Epilepsy in a rural elderly population.

PURPOSE: The first goal of this study was to describe the characteristics of elderly patients with epilepsy and the antiepileptic drugs used to treat them. Next, the factors (such as epilepsy type, seizure frequency, medical comorbidities, etc.) influencing antiepileptic drug choice and living situation were explored. METHODS: Retrospective chart review of patients older than 70 with epilepsy seen in a rural health care system. This yielded 449 patients with epilepsy, 54 patients with isolated seizures and 38 patients with syncope as the primary diagnosis. RESULTS: The most commonly used antiepileptic drug was phenytoin. New generation AED's which had fewer side effects were used much less frequently than old generation AED's but the probability of using new generation AED's was increased in patients with renal failure and congestive heart failure as well as in patients that had seen a neurologist. Patients with acute symptomatic seizures, dementia, chronic obstructive pulmonary disease, frequent seizures and advanced age were less likely to be independent. Patients that had seen a neurologist as an outpatient were more likely to live independently. CONCLUSIONS: The elderly are a vulnerable population because of difficulty communicating their symptoms and their needs. This leads to the suboptimal use of AED's as well as poor outcomes. Careful attention to seizure control and medication side effects is critical in promoting good outcomes in this patient group. This retrospective study suggests that access of elderly patients with epilepsy to specialty care improves outcomes in terms of living status. This important information needs to be confirmed by prospective studies.     

中老年人血脂水平与偏头痛的相关性分析

目的 探讨血脂水平与中老年人偏头痛的相关性,分析其对偏头痛的诊断的临床意义.方法 选取41例偏头痛患者为实验组,46例健康体检者为对照组.采用标准酶促法测定实验组和对照组的血清中的TC、TG、LDL-C的水平,并进行统计分析.结果 偏头痛组TC、LDL-C水平与对照组相比无统计学差异,偏头痛组TG水平与对照组相比差异有...     

Epilepsy and antiepileptic drug use in elderly people as risk factors for dementia

OBJECTIVE: To assess the role of epilepsy and antiepileptic drugs (AEDs) as risk factors for probable Alzheimer's disease (AD) and for all dementias in the Canadian Study of Health and Aging (CSHA). A secondary objective was to isolate the effect of the AED phenytoin on the development of dementia and AD. METHODS: The cohort consists of 5376 participants aged 65 years or older with no evidence of dementia, defined as Modified Mini-Mental State (3MS) score > or =78. Primary exposure was self-report or clinical diagnosis of epilepsy at baseline (n=39), or self-report of AED therapy (n=67). Primary outcomes were development of dementia, defined as 3MS<78, or AD, determined by clinical examination using standard criteria, during a 5-year follow-up period. People whose 3MS score remained > or =78 served as the comparison group. RESULTS: People reporting AED use at baseline had an age, sex and baseline 3MS adjusted odds ratio (OR) of 2.11 (95% CI 1.11 to 4.01) for developing dementia compared to those not taking AEDs at baseline. The association remained significant using only phenytoin as the exposure. No significant association was found between AED use and development of AD, nor between epilepsy and development of either AD or dementia. CONCLUSIONS: Older adults taking AEDs are at a significantly higher relative risk of developing dementia than those not taking AEDs. Further investigation of this finding is warranted.     

Serum brain-derived neurotrophic factor: Determinants and relationship with depressive symptoms in a community population of middle-aged and elderly people

Abstract

Objectives. Brain-derived neurotrophic factor (BDNF) is involved in major depressive disorder and neurodegenerative diseases. Clinical studies, showing decreased serum BDNF levels, are difficult to interpret due to limited knowledge of potential confounders and mixed results for age and sex effects. We explored potential determinants of serum BDNF levels in a community sample of 1230 subjects. Methods. Multiple linear regression analyses with serum BDNF level as the dependent variable were conducted to explore the effect of four categories of potential BDNF determinants (sampling characteristics, sociodemographic variables, lifestyle factors and somatic diseases) and of self-reported depressive symptoms (Beck's Depression Inventory (BDI). Results. Our results show that BDNF levels decline with age in women, whereas in men levels remain stable. Moreover, after controlling for age and gender, the assays still showed lower serum BDNF levels with higher BDI sum scores. Effects remained significant after correction for two main confounders (time of sampling and smoking), suggesting that they serve as molecular trait factors independent of lifestyle factors. Conclusions. Given the age–sex interaction on serum BDNF levels and the known association between BDNF and gonadal hormones, research is warranted to delineate the effects of the latter interaction on the risk of psychiatric and neurodegenerative diseases.     

Epilepsy in the elderly: prognosis

251 patients were admitted with seizures after the age of 60 years to the county hospital of Frederiksberg during the period 1979-1983, 163 had not received anti-epileptic treatment prior to admission, of these 151 had been admitted with their first seizure, 88 had established epilepsy at the time of admission. Of patients not previously treated and observed for at least 12 months, 62% remained seizure-free throughout the study, while 47% with established epilepsy were seizure-free. Of those not previously treated, 72% entered remission within the first year with a slight increase during the subsequent years. The first year was crucial in determining the long-term prognosis. Compared to previous studies on the prognosis of epilepsy it seems that prognosis in the elderly is as good or even better. Measurement of S-drug-levels at the time of seizure recurrence suggests that suboptimal treatment and poor compliance are important factors, thus indicating the need for regular control and monitoring of S-drug-levels. The presence of paroxysmal activity in the EEG was significantly correlated to seizure recurrence. Thirty-three patients entered nursing homes during the study period. Deterioration in residence status was correlated to degree of dementia and to the presence of focal neurological signs but not to age or to the severity of epilepsy.     

Epilepsy: comorbidity in the elderly

Elderly people experience the highest incidence of epilepsy and their clinical mananagement is often challenging, due to a potential increase in the likelihood of adverse treatment events. In addition, concomitant diseases are highly prevalent in this population and elderly patients are likely to be prescribed a number of medications that must be taken concurrently. As a result, the incidence of adverse drug–drug interactions and adverse drug reactions is also extremely high. Thus, the treatment of elderly patients with epilepsy requires careful consideration of any comorbid conditions and concomitant medications. Most adverse events are drug-related and are therefore preventable. It is important to consider these complications when prescribing antiepileptic drug (AED) treatment. An AED with broad-spectrum efficacy, good tolerability and a favourable drug interaction profile (e.g. valproate, gabapentin and lamotrigine) may prevent many unwanted drug interactions and side effects.     

Epilepsy in the elderly: facts and challenges

The incidence of epilepsy in the elderly has increased steadily over the last few decades. In some industrialized countries, one-third of the population is expected to be over the age of 65 in 2030. Therefore, we will face a dramatic increase in the number of elderly patients with epilepsy, many of whom will likely present comorbidities. This increase will put a heavy burden on health care and pension systems. This article focuses on epidemiology, diagnosis and treatment in epilepsies in the elderlies and outlines current research as well as future requirements for research. The diagnosis of epilepsy in the elderly can be difficult and may require long-term video-EEG monitoring. Stroke is the most frequent etiology in epilepsies in the elderlies. Status epilepticus in acute symptomatic epilepsies often results in fatality and may become an increasing health problem. The article also describes the current strategies in antiepileptic drug treatment and epilepsy surgery in the elderly. Novel antiepileptic drugs are necessary as current antiepileptics have strong interaction potentials and harmful side effects, making them ill-suboptimal for treating epilepsy in the elderly.     

The impact of restless legs syndrome on physical functioning in a community-dwelling population of middle-aged and elderly people

ObjectiveTo investigate whether restless legs syndrome (RLS) is associated with impaired physical functioning using subjective and objective assessments.MethodsFrom 2006–2013, 5,960 participants (mean age 67.2; 57.5% females) of the prospective population-based Rotterdam Study, aged 45 years and over, were cross-sectionally investigated for presence of restless legs syndrome using a questionnaire. Physical functioning was assessed subjectively with the Stanford Health Assessment Questionnaire (basic activities of daily living) and the Instrumental Activities of Daily living scale (instrumental activities of daily living). Additionally, physical functioning was assessed objectively by quantifying fine motor performance with the Purdue Pegboard Test and by quantifying gait with an electronic walkway.ResultsRestless legs syndrome was present in 13.7% of the participants. Persons with restless legs had more impairment in basic (difference in score 0.65, 95% CI 0.41;0.90) and instrumental activities of daily living (difference in score 0.28, 95% CI 0.09;0.48) than persons without restless legs. This association was strongest when symptoms were present two or more times a week (basic activities of daily living score difference 1.69, 95% CI 1.28;2.09). The association between restless legs syndrome and activities of daily living attenuated after adjusting for sleep quality or depressive symptoms. There was no association with the Purdue Pegboard Test score nor with gait.ConclusionsIndividuals with restless legs syndrome experienced significantly more impairment in activities of daily function than persons without restless legs. This seemed to be (partly) mediated by poor sleep quality and depressive symptoms. No association was found with objectively assessed physical functioning.     

Epilepsy in the elderly

There are many unique characteristics in elderly patients with epilepsy. The incidence of seizure in this age group is the highest of any age group and continues to increase as people live longer. Etiology of seizures is different than for adults and includes cerebrovascular disease, dementia, closed head injury, and metabolic encephalopathies. The elderly patient with epilepsy most often presents with complex partial seizures that have a higher recurrence rate than the younger population. The seizures are often difficult to diagnose since they present with atypical symptoms, particularly prolonged postictal symptoms, including memory lapses, confusion, altered mental status, and inattention. There are also therapeutic challenges due to age-related changes in pharmacokinetics, including variations in absorption, distribution, metabolism, and excretion. These must be considered when selecting antiepileptic drug (AED) therapy to avoid harmful side effects. In addition, several of the AEDs have drug-drug interactions, a problem potentially exacerbated in this population of patients due to the use of medications for comorbid conditions.     

Epilepsy in the elderly

Epilepsy is the most common serious neurological disorder in the elderly after stroke and dementia. It may be more important for elderly people because it is intermittent and unpredictable. There is no reliable diagnostic test and so its diagnosis and management requires clinical acumen and experience. The situation is further complicated because the elderly may have many comorbidities and therefore may have many other reasons for losing consciousness. Despite their growing number, there is remarkably little research to underpin the best epilepsy management in the elderly. This article summarizes the scope of epilepsy in elderly people, highlights cerebrovascular and neurodegenerative diseases as the main underlying etiologies, explores the diagnostic challenges in this age group, including the hurdles and processes in their investigation, and examines pertinent clinical management issues.     

Epilepsy in the elderly

The elderly population (Z age 65) continues to grow; this increase extends even to the oldest of the old (Z age 85). This aging population is accompanied by an increase in the cases of epilepsy, which can be especially difficult to diagnose and treat. Age-related difficulties in optimum treatment arise from increased drug sensitivity, altered drug metabolism, comorbid conditions, concomitant multiple medications, inability to self-report symptoms, and drug cost. Although the older antiepileptic drugs (AEDs) are still appropriate treatment for some of the elderly, the newer AEDs should be considered because of their different efficacy and safety profiles.     

Epilepsy in the elderly

The active prevalence rate of epilepsy among persons over 65 years of age is approximately 1.5%, about twice the rate in younger adults. Treatment of epilepsy in the elderly is complicated by alterations in drug metabolism, use of concomitant medications, and multiple medical problems. Drug interactions are a major issue, and a full knowledge of the isoenzyme profile and protein-binding characteristics of each drug (antiepileptic and other) must be known.     

Epilepsy in the elderly

The elderly are the most rapidly growing segment of our population, and onset of epilepsy is higher in this age group than in any other. With advancing age, there are changes in drug absorption, disposition, and binding. In addition, within the elderly are subgroups: (1) elderly healthy except for epilepsy (EH) and (2) elderly with multiple medical problems (EMMP). This review examines the factors that need to be considered when selecting the appropriate antiepileptic drug (AED) for an elderly person with epilepsy. Both the older and newer AEDs are reviewed.     

Neuropsychiatric systemic lupus erythematosus in elderly people: a case series.

Five elderly patients presenting with neuropsychiatric systemic lupus erythematosus were referred to the sectorised psychiatry service of the department of health care of the elderly. They represented 2% of patients admitted over a period of two years. Two patients presented with a subacute confusional state, two with dementia, and one with depression. Three patients responded well to treatment. This suggests that systemic lupus erythematosus (SLE) is more common in elderly people than was originally thought and is a potentially treatable cause of organic brain disorder. The absence of reports of elderly patients with SLE is likely to be due to the continued application of the American Rheumatism Association's revised 1982 classification criteria, which are inappropriate for this population.     

Risk factors for depression in elderly people: a prospective study.

In 1982-1983 a random sample of 1486 people aged 65 years and above was generated from general practitioner lists; 1070 were interviewed in the community using the Geriatric Mental State and a Social History questionnaire. The cohort was followed up by interview 3 years later. At year 3 the diagnostic computer program AGECAT diagnosed 44 incident cases of depression. Information from the depressed group's initial and further interviews was compared with a control group (which excluded cases of affective or organic mental illness). Univariate analysis yielded three factors that were significantly associated with the development of depression 3 years later: a lack of satisfaction with life; feelings of loneliness; and smoking. Multivariate analysis confirmed their independent effects and revealed 2 further factors attaining significance: female gender and a trigger factor, bereavement of a close figure within 6 months of the third-year diagnosis. Some other factors traditionally associated with depression, such as poor housing, marital status and living alone, failed to attain significance as risk factors.     

Epilepsy and EEG in the elderly

Seizures are now the third most frequently encountered neurologic problem in the elderly population. The incidence of recurrent unprovoked seizures peaks in older patients. Because of this age-related increase and the growing elderly population, evaluation and treatment of the elderly patient has received increasing attention. This article focuses on epilepsy, not acute seizures in the elderly. The causes and types of epilepsy older individuals experience are reviewed, along with the diagnostic role of EEG. Treatment options are briefly addressed.     

Epilepsy and dementia in the elderly

Epilepsy is a frequent condition in the elderly; however, it remains a relatively understudied condition in older adults with dementia. The diagnosis of a seizure is particularly difficult and is most often based on questions to the caregiver. Epilepsy in dementia has significant consequences on the prognosis of the underlying dementia: it can result in a worsening of cognitive performance, particularly in language, as well as a reduction in autonomy, a greater risk of injury and a higher mortality rate. In this review, management strategies are recommended for the clinician. The presence of pre-existing Alzheimer's disease does not exempt the clinician from ruling out other symptomatic causes of seizures. Anti-epileptic drugs (AED) should be started only after the diagnosis has been clearly established, when the risk of recurrence is high, and with monotherapy whenever possible. Although few data are available, the more recent AED offer significant advantages over the older medications in this context.