O386 Prevalence and impact of subclinical epileptiform activity in Alzheimer’s-disease

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Introduction Alzheimer’s-disease (AD) is the most common type of neurodegenerative disorders leading to a significant social and medical burden on the society. Evidence suggests that epileptiform activity might have a prominent role in the pathophysiology of AD. While numerous studies investigated the prevalence of epileptic seizures in AD, we lack of observations on the incidence and importance of subclinical epileptiform activity. The aim of our study was to examine AD patients using long-term EEG recording to identify the prevalence of epileptiform activity and to measure its impact on the progression of AD. Methods We selected 42 patients meeting the criteria for probable AD. The patients underwent rigorous clinical investigation including long-term (24 h) EEG monitoring. We followed them in a 3 years long period and applied serial neuropsychological examination. Results We identified subclinical epileptiform activity in 47% of AD patients. Activity was visible mostly on the frontotemporal electrodes (95%) with significant left side predominance (65%). Epileptiform potentials occurred prominently in sleep (82%), especially in slow wave sleep (45%). We were able to follow 21 patients (8 with-, 13 without epileptiform activity) through 3 years. Patients with epileptiform discharges showed 2-times faster cognitive decline. Conclusion Epileptiform activity is frequent in AD, predominantly occurring in slow-wave sleep with left frontotemporal origin. Since epileptiform discharges are important contributors in the progression, antiepileptic treatment might represent a promising future target in AD.