The implications of frailty in older adults with epilepsy

被引:2
作者
Hashmi, Syeda Amrah [1 ]
Sachdeva, Seerat [2 ]
Sindhu, Udeept [2 ]
Tsai, Carolyn [3 ]
Bonda, Kalyanchakradhar [2 ]
Keezer, Mark [4 ]
Zawar, Ifrah [1 ]
Punia, Vineet [3 ]
机构
[1] Univ Virginia, Dept Neurol, Sch Med, Charlottesville, VA USA
[2] Cleveland Clin, Epilepsy Ctr, Clin Observer, Cleveland, OH USA
[3] Cleveland Clin, Epilepsy Ctr, Cleveland, OH 44195 USA
[4] Univ Montreal, Dept Neurosci, Montreal, PQ, Canada
关键词
epilepsy; frailty; older adults; seizure; TEMPORAL-LOBE EPILEPSY; ANTIEPILEPTIC DRUGS; PHYSICAL FRAILTY; OUTCOMES; HEALTH; RISK; CARE; VALIDATION; VALIDITY; THERAPY;
D O I
10.1002/epi4.13046
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Older adults constitute a large proportion of people with epilepsy (PWE) due to the changing demographics worldwide and epilepsy's natural history. Aging-related pathophysiological changes lower the tolerance and increase our vulnerability to stressors, which manifests as frailty. Frailty is closely associated with adverse health outcomes. This narrative review examines the interplay between frailty and epilepsy, especially in older adults, emphasizing its clinical implications, including its role in managing PWE. Mechanistically, frailty develops through complex interactions among molecular and cellular damage, including genomic instability, mitochondrial dysfunction, and hormonal changes. These contribute to systemic muscle mass, bone density, and organ function decline. The concept of frailty has evolved from a primarily physical syndrome to include social, psychological, and cognitive dimensions. The "phenotypic frailty" model, which focuses on physical performance, and the "deficit accumulation" model, which quantifies health deficits, provide frameworks for understanding and assessing frailty. PWE are potentially more prone to developing frailty due to a higher prevalence of risk factors predisposing to frailty. These include, but are not limited to, polypharmacy, higher comorbidity, low exercise level, social isolation, low vitamin D, and osteoporosis. We lack commercial biomarkers to measure frailty but can diagnose it using self- or healthcare provider-administered frailty scales. Recent attempts to develop a PWE-specific frailty scale are promising. Unlike chronological age, frailty is reversible, so its management using multidisciplinary care teams should be strongly considered. Frailty can affect antiseizure medication (ASM) tolerance secondary to its impact on pharmacokinetics and pharmacodynamics. While frailty's effect on seizure control efficacy of ASM is poorly understood, its undoubted association with overall poor outcomes, including epilepsy surgery, behooves us to consider its presence and implication while treating older PWE. Incorporation of frailty measures in future research is essential to improve our understanding of frailty's role in PWE health.Plain Language SummaryFrailty is the declining state of the human body. People with epilepsy are more prone to it. It should be factored into their management.
引用
收藏
页码:2128 / 2143
页数:16
相关论文
共 92 条
  • [1] Allison R II, 2021, AM FAM PHYSICIAN, V103, P219
  • [2] Patient-reported cognitive side effects of antiepileptic drugs: Predictors and comparison of all commonly used antiepileptic drugs
    Arif, Hiba
    Buchsbaum, Richard
    Weintraub, David
    Pierro, Joanna
    Resor, Stanley R., Jr.
    Hirsch, Lawrence J.
    [J]. EPILEPSY & BEHAVIOR, 2009, 14 (01) : 202 - 209
  • [3] Molecular and biological hallmarks of ageing
    Aunan, J. R.
    Watson, M. M.
    Hagland, H. R.
    Soreide, K.
    [J]. BRITISH JOURNAL OF SURGERY, 2016, 103 (02) : E29 - E46
  • [4] Frailty in Older Adults: A Nationally Representative Profile in the United States
    Bandeen-Roche, Karen
    Seplaki, Christopher L.
    Huang, Jin
    Buta, Brian
    Kalyani, Rita R.
    Varadhan, Ravi
    Xue, Qian-Li
    Walston, Jeremy D.
    Kasper, Judith D.
    [J]. JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES, 2015, 70 (11): : 1427 - 1434
  • [5] Drug-resistant epilepsy at the age extremes: Disentangling the underlying etiology
    Bartolini, Emanuele
    Ferrari, Anna Rita
    Lattanzi, Simona
    Pradella, Silvia
    Zaccara, Gaetano
    [J]. EPILEPSY & BEHAVIOR, 2022, 132
  • [6] Anticonvulsant therapy in aged patients - Clinical pharmacokinetic considerations
    Bernus, I
    Dickinson, RG
    Hooper, WD
    Eadie, MJ
    [J]. DRUGS & AGING, 1997, 10 (04) : 278 - 289
  • [7] Prevalence and outcomes of frailty in unplanned hospital admissions: a systematic review and meta-analysis of hospital- wide and general (internal) medicine cohorts
    Boucher, Emily L.
    Gan, Jasmine M.
    Rothwell, Peter M.
    Shepperd, Sasha
    Pendlebury, Sarah T.
    [J]. ECLINICALMEDICINE, 2023, 59
  • [8] Burton JK., 2022, AGE AGEING, V51, pafac064, DOI [10.1093/ageing/afac064, DOI 10.1093/ageing/afac064, DOI 10.1093/AGEING/AFAC064]
  • [9] A meta-analysis on progressive atrophy in intractable temporal lobe epilepsy Time is brain?
    Caciagli, Lorenzo
    Bernasconi, Andrea
    Wiebe, Samuel
    Koepp, Matthias J.
    Bernasconi, Neda
    Bernhardt, Boris C.
    [J]. NEUROLOGY, 2017, 89 (05) : 506 - 516
  • [10] Towards frailty biomarkers: Candidates from genes and pathways regulated in aging and age-related diseases
    Cardoso, Ana Luisa
    Fernandes, Adelaide
    Aguilar-Pimentel, Juan Antonio
    de Angelis, Martin Hrabe
    Guedes, Joana Ribeiro
    Brito, Maria Alexandra
    Ortolano, Saida
    Pani, Giovambattista
    Athanasopoulou, Sophia
    Gonos, Efstathios S.
    Schosserer, Markus
    Grillari, Johannes
    Peterson, Part
    Tuna, Bilge Guvenc
    Dogan, Soner
    Meyer, Angelika
    van Os, Ronald
    Trendelenburg, Anne-Ulrike
    [J]. AGEING RESEARCH REVIEWS, 2018, 47 : 214 - 277