Revisión bibliográfica sobre el diagnóstico y manejo de primera crisis convulsiva en pacientes de tercera edad

Abstract

The WHO for 2017 has published that an estimated 2.4 million cases of epilepsy are diagnosed each year, pointing out that the groups of 60-65 years and over 80 years are the most affected, presenting 140 cases per 100,000 people; demonstrating that the incidence of onset of epilepsy increases with age. For this reason, we carry out an updated review in order to obtain a guide on the diagnosis and management of seizures in elderly patients who come to the emergency service. Emphasizing that in the elderly most seizures originate in the frontal and parietal lobes, therefore, seizure episodes can be accompanied by auras. Its diagnosis is based on the description of the convulsive event, the manifestations in the electroencephalogram, support in imaging tests such as tomography or resonance. A search was carried out in databases such as: PubMed, DynaMed, Up to Date, Scielo, Scopus, etc. The information was taken within the time limit of the last 5 years, selecting 20 articles for analysis. Concluding that the exact diagnosis in third-class patients represents an enormous challenge for doctors due to the limitations in the clinical history, the atypical symptoms and the medical comorbidities that they present. The anti-seizure drugs are: valproate, carbamazepine, phenytoin, lamotrigine, gabapentin, oxcarbazepine, topiramate, levetiracetam and lacosamide. The choice of an ideal anticonvulsant drug should not only be based on efficacy, but also on adverse effects, altered pharmacodynamics in older adults, and comorbidities.