老年癫痫的药物治疗：聚焦共病、药代动力学与药物选择策略
Pharmacotherapy for Epilepsy in the Elderly: Focusing on Comorbidities, Pharmacokinetics, and Drug Selection Strategies
摘要: 随着全球人口老龄化，老年癫痫已成为一个日益突出的公共卫生问题。老年期是癫痫发病率最高的年龄段，其病因、临床表现及药物治疗反应均与年轻患者显著不同。生理机能衰退、高共病负担及多重用药构成了老年癫痫药物治疗的核心挑战。本文旨在系统阐述老年癫痫的病因与诊断特点、年龄相关的药代动力学改变、基于循证医学的药物选择策略，以及处理多重用药的实用方法。核心观点在于，老年癫痫的治疗目标不仅是控制发作，更是最大限度地减少药物不良反应和药物相互作用，保护认知功能和身体稳定性，从而维持其生活质量。本文将为此提供一份现代、全面且实用的临床管理框架。
Abstract: With the global aging of the population, epilepsy in the elderly has become an increasingly prominent public health issue. The elderly represent the age group with the highest incidence of epilepsy, and its etiology, clinical manifestations, and responses to pharmacotherapy differ significantly from those in younger patients. Declining physiological functions, a high burden of comorbidities, and polypharmacy constitute the core challenges in the drug treatment of elderly epilepsy. This article aims to systematically elaborate on the etiological and diagnostic characteristics of elderly epilepsy, age-related pharmacokinetic changes, evidence-based drug selection strategies, and practical approaches to managing polypharmacy. The central tenet is that the treatment goal for elderly epilepsy is not only seizure control but also, critically, the minimization of adverse drug reactions and drug interactions, alongside the preservation of cognitive function and physical stability, thereby maintaining quality of life. This review will provide a modern, comprehensive, and practical framework for its clinical management.
文章引用：刘倩, 林宇琪, 张欣欣, 李在望. 老年癫痫的药物治疗：聚焦共病、药代动力学与药物选择策略[J]. 临床医学进展, 2025, 15(12): 1491-1497. https://doi.org/10.12677/acm.2025.15123557

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