Tratamiento farmacológico de la epilepsia en el adulto mayor, revisión de la literatura.

Autores/as

DOI:

https://doi.org/10.20453/rnp.v85i1.4155

Palabras clave:

Adulto mayor, epilepsia, fármacos anticrisis antiepiléptica, tratamiento

Resumen

Los adultos mayores tienen mayor riesgo de desarrollar epilepsia. Con un aumento progresivo de la expectativa de vida, este grupo muestra el más rápido incremento entre los pacientes con epilepsia. El tratamiento en sí se complica debido a los cambios fisiológicos relacionados con el envejecimiento, las comorbilidades, los problemas cognitivos concomitantes, las interacciones farmacológicas complejas y las dificultades en la adherencia a regímenes medicamentosos. Las crisis epilépticas se pueden controlar en la mayoría de los pacientes adultos mayores con dosis bajas de un solo fármaco anticrisis epiléptica de efecto específico. La tolerabilidad es un factor importante en la selección del fármaco, ya que los pacientes adultos mayores tienden a ser muy sensibles a los efectos secundarios. Los fármacos anticrisis epiléptica que operan como inductores enzimáticos debe valorarse su retiro del arsenal terapéutico en favor de nuevos agentes que han demostrado similar eficacia y mejor tolerabilidad. Lamotrigina y levetiracetam son los fármacos anticrisis epiléptica más recomendados actualmente para el manejo de este cuadro en los adultos mayores. Aun cuando puede tratarse de una epilepsia fácilmente controlable, es recomendable mantener el tratamiento de forma indefinida en los adultos mayores dada la tendencia recurrente de las crisis. Se requieren más estudios que aborden los mecanismos fisiopatológicos de la epilepsia en este grupo etario y una mayor inclusión de los adultos mayores en ensayos clínicos, así como el desarrollo de modelos de atención integral que optimice el cuidado de estos pacientes.

Citas

Seo JG, Cho YW, Kim KT, Kim DW, Yang KI, Lee ST, et al. Pharmacological Treatment of Epilepsy in Elderly Patients. J Clin Neurol. 2020;16(4):556-61. DOI: 10.3988/jcn.2020.16.4.556

Liu S, Yu W, Lü Y. The causes of new-onset epilepsy and seizures in the elderly. Neuropsychiatr Dis Treat. 2016;12:1425-34. DOI: 10.2147/NDT.S107905

Beghi E, Giussani G. Aging and the Epidemiology of Epilepsy. Neuroepidemiology. 2018;51:216-23. DOI: 10.1159/000493484

Acharya JN, Acharya VJ. Epilepsy in the elderly: Special considerations and challenges. Ann Indian Acad Neurol. 2014;17(5):S18-26. DOI: 10.4103/0972-2327.128645

DeLorenzo RJ, Hauser WA, Towne AR, Boggs JG, Pellock JM, Penberthy L, et al. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology. 1996;46(4):1029-35. DOI: 10.1212/wnl.46.4.1029

Ramsay RE, Rowan AJ, Pryor FM. Special considerations in treating the elderly patient with epilepsy. Neurology. 2004;9(2):S24-9. DOI: 10.1212/wnl.62.5_suppl_2.s24

Díaz K, Díaz A. Epilepsia en los ancianos una revisión. Revista Mexicana de Neurociencia. 2009;10(4):287-93.

Assis TM, Bacellar A, Costa G, Nascimento OJ. Mortality predictors of epilepsy and epileptic seizures among hospitalized elderly. Arq Neuropsiquiatr. 2015;73(6):510-15. DOI: 10.1590/0004-282X20150043

Bleck TP. Seven questions about stroke and epilepsy. Epilepsy Curr. 2012;12(6):225-28. DOI: 10.5698/1535-7511-12.6.225

Rowan AJ, Ramsay RE, Collins JF, Pryor F, Boardman KD, Uthman BM, et al. New onset geriatric epilepsy. A randomized study of gabapentin, lamotrigine, and carbamazepine. Neurology. 2005; 64(11): 1868-73. DOI: 10.1212/01.WNL.0000167384.68207.3E

Verellen RM, Cavazos JE. Pathophysiological considerations of seizures, epilepsy, and status epilepticus in the elderly. Aging Dis. 2011;2(4):278-85.

So EL, Annegers JF, Hauser WA, O'Brien PC, Whisnant JP. Population-based study of seizure disorders after cerebral infarction. Neurology. 1996;46(2):350-5. DOI: 10.1212/wnl.46.2.350

Menon B, Shorvon SD. Ischaemic stroke in adults and epilepsy. Epilepsy Res. 2009;87(1):1-21. DOI: 10.1016/j.eplepsyres.2009.08.007

Mendez M, Lim G. Seizures in elderly patients with dementia: epidemiology and management. Drugs Aging. 2003;20(11):791-803. DOI: 10.2165/00002512-200320110-00001

Martin RC, Faught E, Richman J, Funkhouser E, Kim Y, Clements K, et al. Psychiatric and neurologic risk factors for incident cases of new-onset epilepsy in older adults: data from U.S. Medicare beneficiaries. Epilepsia. 2014;55(7):1120-27. DOI: 10.1111/epi.12649

Hauser WA, Annegers JF, Rocca WA. Descriptive epidemiology of epilepsy: contributions of population-based studies from Rochester, Minnesota. Mayo Clin Proc. 1996;71(6):576-86. DOI: 10.4065/71.6.576

Förstl H, Burns A, Levy R, Cairns N, Luthert P, Lantos P. Neurologic signs in Alzheimer's disease. Results of a prospective clinical and neuropathologic study. Arch Neurol. 1992;49(10):1038-42. DOI: 10.1001/archneur.1992.00530340054018

Rao SC, Dove G, Cascino GD, Petersen RC. Recurrent seizures in patients with dementia: frequency, seizure types, and treatment outcome. Epilepsy Behav. 2009;14(1):118-20. DOI: 10.1016/j.yebeh.2008.08.012

Pandis D, Scarmeas N. Seizures in Alzheimer disease: clinical and epidemiological data. Epilepsy Curr. 2012;12(5):184-7. DOI: 10.5698/1535-7511-12.5.184

Roberson ED, Hope OA, Martin RC, Schmidt D. Geriatric epilepsy: research and clinical directions for the future. Epilepsy Behav. 2011;22(1):103-11. DOI: 10.1016/j.yebeh.2011.04.005

Méndez MF, Catanzaro P, Doss RC, Arguello R, Frey WH 2nd. Seizures in Alzheimer's disease: clinicopathologic study. J Geriatr Psychiatry Neurol. 1994;7(4):230-3. DOI: 10.1177/089198879400700407

Irizarry MC, Jin S, He F, Emond JA, Raman R, Thomas RG, et al. Incidence of new-onset seizures in mild to moderate Alzheimer disease. Arch Neurol. 2012;69(3):368-72. DOI: 10.1001/archneurol.2011.830

Ostrom QT, Cioffi G, Gittleman H, Patil N, Waite K, Kruchko C, et al. CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2012-2016. Neuro Oncol. 2019;1(5):1-100. DOI: 10.1093/neuonc/noz150

Kargiotis O, Markoula S, Kyritsis AP. Epilepsy in the cancer patient. Cancer Chemother Pharmacol. 2011;67(3):489-501. DOI: 10.1007/s00280-011-1569-0

Pitkanen A, Bolkvadze T. Head trauma and epilepsy. En: Noebels JL, Avoli M, Rogawski MA, Olsen RW, Delgado-Escueta AV, editors. Jasper’s Basic Mechanisms of the Epilepsies. 4th ed. Bethesda (MD): National Center for Biotechnology Information (US); 2012.

Spitz MC, Bainbridge JL, Winzenburg KV, Ramsay RE, Pryor FM, Uthman BM, et al. DVA CSP 428 Study Group. Observations on the delay in diagnosis of seizures in the elderly: Update 3. Epilepsia. 2003;44(9):18.

Cloyd J, Hauser W, Towne A, Ramsay R, Mattson R, Gilliam F, et al. Epidemiological and medical aspects of epilepsy in the elderly. Epilepsy Res. 2006;68(1):S39-48. DOI: 10.1016/j.eplepsyres.2005.07.016

Brodie MJ, Kwan P. Epilepsy in elderly people. BMJ. 2005;331(7528):1317-22. DOI: 10.1136/bmj.331.7528.1317

Hiyoshi T, Yagi K. Epilepsy in the elderly. Epilepsia. 2000;41(9):31-5. DOI: 10.1111/j.1528-1157.2000.tb02217.x

Kaur U, Chauhan I, Gambhir IS, Chakrabarti SS. Antiepileptic drug therapy in the elderly: a clinical pharmacological review. Acta Neurol Belg. 2019;119(2):163-73. DOI: 10.1007/s13760-019-01132-4

Mohanraj R, Brodie MJ. Diagnosing refractory epilepsy: response to sequential treatment schedules. Eur J Neurol. 2006;13(3):277-82. DOI: 10.1111/j.1468-1331.2006.01215.x

Mattson RH, Cramer JA, Collins JF, Smith DB, Delgado AV, Browne TR, et al. Comparison of carbamazepine, phenobarbital, phenytoin, and primidone in partial and secondarily generalized tonic-clonic seizures. N Engl J Med. 1985;313(3):145-51. DOI: 10.1056/NEJM198507183130303

Poza JJ. Management of epilepsy in the elderly. Neuropsychiatr Dis Treat. 2007;3(6):723-28. DOI: 10.2147/ndt.s1026

Bergey GK. Initial treatment of epilepsy: special issues in treating the elderly. Neurology. 2004; 63(10):S40-8. DOI: 10.1212/wnl.63.10_suppl_4.s40

Giorgi L, Gomez G, O'Neill F, Hammer AE, Risner M. The tolerability of lamotrigine in elderly patients with epilepsy. Drugs Aging. 2001;18(8):621-30. DOI: 10.2165/00002512-200118080-00006

Werhahn KJ. Epilepsy in the elderly. Dtsch Arztebl Int. 2009;106(9):135-42. DOI: 10.3238/arztebl.2009.0135

Italiano D, Perucca E. Clinical pharmacokinetics of new-generation antiepileptic drugs at the extremes of age: an update. Clin Pharmacokinet. 2013;52(8):627-45. DOI: 10.1007/s40262-013-0067-4

Lee SK. Epilepsy in the Elderly: Treatment and Consideration of Comorbid Diseases. J Epilepsy Res. 2019;9(1):27-35. DOI: 10.14581/jer.19003

Perucca E. Clinically relevant drug interactions with antiepileptic drugs. Br J Clin Pharmacol. 2006;61(3):246-55. DOI: 10.1111/j.1365-2125.2005.02529.x

Leppik IE, Birnbaum AK. Epilepsy in the elderly. Ann NY Acad Sci. 2010;1184:208-24. DOI: 10.1111/j.1749-6632.2009.05113.x

Ensrud KE, Walczak TS, Blackwell TL, Ensrud ER, Barrett-Connor E, Orwoll ES; Osteoporotic Fractures in Men (MrOS) Study Research Group. Antiepileptic drug use and rates of hip bone loss in older men: a prospective study. Neurology. 2008;71(10):723-30. DOI: 10.1212/01.wnl.0000324919.86696.a9

Arroyo S, Anhut H, Kugler AR, Lee CM, Knapp LE, Garofalo EA, et al. Pregabalin 1008-011 International Study Group. Pregabalin add-on treatment: a randomized, double-blind, placebo-controlled, dose-response study in adults with partial seizures. Epilepsia. 2004;45(1):20-7. https://doi.org/10.1111/j.0013-9580.2004.31203.x

Katsiki N, D Mikhailidis, Nair D. The effects of antiepileptic drugs on vascular risk factors: A narrative review. Seizure. 2014;23(9):677-84. https://doi.org/10.1016/j.seizure.2014.05.011

Ben-Menachem E, Axelsen M, Johanson EH, Stagge A, Smith U. Predictors of weight loss in adults with topiramate-treated epilepsy. Obes Res. 2003;11(4):556-62. DOI: 10.1038/oby.2003.78

Gidal BE, Sheth RD, Magnus L, Herbeuval AF. Levetiracetam does not alter body weight: analysis of randomized, controlled clinical trials. Epilepsy Res. 2003;56(2-3):121-6. DOI: 10.1016/j.eplepsyres.2003.08.009

Tanaka A, Akamatsu N, Shouzaki T, Toyota T, Yamano M, Nakagawa M, et al. Clinical characteristics and treatment responses in new-onset epilepsy in the elderly. Seizure. 2013;22(9):772-5. DOI: 10.1016/j.seizure.2013.06.005

Stefan H. Epilepsy in the elderly: facts and challenges. Acta Neurol Scand. 2011;124(4):223-37. DOI: 10.1111/j.1600-0404.2010.01464.x

Kanner AM, Ashman E, Gloss D, Harden C, Bourgeois B, Bautista JF, et al. Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs II: Treatment-resistant epilepsy. Epilepsy Curr. 2018;18(4):269-78. DOI: 10.5698/1535-7597.18.4.269

Glauser T, Ben-Menachem E, Bourgeois B, Cnaan A, Guerreiro C, Kälviäinen R, et al. ILAE Subcommission on AED Guidelines. Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia. 2013;54(3):551-63. DOI: 10.1111/epi.12074

Saetre E, Perucca E, Isojärvi J, Gjerstad L, on behalf of the LAM 40089 Study Group. An International Multicenter Randomized Double Blind Controlled Trial of Lamotrigine and Sustained‐Release Carbamazepine in the Treatment of Newly Diagnosed Epilepsy in the Elderly. Epilepsia. 2007;48(7):1292–1302. DOI: 10.1111/j.1528-1167.2007.01128.x

Brodie MJ, Overstall PW, Giorgi L. Multicentre, double-blind, randomised comparison between lamotrigine and carbamazepine in elderly patients with newly diagnosed epilepsy. The UK Lamotrigine Elderly Study Group. Epilepsy Res. 1999;37(1):81-7. DOI: 10.1016/s0920-1211(99)00039-x

Collins NS, Shapiro RA, Ramsay RE. Elders with epilepsy. Med Clin North Am. 2006; 90(5):945-66. DOI: 10.1016/j.mcna.2006.06.002

Werhahn KJ, Trinka E, Dobesberger J, Unterberger I, Baum P, Deckert-Schmitz M, et al. A randomized, double-blind comparison of antiepileptic drug treatment in the elderly with new-onset focal epilepsy. Epilepsia. 2015;56(3):450-9. DOI: 10.1111/epi.12926

Pohlmann-Eden B, Marson AG, Noack-Rink M, Ramirez F, Tofighy A, Werhahn KJ, et al. Comparative effectiveness of levetiracetam, valproate and carbamazepine among elderly atients with newly diagnosed epilepsy: subgroup analysis of the randomized, unblinded KOMET study. BMC Neurol. 2016;16(1):149. DOI: 10.1186/s12883-016-0663-7

Lezaic N, Gore G, Josephson CB, Wiebe S, Jetté N, Keezer MR. The medical treatment of epilepsy in the elderly: A systematic review and meta-analysis. Epilepsia. 2019;60(7):1325-40. DOI: 10.1111/epi.16068

Brigo F, Lattanzi S. Pharmacotherapeutic considerations for late-onset Epilepsy. Expert Opin Pharmacother. 2021;22(4):389-391. DOI: 10.1080/14656566.2020.1865311

Samokhvalov A, Irving H, Mohapatra S, Rehm J. Alcohol consumption, unprovoked seizures, and epilepsy: A systematic review and meta-analysis. Epilepsia. 2010;51(7):1177-84. DOI: 10.1111/j.1528-1167.2009.02426.x

Bender J, Hernández L, Rodríguez L, Menéndez K. Trastornos psiquiátricos asociados a las epilepsias. Revista Habanera de Ciencias Médicas. 2016;15(6):890-905.

Tellez‐Zenteno J, Patten S, Jetté N, Williams J, Wiebe S. Psychiatric Comorbidity in Epilepsy: A Population Based Analysis. Epilepsia. 2007;48(12):2336-44. DOI: 10.1111/j.1528-1167.2007.01222.x

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Publicado

2022-03-21

Cómo citar

1.
Bombón-Albán PE. Tratamiento farmacológico de la epilepsia en el adulto mayor, revisión de la literatura. Rev Neuropsiquiatr [Internet]. 21 de marzo de 2022 [citado 28 de marzo de 2024];85(1):55-6. Disponible en: https://revistas.upch.edu.pe/index.php/RNP/article/view/4155

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