. The descriptive epidemiology of epilepsy-a review. Epilepsy Res 2009; 85: 31-45 DOI: 10.1016/j.eplepsyres.2009.03.003.
- 3 Hauser WA. Epilepsy: frequency, causes and consequences. Epilepsy Found Am 1990: 275
- 4 Faught E, Richman J, Martin R. et al Incidence and prevalence of epilepsy among older U. S. Medicare beneficiaries. Neurology 2012; 78: 448-453 DOI: 10.1212/WNL.0b013e3182477edc.
- 5 Burn J, Dennis M, Bamford J. et al Epileptic seizures after a first stroke: the Oxfordshire Community Stroke Project. Bmj 1997; 315: 1582-1587 DOI: 10.1136/bmj.315.7122.1582.
- 6 Hesdorffer DC, Hauser WA, Annegers JF. et al Dementia and adult-onset unprovoked seizures. Neurology 1996; 46: 727-730 DOI: 10.1212/wnl.46.3.727.
- 7 Fisher RS, van Emde Boas W, Blume W. et al Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia 2005; 46: 470-472 DOI: 10.1111/j.0013-9580.2005.66104.x.
- 8 Beghi E, Carpio A, Forsgren L. et al Recommendation for a definition of acute symptomatic seizure. Epilepsia 2010; 51: 671-675 DOI: 10.1111/j.1528-1167.2009.02285.x.
- 9 Lempert T. Recognizing Syncope: Pitfalls and Surprises. Journal of the Royal Society of Medicine 1996; 89: 372-375 DOI: 10.1177/014107689608900705.
- 10 Lemonick DM. Evaluation of Syncope in the emergency department. Am J Clin Med 2010; 07: 11-19
- 11 Fisher RS, Schachter SC. The Postictal State: A Neglected Entity in the Management of Epilepsy. Epilepsy & Behavior 2000; 01: 52-59 DOI: 10.1006/ebeh.2000.0023.
- 12 Aminoff MJ, Scheinman MM, Griffin JC. et al Electrocerebral accompaniments of syncope associated with malignant ventricular arrhythmias. Ann Intern Med 1988; 108: 791-796 DOI: 10.7326/0003-4819-108-6-791.
- 13 Hampel KG, Thijs RD, Elger CE. et al Recurrence risk of ictal asystole in epilepsy. Neurology 2017; 89: 785-791 DOI: 10.1212/wnl.0000000000004266.
- 14 Lanz M, Oehl B, Brandt A. et al Seizure induced cardiac asystole in epilepsy patients undergoing long term video-EEG monitoring. Seizure 2011; 20: 167-172 DOI: 10.1016/j.seizure.2010.11.017.
- 15 Surges R, Conrad S, Hamer HM. et al SUDEP in brief – knowledge and practice recommendations on sudden unexpected death in epilepsy. Nervenarzt 2021; 92: 809-815 DOI: 10.1007/s00115-021-01075-3.
- 16 Elger CE, Berkenfeld R.. S1-Leitlinie Erster epileptischer Anfall und Epilepsien im Erwachsenenalter. In: Deutsche Gesellschaft für Neurologie (Hrsg.) Leitlinien für Diagnostik und Therapie in der Neurologie www.dgn.org/leitlinien 2017
- 17 Velis D, Plouin P, Gotman J. et al Recommendations regarding the requirements and applications for long-term recordings in epilepsy. Epilepsia 2007; 48: 379-384 DOI: 10.1111/j.1528-1167.2007.00920.x.
- 18 Brodie MJ, Stephen LJ. Outcomes in Elderly Patients With Newly Diagnosed and Treated Epilepsy. In International Review of Neurobiology: Academic Press 2007: 253-263 DOI: 10.1016/S0074-7742(06)81016-0
- 19 Bourgeois FT, Shannon MW, Valim C. et al Adverse drug events in the outpatient setting: an 11-year national analysis. Pharmacoepidemiol Drug Saf 2010; 19: 901-910 DOI: 10.1002/pds.1984.
- 20 Lattanzi S, Trinka E, Del Giovane C. et al Antiepileptic drug monotherapy for epilepsy in the elderly: A systematic review and network meta-analysis. Epilepsia 2019; 60: 2245-2254 DOI: 10.1111/epi.16366.
- 21 Hirsch LJ, Arif H, Buchsbaum R. et al Effect of Age and Comedication on Levetiracetam Pharmacokinetics and Tolerability. Epilepsia 2007; 48: 1351-1359 DOI: 10.1111/j.1528-1167.2007.01043.x.
- 22 Schoenberg MR, Rum RS, Osborn KE. et al A randomized, double-blind, placebo-controlled crossover study of the effects of levetiracetam on cognition, mood, and balance in healthy older adults. Epilepsia 2017; 58: 1566-1574 DOI: 10.1111/epi.13849.
- 23 Rudd GD, Haverkamp W, Mason JW. et al Lacosamide cardiac safety: clinical trials in patients with partial-onset seizures. Acta Neurol Scand 2015; 132: 355-363 DOI: 10.1111/ane.12414.
- 24 French JA, Perucca E, Sander JW. et al FDA safety warning on the cardiac effects of lamotrigine: An advisory from the Ad Hoc ILAE/AES Task Force. Epilepsia Open 2021; 06: 45-48 DOI: 10.1002/epi4.12475.
- 25 Zaccara G, Perucca P, Loiacono G. et al The adverse event profile of lacosamide: a systematic review and meta-analysis of randomized controlled trials. Epilepsia 2013; 54: 66-74 DOI: 10.1111/j.1528-1167.2012.03589.x.
- 26 Intravooth T, Staack AM, Juerges K. et al Antiepileptic drugs-induced hyponatremia: Review and analysis of 560 hospitalized patients. Epilepsy Res 2018; 143: 7-10 DOI: 10.1016/j.eplepsyres.2018.03.023.
- 27 Griepp DW, Kim DJ, Ganz M. et al The effects of antiepileptic drugs on bone health: A systematic review. Epilepsy Research 2021; 173: 106619 DOI: 10.1016/j.eplepsyres.2021.106619.
- 28 Ojemann LM, Ojemann GA, Dodrill CB. et al Language Disturbances as Side Effects of Topiramate and Zonisamide Therapy. Epilepsy Behav 2001; 02: 579-584 DOI: 10.1006/ebeh.2001.0285.
- 29 Masmoudi K, Gras-Champel V, Masson H. et al Parkinsonism and/or cognitive impairment with valproic acid therapy: a report of ten cases. Pharmacopsychiatry 2006; 39: 9-12 DOI: 10.1055/s-2006-931471.
- 30 Segura-Bruna N, Rodriguez-Campello A, Puente V. et al Valproate-induced hyperammonemic encephalopathy. Acta Neurol Scand 2006; 114: 1-7 DOI: 10.1111/j.1600-0404.2006.00655.x.
- 31 Stöllberger C, Finsterer J. Interactions between non-vitamin K oral anticoagulants and antiepileptic drugs. Epilepsy Research 2016; 126: 98-101 DOI: 10.1016/j.eplepsyres.2016.06.003.
- 32 Nasreddine W, Beydoun A. Valproate-induced thrombocytopenia: a prospective monotherapy study. Epilepsia 2008; 49: 438-445 DOI: 10.1111/j.1528-1167.2007.01429.x.
- 33 Sen A, Jette N, Husain M. et al Epilepsy in older people. Lancet 2020; 395: 735-748 DOI: 10.1016/s0140-6736(19)33064-8.
- 34 d’ Orio P, Pelliccia V, Gozzo F. et al Epilepsy surgery in patients older than 50 years: Effectiveness, safety, and predictors of outcome. Seizure 2017; 50: 60-66 DOI: 10.1016/j.seizure.2017.06.003.