항간질약이 노인의 평형에 미치는 영향
The Effects of Antiepileptic Drugs on Balance in Older People
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: The purpose of this study was to quantitatively assess the subclinical balance dysfunction in elderly people taking antiepileptic drugs. Methods: We recruited sixty-three patients who were at least 50 years old, without complaint of dizziness or imbalance, and on a stable dose of carbamazepine, lamotrigine or levetiracetam. Their balance scores were compared with those of newly diagnosed untreated age- and sex-matched epilepsy patients (n=21). All the subjects underwent balance measurements that included an activities-specific balance confidence scale, quantitative caloric and rotational chair testing and posturography. The spectral frequency analysis of body sway while standing upright was also investigated. Sensory organization (SOT) and motor control tests were done by computerized dynamic posturography (CDP). Results: The sway distance and area of center of pressure significantly increased in the patients treated with carbamazepine. Spectral frequency analysis of this group showed a significantly increased spectral power at low and middle frequencies on the antero-posterior (Y) plane and at low frequencies on the lateral (X) plane. CDP showed no significant differences in SOT results among the groups. However, motor control test revealed increased latencies and slowed adaptations in the carbamazepine group. Conclusions: These findings suggest that newer drugs such as lamotrigine or levetiracetam may induce less disequilibrium than carbamazepine in older people on monotherapy for epilepsy. The disturbance is likely related to slowed central postural reflexes.
Abstract
Background: The purpose of this study was to quantitatively assess the subclinical balance dysfunction in elderly people taking antiepileptic drugs. Methods: We recruited sixty-three patients who were at least 50 years old, without complaint of dizziness or imbalance, and on a stable dose of carbamazepine, lamotrigine or levetiracetam. Their balance scores were compared with those of newly diagnosed untreated age- and sex-matched epilepsy patients (n=21). All the subjects underwent balance measurements that included an activities-specific balance confidence scale, quantitative caloric and rotational chair testing and posturography. The spectral frequency analysis of body sway while standing upright was also investigated. Sensory organization (SOT) and motor control tests were done by computerized dynamic posturography (CDP). Results: The sway distance and area of center of pressure significantly increased in the patients treated with carbamazepine. Spectral frequency analysis of this group showed a significantly increased spectral power at low and middle frequencies on the antero-posterior (Y) plane and at low frequencies on the lateral (X) plane. CDP showed no significant differences in SOT results among the groups. However, motor control test revealed increased latencies and slowed adaptations in the carbamazepine group. Conclusions: These findings suggest that newer drugs such as lamotrigine or levetiracetam may induce less disequilibrium than carbamazepine in older people on monotherapy for epilepsy. The disturbance is likely related to slowed central postural reflexes.
참고문헌 (25)
- Hauser WA, "Seizure disorders: the changes with age", Epilepsia, 33(4), pp.6~14 (1992)
- Persson HB, "Risk of extremity fractures in adult outpatients with epilepsy", Epilepsia, 43, pp.768~772 (2002)
- Ensrud KE, "Central nervous system-active medications and risk for falls in older women", J Am Geriatr Soc, 50, pp.1629~1637 (2002)
- Fife TD, "Antiepileptic drugs and their impact on balance", Aging Health, 1, pp.1~8 (2005)
- Sirven JI, "Second- generation antiepileptic drugs’ impact on balance: a meta analysis", Mayo Clin Proc, 82, pp.40~47 (2007)
- Keim RJ, "Dynamic posturography: fundamentals and clinical applications", AAO, 1990, 1~22
- "Data interpretation manual NeuroCom International Inc", 1~25 (1994)
- Lee GH, "Computerized dynamic posturography", J Korean Soc Clin Neurophysiol, 8, pp.97~102 (2006)
- Diener HC, "Long loop reflexes and posture In Disorders of posture and gait. 1st", pp.41~51 (1986), Elsevier
- Powell LE, "The Activities-specific Balance Confidence (ABC) Scale", J Gerontol A Biol Sci Med Sci, 50A, pp.28~34 (1995)
- Lee GH, "The diagnostic value of rotating chair test for vertigo patients", J Korean Neurol Assoc, 13, pp.631~645 (1995)
- Kohen-Raz R, "An initial evaluation of fatigue and circadian changes as assessed by multiple posturography", Percept Mot Skills, 82, pp.547~557 (1996)
- Nashner LM, "Relation of automatic postural responses and reaction-time voluntary movements of human leg muscles", Exp Brain Res, 43, pp.395~405 (1981)
- Rowan AJ, "New onset geriatric epilepsy: a randomized study of gabapentin, lamotrigine, and carbamazepine", Neurology, 64, pp.1868~1873 (2005)
- Torvik A, "Atrophy of the cerebellar vermis in aging: a morphometric and histologic study", J Neurol Sci, 76, pp.283~294 (1986)
- Specht U, "Cerebellar atrophy decreases the threshold of carbamazepine toxicity in patients with chronic focal epilepsy", Arch Neurol, 54, pp.427~431 (1997)
- Faught E, "Long-term tolerability of lamotrigine: data from a 6-year continuation study", Epilepsy Behav, 5, pp.31~36 (2004)
- Cramer JA, "Tolerability of levetiracetam in elderly patients with CNS disorders", Epilepsy Res, 56, pp.135~145 (2003)
- McCrea RA, "Anatomical and physiological characteristics of vestibular neurons mediating the horizontal vestibulo-ocular reflex of the squirrel monkey", J Comp Neurol, 264, pp.547~570 (1987)
- Genç BO, "Pattern-reversal visual evoked potentials in patients with newly diagnosed epilepsy", Epilepsia, 46, pp.1219~1223 (2005)
- Gandelman-Marton R, "Balance performance in adult epilepsy patients", Seizure, 15, pp.582~589 (2006)
- Perrell KL, "Fall risk assessment measures: an analytic review", J Gerontol A Biol Sci Med Sci, 56, pp.761~766 (2001)
- Lajoie Y, "Attention demands for static and dynamic equilibrium", Exp Brain Res, 97, pp.139~144 (1993)
- Cohen AF, "Lamotrigine(BW430C), a potential anticonvulsant. Effects on the central nervous system in comparison with phenytoin and diazepam", Br J Clin Pharmacol, 20, pp.619~629 (1985)
- Meador KJ, "Comparative cognitive effects of anticonvulsants", Neurology, 40, pp.391~394 (1990)