Abstract
Alzheimer's disease (AD) and epilepsy are common disorders in the elderly. Evidence demonstrates that patients with AD have an increased risk of developing epilepsy and seizures.ObjectiveTo review epidemiological, clinical and treatment aspects of epilepsy and AD.MethodsWe reviewed databases (PubMED, LiLACS, Scielo) conducting a search for manuscripts using the terms Alzheimer's disease and epilepsy.ResultsManuscripts related to the areas of interest were reviewed. Studies revealed that epilepsy is more frequent among AD patients. The combined presence of the two disorders may be related to mechanisms of neuronal hyperexcitability as a consequence of amyloid-beta protein (Aβ) or phosphorylated tau accumulation, as well as to structural changes in cortical and hippocampal regions. Available data suggest that the new generation of antiepileptic drugs (AEDs) are better tolerated in the elderly population, and may also be the best option in patients with AD and epilepsy.ConclusionFurther prospective studies involving evaluation of concomitant dementia and epilepsy, neurophysiological findings and biomarkers need to be performed.
Highlights
IntroductionEpilepsy is a neurological disorder defined in the 1989 epilepsy classification as the occurrence of at least two unprovoked seizures (seizures which occur without any obvious immediate cause, in this case called acute symptomatic seizures) which are clinical manifestations of abnormal and excessive neuronal discharge that may cause varied, sudden and transient symptoms including altered consciousness and/or motor, sensory or psychiatric events.[1,2]It is known that the incidence of seizures and epilepsy increases with age and many factors are related to the onset of seizures in the elderly: degenerative diseases (such as Alzheimer’s disease [AD]), strokes, tumors (primary or metastatic), head injuries (mainly subdural hematomas), metabolic disorders, infections, 66 Epilepsy in Alzheimer’s disease Miranda DC, Brucki SMD and the use of medications that may lower seizure threshold.[2,3,4,5]Evidence derived from population-based and observational studies and, more recently, from studies using animal models, show that AD is associated with a substantially increased risk of seizures and epilepsy in the elderly.[1,3,6,7] the actual relationship between these two disorders requires further research.there are many difficulties in establishing the epilepsy diagnosis in this group of patients, since confirmation of a seizure requires a consistent clinical history which is difficult to achieve in patients with a dementia condition owing to difficulties remembering and/or reporting the event.[1]
It is known that the incidence of seizures and epilepsy increases with age and many factors are related to the onset of seizures in the elderly: degenerative diseases, strokes, tumors, head injuries, metabolic disorders, infections, 1MD, Resident of Neurology, Hospital Santa Marcelina, São Paulo, Brazil; 2PhD, Neurologist, Hospital Santa Marcelina; Cognitive and Behavioral Neurology Unit, University of São Paulo, São Paulo, Brazil
After removing the redundant references listed in more than one database, the articles were read and evaluated. Those addressing the areas comprised in this study approach were include, giving a final total of 30 articles
Summary
Epilepsy is a neurological disorder defined in the 1989 epilepsy classification as the occurrence of at least two unprovoked seizures (seizures which occur without any obvious immediate cause, in this case called acute symptomatic seizures) which are clinical manifestations of abnormal and excessive neuronal discharge that may cause varied, sudden and transient symptoms including altered consciousness and/or motor, sensory or psychiatric events.[1,2]It is known that the incidence of seizures and epilepsy increases with age and many factors are related to the onset of seizures in the elderly: degenerative diseases (such as Alzheimer’s disease [AD]), strokes, tumors (primary or metastatic), head injuries (mainly subdural hematomas), metabolic disorders, infections, 66 Epilepsy in Alzheimer’s disease Miranda DC, Brucki SMD and the use of medications that may lower seizure threshold.[2,3,4,5]Evidence derived from population-based and observational studies and, more recently, from studies using animal models, show that AD is associated with a substantially increased risk of seizures and epilepsy in the elderly.[1,3,6,7] the actual relationship between these two disorders requires further research.there are many difficulties in establishing the epilepsy diagnosis in this group of patients, since confirmation of a seizure requires a consistent clinical history which is difficult to achieve in patients with a dementia condition owing to difficulties remembering and/or reporting the event.[1]. It is known that the incidence of seizures and epilepsy increases with age and many factors are related to the onset of seizures in the elderly: degenerative diseases (such as Alzheimer’s disease [AD]), strokes, tumors (primary or metastatic), head injuries (mainly subdural hematomas), metabolic disorders, infections, 66 Epilepsy in Alzheimer’s disease Miranda DC, Brucki SMD and the use of medications that may lower seizure threshold.[2,3,4,5]. Evidence derived from population-based and observational studies and, more recently, from studies using animal models, show that AD is associated with a substantially increased risk of seizures and epilepsy in the elderly.[1,3,6,7] the actual relationship between these two disorders requires further research. It is a challenge to differentiate an ictal symptom from behavioral symptoms of dementia (fluctuating level of consciousness and attention, hallucinations, confusion).[4]
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