Diagnosis and Management of Seizures in Neurodegenerative Diseases

• Published in: Current treatment options in neurology Vol. 23; no. 1
• Main Authors: Adan, G., Mitchell, J. W., Ziso, B., Larner, A. J.
• Format: Journal Article
• Language: English
• Published: New York Springer US 2021
• Subjects: Critical Care Medicine; Dementia (J Pillai; Diabetes; Family Medicine; General Practice; Intensive; Internal Medicine; Medicine; Medicine & Public Health; Neurology; Ophthalmology; Section Editor; Topical Collection on Dementia; Alzheimer’s disease; Pathogenesis; Epilepsy; Prion diseases; Management; Frontotemporal dementia; Dementia with Lewy bodies; Seizures
• ISSN: 1092-8480; 1534-3138
• DOI: 10.1007/s11940-020-00656-y

Purpose of Review
This review presents a critical appraisal of epileptic seizures in common neurodegenerative diseases related to proteinopathy, including Alzheimer’s disease (AD), dementia with Lewy bodies, frontotemporal dementias, and prion diseases. Studies on prevalence, seizure type, and treatment are reviewed, and tentative management recommendations made. Gaps in the evidence base are indicated.
Recent Findings
Epidemiological studies show that patients with AD are at increased risk of epileptic seizures. Cumulative seizure frequency of > 10% is reported and may be higher if subtle seizure features are sought by means of a proforma. Seizures may be associated with more rapid cognitive decline. The evidence base for treatment with anti-epileptic drugs in AD is weak, and potential benefits must be weighed against the risk of adverse events. Animal studies indicate that the abnormal protein species, amyloid peptides and tau, accumulating in AD brain may be implicated in epileptogenesis. Fewer data are available for the other neurodegenerative diseases, meaning that seizure treatment is largely empirical.
Summary
Epileptic seizures may be an integral part of many proteinopathies of the brain, rather than epiphenomena. Symptomatic treatment of seizures is currently largely empirical. The hope for the future is that seizures, like cognitive impairment, may be susceptible to disease-modifying treatments targeting aberrant protein species.