Treatment of Seizures in Older Patients with Dementia
- PDF / 1,355,168 Bytes
- 12 Pages / 595.276 x 790.866 pts Page_size
- 49 Downloads / 173 Views
LEADING ARTICLE
Treatment of Seizures in Older Patients with Dementia Benjamin Cretin1,2,3 Accepted: 18 November 2020 © Springer Nature Switzerland AG 2020
Abstract The numbers of patients with dementia and patients with epilepsy are increasing in the global population. In fact, these two conditions are related, and it is estimated that at least 5–10% of seizures or epilepsy in older individuals (aged > 60 years) are caused by a neurodegenerative dementia. In the vast majority, one of the four following diseases is involved: Alzheimer’s disease, Lewy body dementia, frontotemporal dementia, or vascular dementia. These diseases cause, not only seizures or epilepsy in affected patients, but cognitive, behavioral, and motor disorders as well. As a result, the challenges of treating seizures in older patients with neurodegenerative disease go beyond the usual limitations associated with this age group (i.e., lower fluid compartment, lower protein binding, increased risk of drug–drug interactions) by imposing other issues and pitfalls. In this setting, the drug-related potential aggravation of neurodegenerative symptoms must be taken into account. As cognition is particularly vulnerable, the prescription of antiseizure medications in dementia must consider the potential neurocognitive impact and limit it as much as possible. Consequently, the choice of a treatment for seizures in this age group is even more demanding than in younger patients, and therefore more restricted. Based on current but limited evidence, it appears that second-generation antiseizure medications are more likely to be appropriate for the management of older patients with epilepsy with neurodegenerative disease given their more favorable pharmacokinetic profiles. Nevertheless, even newer antiseizure medications are not devoid of any risks, which can however be anticipated and corrected. Key Points In older individuals (age > 60 years), dementia accounts for at least 5–10% of de novo late-onset epilepsy, with Alzheimer’s disease being the cause of at least half of affected patients. The double condition “dementia plus epilepsy” implies a particular vulnerability to iatrogenesis when a drug treatment is decided. Nevertheless, the impact of antiseizure medications can be significantly lowered when appropriate guidelines are followed. * Benjamin Cretin benjamin.cretin@chru‑strasbourg.fr 1
Clinical Neuropsychology Unit, Neurology Department, CM2R (Memory Resource and Research Centre), University Hospital of Strasbourg, Strasbourg, France
2
CNRS, ICube Laboratory, UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg, Strasbourg, France
3
CMRR d’Alsace, Service de Neurologie des Hôpitaux, Universitaires de Strasbourg, Pôle Tête et Cou, 1 Avenue Molière, 67200 Strasbourg, France
1 Introduction Individuals aged 60 years and older are at particular risk of seizure and epilepsy for multiple reasons [1, 2]. Since the early 1990s, it has been estimated that almost one third of cases of d
Data Loading...
