Seizures and Epileptiform Activity in the Early Stages of Alzheimer Disease

作者：Keith A. Vossel, Alexander J. Beagle, Gil D. Rabinovici, Huidy Shu, Suzee E. Lee, Georges Naasan, Manu Hegde, Susannah Brock Cornes, Maya L. Henry, Alexandra Nelson, William W. Seeley, Michael D. Geschwind, Maria Luisa Gorno‐Tempini, Tina Shih, Heidi E. Kirsch, Paul A. Garcia, Bruce Leonard Miller, Lennart Mucke · 发表于：JAMA Neurology · 年份：2013 · DOI：10.1001/jamaneurol.2013.136 · 被引用次数：767 · 研究领域：Dementia and Cognitive Impairment Research、Epilepsy research and treatment、Alzheimer's disease research and treatments

IMPORTANCE: Epileptic activity associated with Alzheimer disease (AD) deserves increased attention because it has a harmful impact on these patients, can easily go unrecognized and untreated, and may reflect pathogenic processes that also contribute to other aspects of the illness. We report key features of AD-related seizures and epileptiform activity that are instructive for clinical practice and highlight similarities between AD and transgenic animal models of the disease. OBJECTIVE: To describe common clinical characteristics and treatment outcomes of patients with amnestic mild cognitive impairment (aMCI) or early AD who also have epilepsy or subclinical epileptiform activity. DESIGN: Retrospective observational study from 2007 to 2012. SETTING Memory and Aging Center, University of California, San Francisco. PATIENTS: We studied 54 patients with a diagnosis of aMCI plus epilepsy (n = 12), AD plus epilepsy (n = 35), and AD plus subclinical epileptiform activity (n = 7). MAIN OUTCOMES AND MEASURES: Clinical and demographic data, electroencephalogram (EEG) readings, and treatment responses to antiepileptic medications. RESULTS: Patients with aMCI who had epilepsy presented with symptoms of cognitive decline 6.8 years earlier than patients with aMCI who did not have epilepsy (64.3 vs 71.1 years; P = .02). Patients with AD who had epilepsy presented with cognitive decline 5.5 years earlier than patients with AD who did not have epilepsy (64.8 vs 70.3 years; P = .001). Patien...