June 28 is the 18th International Epilepsy Awareness Day, and the theme of this year's "Awareness Day" is "Pay Attention To The Comorbidities of Epilespy".
Epilepsy, cerebrovascular disease, and cognitive impairment are all common diseases in neurology, and the same person can have these diseases at the same time, which we call comorbidities.
1. What is geriatric epilepsy?
With the aging of the population, the physical and mental health of the elderly is closely related to the health of all mankind. In elderly patients, epilepsy and cerebrovascular disease, cognitive impairment, etc., can be mutually causal.
First of all, in the elderly, the most common cause of epilepsy is cerebrovascular disease, such as cerebral hemorrhage, cerebral infarction, subarachnoid hemorrhage, etc., which may lead to seizures. Therefore, actively controlling the risk factors of cerebrovascular disease and reducing the incidence of cerebrovascular disease can indirectly reduce the probability of epilepsy in the elderly.
Secondly, the elderly with epilepsy are also very susceptible to cerebrovascular disease, which may be because individual antiepileptic drugs can affect lipid metabolism and increase cysteine levels, leading to the formation of intravascular atherosclerotic plaques, thereby causing cardiovascular and cerebrovascular diseases.
2. What are the common causes of epilepsy in the elderly?
The International Anti-Epilepsy League has long proposed that the common causes of epilepsy can be divided into six categories: structural, hereditary, metabolic, infectious, immunological and etiological unclear. In terms of age of onset, there are two peaks, one is children, the other is the elderly, and the old and the young cannot be ignored, and from the large sample study, the prevalence of the elderly is higher than that of children.
3. Why is geriatric epilepsy prone to cognitive impairment?
In recent years, more and more doctors have also paid attention to the impact of epilepsy on cognitive function, the elderly are a high-risk group for Alzheimer's disease, and the index of epileptic discharge has a certain impact on the decline of intelligence to a certain extent, so elderly patients with epilepsy are more likely to have cognitive impairment.
The main manifestations of cognitive impairment in elderly patients with epilepsy are: decreased attention, memory loss, executive function and language function. The risk of cognitive impairment in the elderly increases year by year as they age, and many people think that it is very common for the elderly to gradually develop memory loss and unresponsiveness, and do not realize that it requires medical treatment.
When the cognitive impairment gradually worsens to a certain extent, such as getting lost, recognizing a family member or having a seizure, it is often at this time that they are sent to the hospital for treatment, and when the diagnosis of epilepsy is confirmed, it is likely that drug treatment is needed to intervene.
Older people with epilepsy are often easily overlooked when they develop cognitive impairment. It has been reported that the degree of comorbid cognitive impairment in epilepsy patients may be related to the frequency of seizures, the duration of the disease, and the individual side effects of antiepileptic drugs, because the elderly with cerebrovascular disease are also prone to cognitive impairment, so it is not easy to pay attention to epilepsy comorbid dementia after stroke, and later treatment is more difficult, and early diagnosis and early treatment are particularly important.
In addition to the above, geriatric epilepsy can actually cause a variety of comorbid diseases, including anxiety and depression, headache, osteoporosis, emphysema, asthma, obstructive sleep apnea-hypopnea syndrome, etc. Comorbidities in epilepsy significantly affect the quality of life of people with epilepsy and may also increase mortality in these patients. Therefore, we should pay close attention to elderly patients with epilepsy, and the evaluation of elderly patients should be more detailed and in-depth.
For elderly patients with epilepsy, we should pay more attention to the diagnosis and treatment of comorbidities, early screening, diagnosis and treatment of epilepsy comorbidities, so that we can better identify the causes, manage preventable risk factors, diagnose and treat diseases more comprehensively and accurately, provide comprehensive medical services more effectively, improve the quality of life of elderly friends, and let more elderly people have a happy old age!
Author: Jin Ling
Source: Shenyang Fifth People's Hospital
Editor: Wang Yumiao
Proofreading: Chai Yang, Chen Zeming
Preliminary review: Li Qiushuang
Review: Xu Jiang