Co giật ở bệnh nhân cao tuổi mắc chứng sa sút trí tuệ

Springer Science and Business Media LLC - Tập 20 - Trang 791-803 - 2012
Mario F. Mendez1, Gerald T. H. Lim1
1Department of Neurology, The University of California at Los Angeles, Los Angeles, USA

Tóm tắt

Co giật xảy ra ở những bệnh nhân mắc chứng sa sút trí tuệ với tỷ lệ cao hơn so với các cá nhân cao tuổi khỏe mạnh. Tỷ lệ mắc phải cơn co giật trong số bệnh nhân mắc chứng sa sút trí tuệ thay đổi tùy thuộc vào nguyên nhân gây ra bệnh. Ở những bệnh nhân mắc bệnh Alzheimer (hình thức phổ biến nhất của chứng sa sút trí tuệ), khoảng 10–22% có ít nhất một cơn co giật không do nguyên nhân nào. Co giật thường xảy ra ở giai đoạn muộn của bệnh Alzheimer, trung bình là ≥6 năm sau khi bắt đầu bệnh. Co giật trong bệnh Alzheimer có khả năng xảy ra nhiều hơn với bệnh khởi phát sớm, đặc biệt nếu có đột biến gen presenilin I trong gia đình. Tỷ lệ mắc co giật trong các bệnh sa sút trí tuệ khác thì không rõ ràng. Có những xem xét đặc biệt liên quan đến việc quản lý cơn co giật ở người cao tuổi mắc chứng sa sút trí tuệ. Thứ nhất, sự hiện diện của rối loạn nhận thức có thể gây khó khăn trong việc chẩn đoán chính xác cơn co giật. Các bác sĩ lâm sàng cũng có thể nhầm lẫn các biểu hiện co giật với triệu chứng của chứng sa sút trí tuệ cơ sở. Thứ hai, do hầu hết bệnh nhân sa sút trí tuệ đều là người cao tuổi, có những thay đổi về dược động học khi lão hóa ảnh hưởng đến việc sử dụng thuốc chống động kinh. Thứ ba, thuốc chống động kinh có tác dụng phụ tiềm năng về nhận thức có thể làm trầm trọng thêm tình trạng sa sút trí tuệ. Mặc dù có rất ít nghiên cứu, việc suy diễn từ các nghiên cứu trên người trẻ và bệnh nhân cao tuổi không mắc chứng sa sút trí tuệ cung cấp một số khuyến nghị cho việc quản lý cơn co giật ở bệnh nhân mắc chứng sa sút trí tuệ: loại trừ các nguyên nhân triệu chứng của cơn co giật trước khi cam kết điều trị bằng thuốc chống động kinh; điều trị sau cơn co giật đầu tiên nếu có bằng chứng về sự tham gia thần kinh khu trú hoặc có nguy cơ tái phát cơn co giật; sử dụng thuốc chống động kinh có tác dụng phụ về nhận thức tối thiểu, chẳng hạn như carbamazepine, acid valproic, gabapentine và lamotrigine; và sử dụng liều tối thiểu có thể và theo dõi mức độ thuốc chống động kinh, nếu có thể.

Từ khóa


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