摘要
背景:痴呆患者发生癫痫的风险增加,特别是血管性痴呆和阿尔茨海默病患者。在选择最佳的抗癫痫药物时,应考虑到可能的副作用,如嗜睡和认知功能恶化,以及合并的疾病和癫痫类型。 目的:目前的系统综述调查了老年痴呆和癫痫患者服用AED后的疗效、耐受性和认知功能的变化。 方法:我们检索了包括MEDLINE和CENTRAL在内的6个数据库,查阅了参考文献列表,联系了专家,并检索了谷歌Scholar以确定报道随机试验的研究。确定的研究是由两名研究人员独立筛选、提取数据和评价质量的。采用叙述综合方法报告调查结果。 结果:我们纳入了一项95名老年痴呆症患者的研究,随机服用左乙拉西坦、拉莫三嗪或苯巴比妥。疗效没有显著差异,但接受左乙拉西坦治疗的患者在简易精神状态检查评分方面有所改善,不良事件减少。 结论:以随机对照试验的形式提供高质量的证据来指导临床医生在痴呆和伴随癫痫患者中选择AED仍然缺乏。然而,左乙拉西坦此前已被证明可能改善轻度认知障碍和阿尔茨海默病患者的认知能力,在老年人群中耐受性更好,且与胆碱酯酶抑制剂或NMDA受体拮抗剂均无临床相关相互作用。
关键词: 老年痴呆症,阿尔茨海默氏症,癫痫,抗癫痫药物,左乙拉西坦,老年人。
Current Alzheimer Research
Title:Pharmacological Medical Treatment of Epilepsy in Patients with Dementia: A Systematic Review
Volume: 18 Issue: 9
关键词: 老年痴呆症,阿尔茨海默氏症,癫痫,抗癫痫药物,左乙拉西坦,老年人。
摘要:
Background: Patients with dementia have an increased risk of developing epilepsy, especially in patients with vascular dementia and Alzheimer’s disease. In selecting the optimal anti- epileptic drug (AED), the possible side effects such as drowsiness and worsening of cognitive function should be taken into consideration, together with co-morbidities and type of epilepsy.
Objective: The current systematic review investigates the efficacy, tolerability, and changes in cognitive function after administration of AED in patients with dementia and epilepsy.
Methods: We searched six databases, including MEDLINE and CENTRAL, checked reference lists, contacted experts, and searched Google Scholar to identify studies reporting randomized trials. Studies identified were independently screened, data extracted, and quality appraised by two researchers. A narrative synthesis was used to report findings.
Results: We included one study with 95 patients with Alzheimer’s disease randomized to either levetiracetam, lamotrigine, or phenobarbital. No significant differences were found for efficacy, but patients receiving levetiracetam showed an improvement in mini-mental state examination scores and had fewer adverse events.
Conclusion: High-quality evidence in the form of randomized controlled trials to guide clinicians in choosing an AED in patients with dementia and concomitant epilepsy remains scarce. However, levetiracetam has previously been shown to possibly improve cognition in patients with both mild cognitive impairment and Alzheimer’s disease, is better tolerated in the elderly population, and has no clinically relevant interaction with either cholinesterase inhibitors or NMDA receptor antagonists.
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Cite this article as:
Pharmacological Medical Treatment of Epilepsy in Patients with Dementia: A Systematic Review, Current Alzheimer Research 2021; 18 (9) . https://dx.doi.org/10.2174/1567205018666211126121529
DOI https://dx.doi.org/10.2174/1567205018666211126121529 |
Print ISSN 1567-2050 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-5828 |
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