高齢者のてんかん—臨床と最近の知見

Epilepsy in the Elderly Population: Clinical Practice and Recent Updates

超高齢社会へ突入した本邦において，適切な高齢者医療・福祉の提供は喫緊の課題である。本論では，高齢者てんかんの臨床と最近の知見を概説する。高齢者てんかんでは，軽微な発作症状や脳波所見に注意が必要で，鑑別も多岐にわたる。治療は薬物療法が中心で，比較的発作抑制が得られやすい。原因は認知症や脳血管障害などが挙げられるが，明らかな原因が不明な例も多い。運転免許やスティグマなどの心理社会的問題も重要課題である。

Abstract

Optimal medical care and welfare is an urgent issue among the elderly population in a rapidly aging society. Epilepsy is a common chronic neurological disorder that affects all ages with peaks observed in children and in elderly individuals. Considering rapid population aging, the prevalence of epilepsy in the elderly population is expected to increase in the future. Clinicians should be aware of the clinical features of epilepsy in elderly patients because these differ from those observed in young patients from several perspectives. In this article, we review the clinical practice and recent updates in epilepsy in the elderly population. Epilepsy in elderly patients requires careful attention to subtle seizure symptoms and electroencephalography findings, and this disorder is associated with a wide range of differential diagnosis. Treatment is primarily pharmacological, and seizures may often be well controlled. Etiologies include dementia and cerebrovascular disease; however, a few patients may present with epilepsy secondary to an unknown cause. Psychosocial issues such as driver's license and stigma are also important.