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Elderly Onset Epilepsy and Post-Stroke Epilepsy Takeharu KUNIEDA 1 1Department of Neurosurgery, Ehime University Graduate School of Medicine Keyword: 高齢発症てんかん , 非けいれん性てんかん重積 , NCSE , 脳卒中後てんかん , PSE , 予防投与 , 酵素誘導 , elderly onset epilepsy , non-convulsive status epilepticus , post-stroke epilepsy , prophylaxis , enzyme inducing pp.59-67
Published Date 2023/1/10
DOI https://doi.org/10.11477/mf.1436204715
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 It has been reported that the incidence of epilepsy in individuals over the age of 75 years is similar to or higher than one year, suggesting that epilepsy is an important clinical condition in older people. The aging rate in Japan, which reached 27.3% in 2017, makes this an issue of increasing concern. Diagnosis begins with the collection of medical history and knowledge of seizure semiology. In the elderly, most seizures are of extratemporal origin with various seizure semiologies. Difficulties in diagnosis lie in the influence of the autonomic nervous system and nonconvulsive status epilepticus(NCSE). It is necessary to suspect “epilepsy” for any sudden-onset episodes of atypical symptoms and unusual behaviors. NCSE can be diagnosed by recording EEG for more than 6 hours. The narrow therapeutic window and pharmacokinetics complicated by aging make treatment much more difficult with anti-seizure medication(ASM). Comorbidities and drug interactions should also be considered. Stroke is the most common etiology of geriatric epilepsy. Despite several clinical reports on the risk factors of post-stroke epilepsy(PSE)on the preventive administration of enzyme-inducing ASM, a treatment protocol has not yet been established. Prophylactic administration is not recommended; however, ASM is often administered in the acute phase. Therefore, some guidelines for non-enzyme-inducing ASM are required for efficient control of PSE.


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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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