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老年患者癫痫发作和癫痫的病因、临床表现和诊断

Author
Jane G Boggs, MD
Section Editors
Timothy A Pedley, MD
Kenneth E Schmader, MD
Deputy Editor
April F Eichler, MD, MPH
Translators
冯华, 主任医师，教授

引言

出于多种原因，专门针对老年患者的癫痫发作和癫痫的讨论非常重要。很大一部分(近25%)新发癫痫发作见于65岁以上个体[1,2]。在该年龄段人群中，癫痫发作和癫痫的病因和临床表现有所不同，并且会影响诊断方法。老年患者治疗方面的问题较为复杂。最后，对于已经容易丧失自理能力、驾驶受限制、自信心受损和跌倒风险升高的老年人，这些会导致身体受伤和其他后遗症，并使得健康相关生命质量低于无癫痫者，所以该人群中癫痫发作的诊断具有诸多重要意义[3,4]。

急性症状性癫痫发作是诱发性事件，在没有特殊诱因(如，低血糖、酒精戒断)的情况下预计不会复发。癫痫是一种在未进行治疗的情况下预计会出现反复无诱因性癫痫发作的疾病。本专题将讨论老年患者癫痫发作和癫痫的病因、临床表现和鉴别诊断。老年患者癫痫发作和癫痫的治疗将单独讨论。 (参见“老年患者抽搐和癫痫的治疗”)

流行病学

在65岁以上人群中，癫痫的发病率和患病率是最高的。在美国明尼苏达州罗契斯特市，报道的新发癫痫发病率为134例/100,000老年人[5,6]。其他人群中报道的发病率也相近[7-11]。一项研究估计，在65岁以上人群中，癫痫患病率约为9‰[12]。在60岁以上人群中，年龄每增加10岁，癫痫的年发病率也随之升高(图 1)。退伍军人事务部合作研究(Veterans Affairs Cooperative Study, VACS)#428是一项在老年癫痫患者中进行抗癫痫发作药物治疗的临床试验，其数据显示，老年患者的癫痫发作常被漏诊；因此，老年个体中癫痫的发病率可能是现有数据的2-3倍，并且是较年轻个体中发病率的6-7倍[1]。

对于65岁及以上的美国医疗照顾保险受益人，2001-2005年的平均年发病率在非裔美国人中最高(4.1‰)，其次是白种人(2.3‰)，而亚裔美国人和原住民最低(1.6‰和1.1‰)[11]。

急性症状性癫痫发作在老年人群中也较常见。60岁以上人群中的急性癫痫发作发病率估计为50-100/100,000，并且在30岁以上人群中，年龄每增加10岁，发病率也随之呈线性增长(图 2)[8,10,13]。

                            

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Literature review current through: 2017-06 . | This topic last updated: 2017-05-12.
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References
Top
  1. Ramsay RE, Rowan AJ, Pryor FM. Special considerations in treating the elderly patient with epilepsy. Neurology 2004; 62:S24.
  2. Sander JW, Hart YM, Johnson AL, Shorvon SD. National General Practice Study of Epilepsy: newly diagnosed epileptic seizures in a general population. Lancet 1990; 336:1267.
  3. Laccheo I, Ablah E, Heinrichs R, et al. Assessment of quality of life among the elderly with epilepsy. Epilepsy Behav 2008; 12:257.
  4. Lees A. Retrospective study of seizure-related injuries in older people: a 10-year observation. Epilepsy Behav 2010; 19:441.
  5. Hauser WA. Seizure disorders: the changes with age. Epilepsia 1992; 33 Suppl 4:S6.
  6. Hauser WA, Annegers JF, Kurland LT. Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935-1984. Epilepsia 1993; 34:453.
  7. Lühdorf K, Jensen LK, Plesner AM. Epilepsy in the elderly: incidence, social function, and disability. Epilepsia 1986; 27:135.
  8. Loiseau J, Loiseau P, Duché B, et al. A survey of epileptic disorders in southwest France: seizures in elderly patients. Ann Neurol 1990; 27:232.
  9. Sillanpää M, Lastunen S, Helenius H, Schmidt D. Regional differences and secular trends in the incidence of epilepsy in Finland: a nationwide 23-year registry study. Epilepsia 2011; 52:1857.
  10. Tchalla AE, Marin B, Mignard C, et al. Newly diagnosed epileptic seizures: focus on an elderly population on the French island of Réunion in the Southern Indian Ocean. Epilepsia 2011; 52:2203.
  11. Faught E, Richman J, Martin R, et al. Incidence and prevalence of epilepsy among older U.S. Medicare beneficiaries. Neurology 2012; 78:448.
  12. Cossu P, Deriu MG, Casetta I, et al. Epilepsy in Sardinia, insular Italy: a population-based prevalence study. Neuroepidemiology 2012; 39:19.
  13. Annegers JF, Hauser WA, Lee JR, Rocca WA. Incidence of acute symptomatic seizures in Rochester, Minnesota, 1935-1984. Epilepsia 1995; 36:327.
  14. Li X, Breteler MM, de Bruyne MC, et al. Vascular determinants of epilepsy: the Rotterdam Study. Epilepsia 1997; 38:1216.
  15. Stephen LJ, Brodie MJ. Epilepsy in elderly people. Lancet 2000; 355:1441.
  16. Giroud M, Gras P, Fayolle H, et al. Early seizures after acute stroke: a study of 1,640 cases. Epilepsia 1994; 35:959.
  17. Sung CY, Chu NS. Epileptic seizures in thrombotic stroke. J Neurol 1990; 237:166.
  18. Bladin CF, Alexandrov AV, Bellavance A, et al. Seizures after stroke: a prospective multicenter study. Arch Neurol 2000; 57:1617.
  19. Lancman ME, Golimstok A, Norscini J, Granillo R. Risk factors for developing seizures after a stroke. Epilepsia 1993; 34:141.
  20. Asconapé JJ, Penry JK. Poststroke seizures in the elderly. Clin Geriatr Med 1991; 7:483.
  21. Kilpatrick CJ, Davis SM, Tress BM, et al. Epileptic seizures in acute stroke. Arch Neurol 1990; 47:157.
  22. Loiseau P. Pathologic processes in the elderly and their association with seizures.. In: Seizures and epilepsy in the elderly, Rowan AJ, Ramsay RE (Eds), Butterworth-Heinemann, Boston 1997. p.63.
  23. Malouf R, Brust JC. Hypoglycemia: causes, neurological manifestations, and outcome. Ann Neurol 1985; 17:421.
  24. Messing RO, Closson RG, Simon RP. Drug-induced seizures: a 10-year experience. Neurology 1984; 34:1582.
  25. Franson KL, Hay DP, Neppe V, et al. Drug-induced seizures in the elderly. Causative agents and optimal management. Drugs Aging 1995; 7:38.
  26. Hauser WA, Ng SK, Brust JC. Alcohol, seizures, and epilepsy. Epilepsia 1988; 29 Suppl 2:S66.
  27. Bruns J Jr, Hauser WA. The epidemiology of traumatic brain injury: a review. Epilepsia 2003; 44 Suppl 10:2.
  28. Hauser WA. Epidemiology of seizures and epilepsy in the elderly, -Henemann, Boston 1997.
  29. Hart YM, Sander JW, Johnson AL, Shorvon SD. National General Practice Study of Epilepsy: recurrence after a first seizure. Lancet 1990; 336:1271.
  30. Roberts MA, Godfrey JW, Caird FI. Epileptic seizures in the elderly: I. Aetiology and type of seizure. Age Ageing 1982; 11:24.
  31. So EL, Annegers JF, Hauser WA, et al. Population-based study of seizure disorders after cerebral infarction. Neurology 1996; 46:350.
  32. Adelöw C, Andersson T, Ahlbom A, Tomson T. Prior hospitalization for stroke, diabetes, myocardial infarction, and subsequent risk of unprovoked seizures. Epilepsia 2011; 52:301.
  33. Ng SK, Hauser WA, Brust JC, Susser M. Hypertension and the risk of new-onset unprovoked seizures. Neurology 1993; 43:425.
  34. Shinton RA, Gill JS, Zezulka AV, Beevers DG. The frequency of epilepsy preceding stroke. Case-control study in 230 patients. Lancet 1987; 1:11.
  35. Cleary P, Shorvon S, Tallis R. Late-onset seizures as a predictor of subsequent stroke. Lancet 2004; 363:1184.
  36. Hauser WA, Morris ML, Heston LL, Anderson VE. Seizures and myoclonus in patients with Alzheimer's disease. Neurology 1986; 36:1226.
  37. McAreavey MJ, Ballinger BR, Fenton GW. Epileptic seizures in elderly patients with dementia. Epilepsia 1992; 33:657.
  38. Romanelli MF, Morris JC, Ashkin K, Coben LA. Advanced Alzheimer's disease is a risk factor for late-onset seizures. Arch Neurol 1990; 47:847.
  39. Scarmeas N, Honig LS, Choi H, et al. Seizures in Alzheimer disease: who, when, and how common? Arch Neurol 2009; 66:992.
  40. Imfeld P, Bodmer M, Schuerch M, et al. Seizures in patients with Alzheimer's disease or vascular dementia: a population-based nested case-control analysis. Epilepsia 2013; 54:700.
  41. Hesdorffer DC, Hauser WA, Annegers JF, et al. Dementia and adult-onset unprovoked seizures. Neurology 1996; 46:727.
  42. Amatniek JC, Hauser WA, DelCastillo-Castaneda C, et al. Incidence and predictors of seizures in patients with Alzheimer's disease. Epilepsia 2006; 47:867.
  43. Irizarry MC, Jin S, He F, et al. Incidence of new-onset seizures in mild to moderate Alzheimer disease. Arch Neurol 2012; 69:368.
  44. Vossel KA, Beagle AJ, Rabinovici GD, et al. Seizures and epileptiform activity in the early stages of Alzheimer disease. JAMA Neurol 2013; 70:1158.
  45. Cordonnier C, Hénon H, Derambure P, et al. Influence of pre-existing dementia on the risk of post-stroke epileptic seizures. J Neurol Neurosurg Psychiatry 2005; 76:1649.
  46. Rao SC, Dove G, Cascino GD, Petersen RC. Recurrent seizures in patients with dementia: frequency, seizure types, and treatment outcome. Epilepsy Behav 2009; 14:118.
  47. Smith DF, Hutton JL, Sandemann D, et al. The prognosis of primary intracerebral tumours presenting with epilepsy: the outcome of medical and surgical management. J Neurol Neurosurg Psychiatry 1991; 54:915.
  48. Hashimoto H, Iida J, Kawaguchi S, Sakaki T. Clinical features and management of brain arteriovenous malformations in elderly patients. Acta Neurochir (Wien) 2004; 146:1091.
  49. Hiyoshi T, Yagi K. Epilepsy in the elderly. Epilepsia 2000; 41 Suppl 9:31.
  50. Chihorek AM, Abou-Khalil B, Malow BA. Obstructive sleep apnea is associated with seizure occurrence in older adults with epilepsy. Neurology 2007; 69:1823.
  51. Loiseau J, Crespel A, Picot MC, et al. Idiopathic generalized epilepsy of late onset. Seizure 1998; 7:485.
  52. Ramsay RE, Pryor F. Epilepsy in the elderly. Neurology 2000; 55:S9.
  53. Tinuper P, Provini F, Marini C, et al. Partial epilepsy of long duration: changing semiology with age. Epilepsia 1996; 37:162.
  54. Kellinghaus C, Loddenkemper T, Dinner DS, et al. Seizure semiology in the elderly: a video analysis. Epilepsia 2004; 45:263.
  55. Theodore WH. The postictal state: effects of age and underlying brain dysfunction. Epilepsy Behav 2010; 19:118.
  56. Sheth RD, Drazkowski JF, Sirven JI, et al. Protracted ictal confusion in elderly patients. Arch Neurol 2006; 63:529.
  57. Spitz, MC, Bainbridge, JL, Ramsay, RE, et al. Observations on delay in diagnosis of seizures in the elderly. Epilepsia 2002; 43 Suppl 7:166 [abstract].
  58. Sung CY, Chu NS. Status epilepticus in the elderly: etiology, seizure type and outcome. Acta Neurol Scand 1989; 80:51.
  59. Waterhouse EJ, DeLorenzo RJ. Status epilepticus in older patients: epidemiology and treatment options. Drugs Aging 2001; 18:133.
  60. Canouï-Poitrine F, Bastuji-Garin S, Alonso E, et al. Risk and prognostic factors of status epilepticus in the elderly: a case-control study. Epilepsia 2011; 52:1849.
  61. Towne AR, Pellock JM, Ko D, DeLorenzo RJ. Determinants of mortality in status epilepticus. Epilepsia 1994; 35:27.
  62. Atefy R, Tettenborn B. Nonconvulsive status epilepticus on treatment with levetiracetam. Epilepsy Behav 2005; 6:613.
  63. Martin Y, Artaz MA, Bornand-Rousselot A. Nonconvulsive status epilepticus in the elderly. J Am Geriatr Soc 2004; 52:476.
  64. Fernández-Torre JL, Díaz-Castroverde AG. Non-convulsive status epilepticus in elderly individuals: report of four representative cases. Age Ageing 2004; 33:78.
  65. Towne AR, Waterhouse EJ, Boggs JG, et al. Prevalence of nonconvulsive status epilepticus in comatose patients. Neurology 2000; 54:340.
  66. Chung PW, Seo DW, Kwon JC, et al. Nonconvulsive status epilepticus presenting as a subacute progressive aphasia. Seizure 2002; 11:449.
  67. Thomas P, Giraud K, Alchaar H, Chatel M. Ictal asomatognosia with hemiparesis. Neurology 1998; 51:280.
  68. Olnes MJ, Golding A, Kaplan PW. Nonconvulsive status epilepticus resulting from benzodiazepine withdrawal. Ann Intern Med 2003; 139:956.
  69. Litt B, Wityk RJ, Hertz SH, et al. Nonconvulsive status epilepticus in the critically ill elderly. Epilepsia 1998; 39:1194.
  70. Martínez-Rodríguez JE, Barriga FJ, Santamaria J, et al. Nonconvulsive status epilepticus associated with cephalosporins in patients with renal failure. Am J Med 2001; 111:115.
  71. Bottaro FJ, Martinez OA, Pardal MM, et al. Nonconvulsive status epilepticus in the elderly: a case-control study. Epilepsia 2007; 48:966.
  72. Shneker BF, Fountain NB. Assessment of acute morbidity and mortality in nonconvulsive status epilepticus. Neurology 2003; 61:1066.
  73. Walker MC. Status epilepticus on the intensive care unit. J Neurol 2003; 250:401.
  74. Ali S, Khan MA, Khealani B. Limb-shaking Transient Ischemic Attacks: case report and review of literature. BMC Neurol 2006; 6:5.
  75. Persoon S, Kappelle LJ, Klijn CJ. Limb-shaking transient ischaemic attacks in patients with internal carotid artery occlusion: a case-control study. Brain 2010; 133:915.
  76. Butler CR, Graham KS, Hodges JR, et al. The syndrome of transient epileptic amnesia. Ann Neurol 2007; 61:587.
  77. Tinuper P, Cerullo A, Marini C, et al. Epileptic drop attacks in partial epilepsy: clinical features, evolution, and prognosis. J Neurol Neurosurg Psychiatry 1998; 64:231.
  78. Rozen T, Gordon CD. Vertebral artery dissection in a migraine patient with recurrent drop attacks. Headache 2007; 47:605.
  79. Welsh LW, Welsh JJ, Lewin B, Dragonette JE. Vascular analysis of individuals with drop attacks. Ann Otol Rhinol Laryngol 2004; 113:245.
  80. Dallan I, Bruschini L, Nacci A, et al. Drop attacks and vertical vertigo after transtympanic gentamicin: diagnosis and management. Acta Otorhinolaryngol Ital 2005; 25:370.
  81. Brantberg K, Ishiyama A, Baloh RW. Drop attacks secondary to superior canal dehiscence syndrome. Neurology 2005; 64:2126.
  82. Lee H, Yi HA, Lee SR, et al. Drop attacks in elderly patients secondary to otologic causes with Meniere's syndrome or non-Meniere peripheral vestibulopathy. J Neurol Sci 2005; 232:71.
  83. Kellinghaus C, Loddenkemper T, Dinner DS, et al. Non-epileptic seizures of the elderly. J Neurol 2004; 251:704.
  84. Duncan R, Oto M, Martin E, Pelosi A. Late onset psychogenic nonepileptic attacks. Neurology 2006; 66:1644.
  85. Behrouz R, Heriaud L, Benbadis SR. Late-onset psychogenic nonepileptic seizures. Epilepsy Behav 2006; 8:649.
  86. Veran O, Kahane P, Thomas P, et al. De novo epileptic confusion in the elderly: a 1-year prospective study. Epilepsia 2010; 51:1030.
  87. Drury I, Beydoun A. Seizures and epilepsy in the elderly revisited. Arch Intern Med 1998; 158:99.
  88. McBride AE, Shih TT, Hirsch LJ. Video-EEG monitoring in the elderly: a review of 94 patients. Epilepsia 2002; 43:165.
  89. Normand MM, Wszolek ZK, Klass DW. Temporal intermittent rhythmic delta activity in electroencephalograms. J Clin Neurophysiol 1995; 12:280.
  90. Ramsay, RE, Rowan, AJ, Pryor, FM, et, al. Seizures in the older patient: demographics. Diagnosis and treatment. Epilepsia 2000; 41:172.
  91. Drury I, Beydoun A. Interictal epileptiform activity in elderly patients with epilepsy. Electroencephalogr Clin Neurophysiol 1998; 106:369.
  92. Drury I, Selwa LM, Schuh LA, et al. Value of inpatient diagnostic CCTV-EEG monitoring in the elderly. Epilepsia 1999; 40:1100.
  93. Lancman ME, O'Donovan C, Dinner D, et al. Usefulness of prolonged video-EEG monitoring in the elderly. J Neurol Sci 1996; 142:54.