| Popis: |
Dementia is associated with an increased risk of unprovoked seizures and epilepsy, which carry a risk of reduced quality of life and adverse events. The management of seizures and epilepsy in patients with cognitive impairment presents a multitude of challenges for the clinician. The pathology underlying the dementia syndrome may differ and range from neurodegeneration associated with accumulation of beta-amyloid and tau to ischaemic changes, and hence a seizure in a patient with dementia may be considered having a structural cause. Nevertheless, taking the decision to treat or not to treat seizures in dementia patients can be difficult, as the risks of recurrent seizures versus an increased risk of adverse effects of antiepileptic medications have to be weighed up against each other. Moreover, seizures, especially focal onset impaired awareness seizures (previously called complex partial seizures) may be difficult to identify for both patients and caregivers. This may be partly due to lack of awareness of seizures, lack of insight by the patient, and in some instances, such as Lewy body dementia, similarities with other non-epileptic phenomena that are part of the disease. Enquiring about seizure markers should be part of the routine follow-up of patients with dementia and carers should be taught to identify and record episodes of altered awareness. This chapter will present a background on the pathophysiology of seizures and epilepsy in dementia, a guide to diagnosis and differential diagnosis, provide a summary of treatment options, and a discussion on practical issues to consider when choosing an antiepileptic drug, including side effects. These topics will be supplemented by three case scenarios exemplifying these issues. |
