Treatment and Management of Epilepsy in the Elderly Demented Patient

Jenssen, Sigmund; Schere, Daniel

doi:10.1177/1533317508319433

Cited by 23 publications

(20 citation statements)

References 50 publications

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“…Pour finir, l'association de l'une et de l'autre avec une démence, présente ou future, étant de moins en moins considérée comme le fruit du hasard [47], un suivi cognitif devrait, de toute façon, être proposé à distance de l'épisode aigu quel que soit le diagnostic final [48][49][50].…”

Section: Resultsunclassified

Confusion et épilepsie

Harston

2009

cah. année gerontol.

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La confusion mentale, fréquente chez le sujet âgé hospitalisé, réalise un syndrome clinique peu spécifique, généralement secondaire à une pathologie générale aiguë. L'épilepsie, dont la prévalence croît significativement après 60 ans, fait néanmoins partie des étiologies à rechercher, parce qu'une confusion peut être postcritique ou due à un état de mal non convulsif. La confusion partage, par ailleurs, de nombreux déterminants avec les crises d'épilepsie dites situationnelles, et la tolérance cognitive ou comportementale des anticonvulsivants est inégale. Mots clés Épilepsie · Confusion · État de mal · Personne âgée · ÉlectroencéphalogrammeAbstract Confusion is a common feature in the hospitalized elderly and consists of a relatively non-specific syndrome, usually due to a general pathology. Nevertheless, the prevalence of epilepsy significantly increases after the age of sixty, and this aetiology must be searched for in the case of acute confusion, as this can be a postictal state, or nonconvulsive status epilepticus. Moreover, confusion and acute symptomatic seizures share numerous factors, and cognitive and behavioural tolerability of antiepileptic drugs is fairly variable.

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Section: Resultsunclassified

Confusion et épilepsie

Harston

2009

cah. année gerontol.

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“…Unlike the younger population, the motor manifestations are usually lacking, and the confusion tends to be protracted with a waxing and waning quality [34,35]. These features tend to make the diagnosis difficult, requiring a high index of suspicion.…”

Section: Treatmentmentioning

confidence: 99%

“…History taking in these patients could be rather demanding secondary to memory deficits of the patient. The fact that many of these patients are institutionalized and have limited social interactions further decreases the probability of finding a witness [34]. Additional recommended investigations would include obtaining an EEG, lab work to rule out toxic and metabolic etiologies, and imaging studies, preferably a magnetic resonance imaging (MRI).…”

Section: Treatmentmentioning

confidence: 99%

“…Some AEDs like phenytoin are highly susceptible to these effects, and its levels in the elderly can fluctuate as much as tenfold [39,40]. Reduced gastric motility and blood flow coupled with low gastric acid production can vary the absorption of acidic and alkaline drugs [34]. The absorption of highly water-insoluble drugs like phenytoin or carbamazepine can be dependent on the hydration status of the patient, with poor hydration contributing to decreases in absorption.…”

Section: Pharmacokinetic Changes With Agingmentioning

confidence: 99%

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Seizures in Setting of Dementia

Sivaraaman

Vajjala

2015

Curr Treat Options Neurol

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Dementia, especially Alzheimer's disease, is an important cause of seizures and epilepsy midst the elderly. With the increasing life span, the incidence of dementia and epilepsy is expected to increase exponentially. Care of patients with advanced dementia can be demanding and seizures add to this burden. Though recognition of seizures in these patients can be difficult, seizures in these patients tend to be highly responsive to pharmacological therapy. However, choosing the right antiepileptic drug can be a challenge and complicated by altered kinetics and polypharmacy. While ongoing seizures can worsen the cognitive status in these patients, antiepileptic drugs could also add to the cognitive burden. The newer generation drugs show promise in terms of their side effect profile without compromising on the efficacy.

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“…Therefore, many computer-aided solutions have been developed to assist neurologists. Combining signal processing and machine learning, most of those approaches model the problem as classification of signals, such as epileptic vs. healthy for epilepsy diagnosis [9, 10], ictal (on seizure) vs. inter-ictal for seizure onset detection [11, 12], etc. The most common classification problem is seizure detection, where seizure and non-seizure EEG segments of patients need to be identified [6].…”

Section: Introductionmentioning

confidence: 99%

A high-performance seizure detection algorithm based on Discrete Wavelet Transform (DWT) and EEG

et al. 2017

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In the past decade, Discrete Wavelet Transform (DWT), a powerful time-frequency tool, has been widely used in computer-aided signal analysis of epileptic electroencephalography (EEG), such as the detection of seizures. One of the important hurdles in the applications of DWT is the settings of DWT, which are chosen empirically or arbitrarily in previous works. The objective of this study aimed to develop a framework for automatically searching the optimal DWT settings to improve accuracy and to reduce computational cost of seizure detection. To address this, we developed a method to decompose EEG data into 7 commonly used wavelet families, to the maximum theoretical level of each mother wavelet. Wavelets and decomposition levels providing the highest accuracy in each wavelet family were then searched in an exhaustive selection of frequency bands, which showed optimal accuracy and low computational cost. The selection of frequency bands and features removed approximately 40% of redundancies. The developed algorithm achieved promising performance on two well-tested EEG datasets (accuracy >90% for both datasets). The experimental results of the developed method have demonstrated that the settings of DWT affect its performance on seizure detection substantially. Compared with existing seizure detection methods based on wavelet, the new approach is more accurate and transferable among datasets.

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Treatment and Management of Epilepsy in the Elderly Demented Patient

Cited by 23 publications

References 50 publications

Confusion et épilepsie

Confusion et épilepsie

Seizures in Setting of Dementia

A high-performance seizure detection algorithm based on Discrete Wavelet Transform (DWT) and EEG

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