Epilepsija pri starostnikih = Epilepsy in the elderly
Zupan, Marko, zdravnik
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 certaindrugs, 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. Amongolder antiepileptics we prescribe carbamazepine, valproate, phenitoin anddonazepam. 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.
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