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J Alzheimers Dis. 2017;60(4):1267-1274. doi: 10.3233/JAD-170392.

Adult-Onset Epilepsy in Presymptomatic Alzheimer's Disease: A Retrospective Study.

Author information

1
Department of Neurology, San Gerardo Hospital, Monza, Italy.
2
School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, Monza, Italy.
3
Department of Neuroscience, IRCCS-Institute for Pharmacological Research "Mario Negri", Milan, Italy.

Abstract

BACKGROUND:

The prevalence of epilepsy with onset in adulthood increases with age, mainly due to the accumulation of brain damage. However, a significant proportion of patients experience seizures of unknown cause. Alzheimer's disease (AD) is associated with an increased risk of seizures. Seizure activity is interpreted as a secondary event related to hyperexcitability caused by amyloid-β aggregation.

OBJECTIVE:

Since neurodegenerative processes begin several years before clinical symptoms, epilepsy could be more frequent in the presymptomatic stages of dementia.

METHODS:

We retrospectively reviewed the prevalence of epilepsy of unknown origin with adult onset before cognitive decline in a large cohort of AD patients (EPS-AD) recruited based on clinical and neuropsychological data. Data of patients with epilepsy followed by AD were compared with two control groups: patients with AD without seizures (no EPS-AD) and a large reference population (RP).

RESULTS:

In AD patients, the prevalence of epilepsy of unknown origin, with onset in the adulthood before cognitive decline is 17.1 times higher compared with the RP (95% CI: 10.3-28.3). In EPS-AD, seizures begin on average 4.6 years (median 2.0) before the onset of cognitive symptoms and cognitive decline starts 3.6 years earlier compared with noEPS-AD.

CONCLUSIONS:

Neurodegenerative processes of dementia could play a key role in the pathogenesis of epilepsy in a subgroup of individuals intended to develop cognitive decline. Adult-onset epilepsy of undefined cause could thus represent a risk factor for the ongoing neurodegenerative damage, even preceding by years the onset of clinical symptoms of dementia.

KEYWORDS:

Alzheimer’s disease; disease modifying therapies; epilepsy; neurodegeneration; prevalence; seizure

PMID:
28968234
DOI:
10.3233/JAD-170392
[Indexed for MEDLINE]

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