Incidence and Predictors of Seizures in Patients with Alzheimer's Disease

Abstract

Summary: Purpose: To determine cumulative incidence and predictors of new-onset seizures in mild Alzheimer's disease (AD) with a cohort followed prospectively. Limited information is available on the incidence of seizures, and no reports exist of seizure predictors in AD patients.Methods: Mild AD patients were prospectively followed at 6-month intervals to estimate incidence of unprovoked seizures, compare age-specific risk of unprovoked seizures with population norms, and identify characteristics at baseline (demographics, duration and severity of AD, physical and diagnostic test findings, and comorbid medical and psychiatric conditions) influencing unprovoked seizure risk. Review of study charts and medical records supplemented coded end-point data.Results: The cumulative incidence of unprovoked seizures at 7 years was nearly 8%. In all age groups, risk was increased compared with a standard population, with an 87-fold increase in the youngest group (age 50-59 years) and more than a threefold increase in the oldest group (age 85+ years). In multivariate modeling, independent predictors of unprovoked seizures were younger age [relative risk (RR), 0.89 per year increase in age; 95% confidence interval (CI), 0.82-0.97], African-American ethnic background (RR, 7.35; 95% CI, 1.42-37.98), more-severe dementia (RR, 4.15; 95% CI,, and focal epileptiform findings on electroencephalogram (EEG) (RR, 73.36; 95% CI, 1.75-3075.25).Conclusions: Seizure incidence is increased in people starting with mild-to-moderate AD. Younger individuals, African Americans, and those with more-severe disease or focal epileptiform findings on EEG were more likely to have unprovoked seizures.

Loss of Astrocytic Domain Organization in the Epileptic Brain

“…Gliosis is prominent in Alzheimer's disease, but the incidence of seizure is only moderately increased compared with reference populations (Hauser et al, 1986;Unger, 1998;Amatniek et al, 2006). Interestingly, a recent report has revealed that some mouse models of Alzheimer's disease (hAPPJ20) have nonconvulsive seizures and compensatory inhibitory changes in hippocampal circuitry (Palop et al, 2007).…”

Hypermetabolic State in the 7-Month-Old Triple Transgenic Mouse Model of Alzheimer'S Disease and the Effect of Lipoic Acid: A 13C-NMR Study

“…31 This is correlated with increased epileptic seizures in AD patients. 32 In addition, the risk of epileptic activity is 87-fold greater in AD patients with early-onset dementia (that is typically characterized by Aβ pathology) and the relationship between AD and seizures is even tighter in early-onset familial AD 33,34 (the 3xTg-AD mouse model perhaps resembles early-onset familial AD better than late onset AD, as it has genetic mutations from birth). These results raise an important question of whether the extent of subclinical epileptic activity in AD has been underestimated.…”

Hippocampal Sclerosis and Epilepsy in Elderly Population

“…Furthermore, the incidence has been shown to increase with age in the Nordic population [21][22][23]. The reported prevalence of EP in dementia and AD varied from 5% to 64% [24][25][26][27][28][29][30][31][32][33][34]. When all cognitively unimpaired subjects with HS were lumped together here, three out of 23 (11%) had displayed EP during life, thus indicating a high frequency, when compared to the general population.…”