Putting the Brakes on Accelerated Cognitive Decline in Alzheimer's Disease with Epileptic Activity

Abstract

Epileptic activity is known to exacerbate Alzheimer's disease (AD) pathology and worsen disease course. However, few studies have assessed whether treating epileptic activity with antiseizure drugs (ASDs) can improve patient outcomes. The current study by Hautecloque-Raysz et al. shows that patients with prodromal AD and epilepsy (epAD) fare well with ASD treatment, achieving seizure control in a large majority of cases using low dosage ASDs in monotherapy. Compared to slowly progressing AD patients without epilepsy, treated epAD patients experienced a similarly slow cognitive decline. These results suggest that ASDs that suppress seizures can improve outcomes in AD patients with epileptic activity.

Keywords: Alzheimer’s disease; antiseizure drugs; epilepsy; epileptic activity; mild cognitive impairment.

Fig. 1

Potential disease modification with treatment of antiseizure drugs (ASD) in patients with Alzheimer’s disease (AD) and epileptic activity. In a previous study by Vossel et al. [1], AD patients with subclinical epileptic activity, detected by overnight EEG and/or 1-h magnetoencephalography recordings, had a faster decline in their Mini-Mental State Examination (MMSE) scores (AD-Epi+, 3.9 points/year) than AD patients without detectable epileptic activity (AD-Epi-, 1.6 points/year). In the current study by Hautecloque-Raysz et al. [7], patients with prodromal AD and epileptic seizures (AD-EpiSz+) treated with ASDs had a slow cognitive decline of one MMSE point a year, which was similar to the slow rate of decline in prodromal AD patients without epilepsy in their study (AD-EpiSz-), as well as the slow rate of decline in the AD-Epi- group in Vossel et al. These studies indicate that epileptic activity worsens cognitive decline in AD and that ASDs can slow progression in AD patients with detectible epileptic activity.