Epileptic activity associated with Alzheimer disease has a harmful impact on these patients as well as reflecting pathogenic processes that contribute to other aspects of the disease. The authors of this study report key features of Alzheimer’s-related seizures and epileptiform activity that are instructive for clinical practice. The retrospective observational study was done from 2007 to 2012 at the Memory and Aging Center, University of California, San Francisco.
Epilepsy in aMCI and Alzheimer’s patients was observed to be associated with symptoms of cognitive decline 5.5 to 6.8 years earlier compared to aMCI and Alzheimer’s patients who did not have epilepsy. Patients with Alzheimer’s who had subclinical epileptiform activity also had an early onset of cognitive decline.
The timing of seizure onset in patients with aMCI and AD was nonuniform, clustering near the onset of cognitive decline. Epilepsies were most often complex partial seizures (47%) and more than half were nonconvulsive. Serial or extended EEG monitoring appeared to be more effective than routine EEG at detecting interictal and subclinical epileptiform activity. Epileptic foci were predominantly unilateral and temporal. Of the most commonly prescribed antiepileptics, treatment outcomes appeared to be better for lamotrigine and levetiracetam than for phenytoin. The authors suggest that careful identification and treatment of epilepsy in such patients may improve their clinical course.
Vossel KA, Beagle AJ, Rabinovici GD, Shu H, Lee SE, Naasan G, Hegde M, Cornes SB, Henry ML, Nelson AB, Seeley WW, Geschwind MD, Gorno-Tempini ML, Shih T, Kirsch HE, Garcia PA, Miller BL, Mucke L: Seizures and Epileptiform Activity in the Early Stages of Alzheimer Disease. JAMA Neurology [Epub ahead of print, July 8, 2013; doi:10.1001/jamaneurol.2013.136.].