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. 2018 Dec 20;12(12):CD011922.
doi: 10.1002/14651858.CD011922.pub3.

Treatment of epilepsy for people with Alzheimer's disease

Jia Liu  1 , Lu-Ning Wang, Li-Yong Wu, Yu-Ping Wang
Affiliations

Treatment of epilepsy for people with Alzheimer's disease

Jia Liu et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Any type of seizure can be observed in Alzheimer's disease (AD). Antiepileptic drugs seem to prevent the recurrence of epileptic seizures in most people with AD. There are pharmacological and non-pharmacological treatments for epilepsy in people with AD. There are no current systematic reviews to evaluate the efficacy and tolerability of these treatments; this review aims to review those different modalities. This is an updated version of the original Cochrane Review published in Issue 11, 2016.

Objectives: To assess the efficacy and tolerability of pharmacological or non-pharmacological interventions for the treatment of epilepsy in people with AD (including sporadic AD and dominantly inherited AD).

Search methods: For the latest update, on 10 July 2018 we searched the Cochrane Register of Studies (CRS Web), which includes the Cochrane Epilepsy Group's Specialized Register and the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid 1946- ), ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP). In an effort to identify further published, unpublished and ongoing trials, we searched ongoing trials registers, reference lists and relevant conference proceedings, and contacted authors and pharmaceutical companies.

Selection criteria: We included randomized and quasi-randomized controlled trials investigating treatment for epilepsy in people with AD, with the outcomes of proportion of participants with seizure freedom or proportion of participants experiencing adverse events.

Data collection and analysis: Two review authors independently screened the titles and abstracts of identified records, selected studies for inclusion, extracted data, cross-checked the data for accuracy and assessed the methodological quality. We performed no meta-analyses due to the limited available data.

Main results: We included one randomized controlled trial on pharmacological interventions with 95 participants. No studies were found for non-pharmacological interventions. Concerning the proportion of participants with seizure freedom, no significant differences were found for the comparisons of levetiracetam (LEV) versus lamotrigine (LTG) (risk ratio (RR) 1.20, 95% confidence interval (CI) 0.53 to 2.71), LEV versus phenobarbital (PB) (RR 1.01, 95% CI 0.47 to 2.19), or LTG versus PB (RR 0.84, 95% CI 0.35 to 2.02). It seemed that LEV could improve cognition and LTG could relieve depression, while PB and LTG could worsen cognition, and LEV and PB could worsen mood. Unclear risk of bias was found in allocation, blinding and selective reporting. We judged the quality of the evidence to be very low.

Authors' conclusions: This review does not provide sufficient evidence to support LEV, PB or LTG for the treatment of epilepsy in people with AD. Regarding efficacy and tolerability, no significant differences were found between LEV, PB and LTG. Large randomized controlled trials with a double-blind, parallel-group design are required to determine the efficacy and tolerability of treatment for epilepsy in people with AD.

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Conflict of interest statement

JL: none known.

L‐NW: none known.

Y‐PW: none known.

L‐YW: none known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Levetiracetam versus lamotrigine, Outcome 1 Proportion with seizure freedom.
1.2
1.2. Analysis
Comparison 1 Levetiracetam versus lamotrigine, Outcome 2 Reduction in seizure frequency of 50% or more.
1.3
1.3. Analysis
Comparison 1 Levetiracetam versus lamotrigine, Outcome 3 Proportion with adverse events.
2.1
2.1. Analysis
Comparison 2 Levetiracetam versus phenobarbital, Outcome 1 Proportion with seizure freedom.
2.2
2.2. Analysis
Comparison 2 Levetiracetam versus phenobarbital, Outcome 2 Reduction in seizure frequency of 50% or more.
2.3
2.3. Analysis
Comparison 2 Levetiracetam versus phenobarbital, Outcome 3 Proportion with adverse events.
3.1
3.1. Analysis
Comparison 3 Lamotrigine versus phenobarbital, Outcome 1 Proportion with seizure freedom.
3.2
3.2. Analysis
Comparison 3 Lamotrigine versus phenobarbital, Outcome 2 Reduction in seizure frequency of 50% or more.
3.3
3.3. Analysis
Comparison 3 Lamotrigine versus phenobarbital, Outcome 3 Proportion with adverse events.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Cumbo 2010 {published data only}
    1. Cumbo E, Ligori LD. Levetiracetam, lamotrigine, and phenobarbital in patients with epileptic seizures and Alzheimer's disease. Epilepsy & Behavior 2010;17(4):461‐6. - PubMed

References to studies excluded from this review

Campion 1995 {published data only}
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Musaeus 2017 {published data only}
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NCT02002819 {unpublished data only}
    1. Levetiracetam for Alzheimer's Disease‐Associated Network Hyperexcitability.
NCT03489044 {unpublished data only}
    1. An Investigation of Levetiracetam in Alzheimer's Disease.

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