Author/Editor		Zupan, Marko
Title		Epilepsija pri starostnikih
Translated title		Epilepsy in the elderly
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 39, št. Suppl 10
Publication year		2000
Volume		str. 57-62
Language		slo
Abstract		Older people often experience paroxysms of disturbed consciousness. Many of these paroxysms are epileptic attacks. Usually, they are focal. One can also see secondary or primary generalised attacks as well as epileptic status. Reasons for the attacks lie in higher incidence of cerebrovascular diseases, dementia, tumours, accidents (especially falls), alcocholism, abuse of certain drugs, metabolotoxic and cardiocirculatory disturbances and insufficiency of inner organs because of diseases and process of aging. For making a diagnosis you need a good heteroanamnesis, neurological and physical examination, laboratory analysis of blood and urine, electrocardiogram, ultrasound of heart and vessels, head up tilt test, computer axial tomography, magnetic resonance of the head and electroencephalography. Usually, therapy with antiepileptic drugs is successful. Higher incidence of depressia and dementia in the elderly demands control over taking drugs. Among older antiepileptics we prescribe carbamazepine, valproate, phenitoin and donazepam. Newer drugs in use are lamotrigine, topiramate and gabapentineewhich can be taken as a single drug or as adjunctive therapy. Adverse reactions in the elderly are common. We can overcome them by taking lower doses of drugs more times a day or by selecting less toxic substances. Epileptic status should be treated at onceby i. v. application of diazepam, thiopental, phenitoin, phosphenitoin or lorazepam. Repeated seizures are reason for continuance and further induction of epileptic acrivity in the brain. In the elderly this situation soon leads to heart and respiratory insufficiency.
Summary		Starostniki pogosto doživljajo paroksizme motenj zavesti, med katerimi je veliko epileptičnih napadov. Večina teh napadov je žariščnih. Pojavljajo pa se tudi sekundarno in primarno generalizirani napadi kot tudi epileptični statusi. Razlogi za napade so v večji incidenci cerebrovaskularnih bolezni, demence, tumorjev, poškodb (padci), alkoholizma, abuzusa zdravil, metaboličnotoksičnih in kardiocirkulatornih motenj ob popuščanju delovanja notranjih organov zaradi bolezni in procesov staranja Za diagnozo so potrebni dobra heteroanamneza z nevrološkim in somatskim pregledom, laboratorijska analiza krvi in seča, elektrokardiogram, ultrazvočne preiskave srca in ožilja, test z nagibno mizo, računalniška aksialna tomografija, magnetna rezonanca glave in elektroencefalografija. Zdravljenje z antiepileptiki je praviloma uspešno, vendar je pri nekaterih starostnikih zaradi depresije in demence potrebna kontrola uživanja zdravil. Od starejših antiepileptikov se pri starostnikih največ uporabljajo karbamazepin, valproat, fenitoin in klonazepam, od novejših pa lamotrigin, topiramat in gabapentin bodisi kot monoterapija ali kot drugi antiepileptik. Stranski učinki zdravil so pri starostnikih pogosti. Izognemo se jim z večkratnim dnevnim odmerjanjem nižjih doz zdravila in z izbiro manj toksičnih substanc. Epileptični status je potrebno ozdraviti takoj z i. v. aplikacijo diazepama, tiopentala, fenitoina, fosfenitoina ali lorazepama. Ponavljajoče se proženje napadov vzdržuje in dodatno inducixa epileptično aktivnost možganov. Pri ostarelem organizmu to hitro privede do popuščanja srca in poglobitve respiratorne insuficience.
Descriptors		EPILEPSY AGED EPILEPSY, PARTIAL STATUS EPILEPTICUS