老年人癫痫发作的临床特征分析

目的探讨老年人癫痫发作的临床表现、病因及其诊断与鉴别诊断。方法回顾性分析139例患者的临床资料,其中癫痫发作125例,非癫痫发作误诊为癫痫发作14例。结果主要病因为脑血管病(46.4%),其次为病因不详(29.6%)。125例癫痫发作患者中,部分性发作86例(68.8%),全面性发作39例(31.2%);53例行常规脑电图检查,12例(22.6%)出现非特异性异常,1例(1.9%)出现癫痫样电发放;43例行长程视频脑电图检查,38例(88.4%)出现癫痫样电发放。14例非癫痫发作均误诊为癫痫发作。结论脑血管病是老年患者癫痫发作最常见的病因,部分性发作为老年患者癫痫发作最常见的发作形式。Todd麻痹和非抽搐性癫痫持续状态为癫痫发作的特殊形式,极易误诊。代谢障碍性疾病、晕厥、短暂性全面性遗忘、短暂性脑缺血发作所致的非癫痫发作与癫痫发作的鉴别诊断较为困难。

Clinical features of epileptic seizure in the elderly

Objective To study the clinical features,etiology,diagnosis and differential diagnosis of epileptic seizure in the elderly.Methods Clinical data about 139 epilepsy patients(125 were diagnosed as epileptic seizure and 14 were misdiagnosed as epileptic seizure) were retrospectively analyzed.Results The main cause of epileptic seizure was cerebrovascular disease(46.4%) followed by unclear reasons(29.6%).Of the 125 epileptic seizure patients,86(68.8%) had partial epilepsy,39(31.2%) had general epilepsy.Of the 53 epilepsy patients who underwent routine EEG,12(22.6%) showed non-specific abnormality and 1(1.9%) presented with epilepsy-like discharge.Of the 43 epilepsy patients who underwent VEEG,38(88.4%) presented with epilepsy-like discharge and 1(11.6%) showed Todd's paralysis due to Jackson epilepsy which was misdiagnosed as transient ischemic attack(TIA).The 14 patients with non-epileptic seizure were misdiagnosed as epileptic seizure.Conclusion Cerebrovascular disease is the most common cause of epileptic seizure in the elderly.Partial seizure is the most common type of epileptic seizure in the elderly.Todd's paralysis and non-convulsive epilepsy are the specific forms of epileptic seizure which are easily misdiagnosed.It is difficult to make the differential diagnosis of non-epileptic seizure due to metabolic disturbance,syncope,transient general amenesia and TIA from epileptic seizure.