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Zawar I, Kapur J, Mattos MK, Aldridge CM, Manning C, Quigg M. Association of Seizure Control With Cognition in People With Normal Cognition and Mild Cognitive Impairment. Neurology 2024; 103:e209820. [PMID: 39173101 PMCID: PMC11343585 DOI: 10.1212/wnl.0000000000209820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 07/01/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Seizures are common in dementia and associated with accelerated cognitive decline. However, the impact of active vs remote seizures on cognition remains understudied. This study aimed to investigate the impact of active vs remote seizures on cognition in people with normal cognition and mild cognitive impairment (MCI). METHODS This longitudinal, multicenter cohort is based on National Alzheimer's Coordinating Center data of participants recruited from 39 Alzheimer's Disease Centers in the United States from September 2005 to December 2021. All participants with normal cognition and MCI and at least 2 visits were included. Primary outcome, that is, cognitive decline, was determined using Clinical Dementia Rating (CDR) from (1) normal-to-impaired (CDR ≥0.5) and (2) MCI-to-dementia (CDR ≥1) groups. The effect of active seizures (over the preceding 12 months), remote seizures (previous seizures but none over the preceding 12 months), and no seizures (controls) on cognition was assessed. Subgroups of chronic seizures at enrollment and new-onset seizures were further analyzed. Cox regression models assessed the risk of all-cause MCI and/or dementia. All models were adjusted for age, sex, education, race, hypertension, and diabetes. RESULTS Of the 13,726 participants with normal cognition at enrollment (9,002 [66%] female; median age 71 years), 118 had active seizures and 226 had remote seizures. Of the 11,372 participants with MCI at enrollment (5,605 [49%] female; median age 73 years), 197 had active seizures and 226 had remote seizures. Active seizures were associated with 2.1 times higher risk of cognitive impairment (adjusted hazard ratio [aHR] 2.13, 95% CI 1.60-2.84, p < 0.001) in cognitively healthy adults (median years to decline: active seizures = ∼1, remote seizures = ∼3, no seizures = ∼3) and 1.6 times higher risk of dementia (aHR 1.58, 95% CI 1.24-2.01, p < 0.001) in those with MCI (median years to decline: active seizures = ∼1, remote seizures = ∼2, controls = ∼2). This risk was not observed with remote seizures. DISCUSSION In this study, active seizures but not remote seizures were associated with earlier cognitive decline in both cognitively normal adults and those with MCI, independent of other dementia risk factors. Therefore, early identification and management of seizures may present a path to mitigation of cognitive decline in the aging epileptic population. A limitation is that causality cannot be confirmed in our observational longitudinal study.
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Affiliation(s)
- Ifrah Zawar
- From the Department of Neurology (I.Z., J.K., C.M.A., C.M., M.Q.), and School of Nursing (M.K.M.), University of Virginia, Charlottesville
| | - Jaideep Kapur
- From the Department of Neurology (I.Z., J.K., C.M.A., C.M., M.Q.), and School of Nursing (M.K.M.), University of Virginia, Charlottesville
| | - Meghan K Mattos
- From the Department of Neurology (I.Z., J.K., C.M.A., C.M., M.Q.), and School of Nursing (M.K.M.), University of Virginia, Charlottesville
| | - Chad M Aldridge
- From the Department of Neurology (I.Z., J.K., C.M.A., C.M., M.Q.), and School of Nursing (M.K.M.), University of Virginia, Charlottesville
| | - Carol Manning
- From the Department of Neurology (I.Z., J.K., C.M.A., C.M., M.Q.), and School of Nursing (M.K.M.), University of Virginia, Charlottesville
| | - Mark Quigg
- From the Department of Neurology (I.Z., J.K., C.M.A., C.M., M.Q.), and School of Nursing (M.K.M.), University of Virginia, Charlottesville
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Sung KL, Kuo MJ, Yang HY, Tsai CF, Sung SF. Poststroke seizures and epilepsy increase the risk of dementia among stroke survivors: A population-based study. Epilepsia 2024. [PMID: 39254353 DOI: 10.1111/epi.18117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 08/23/2024] [Accepted: 08/23/2024] [Indexed: 09/11/2024]
Abstract
OBJECTIVE With global aging, the occurrence of stroke and associated outcomes like dementia are on the rise. Seizures and epilepsy are common poststroke complications and have a strong connection to subsequent dementia. This study examines the relationship between poststroke seizures (PSS) or poststroke epilepsy (PSE) and dementia using a national health care database. METHODS We conducted a retrospective study using data from the Taiwan National Health Insurance Research Database from 2009 to 2020. We identified acute stroke patients from 2010 to 2015, excluding those with pre-existing neurological conditions. Based on age, sex, stroke severity level, and the year of index stroke, patients with PSS or PSE were matched to those without. The main outcome was incident dementia. RESULTS This study included 62 968 patients with an average age of 63 years, with males accounting for 62.9%. Of them, 60.3% had ischemic strokes, and 39.7% had hemorrhagic strokes. After an average follow-up period of 5.2 years, dementia developed in 15.9% of patients who had PSS or PSE, as opposed to 8.4% of those without these conditions. A time-dependent Fine and Gray competing risk analysis showed that PSS and PSE were significantly associated with dementia across all stroke types. Subgroup analyses revealed significantly increased risk of dementia across all age groups (<50, 50-64, and ≥65 years), sexes, and various stroke severity levels. The link between PSS or PSE and dementia was particularly pronounced in men, with a less distinct correlation in women. SIGNIFICANCE The risk of incident dementia was higher in patients with PSS or PSE. The potential for therapeutic interventions for seizures and epilepsy to reduce poststroke dementia underscores the importance of seizure screening and treatment in stroke survivors.
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Affiliation(s)
- Kuan-Lin Sung
- School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Miao-Jen Kuo
- School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsin-Yi Yang
- Clinical Data Center, Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Ching-Fang Tsai
- Clinical Data Center, Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
- Department of Nursing, Fooyin University, Kaohsiung, Taiwan
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O'Dwyer R, Leppik IE, Eads P, Long Y, Birnbaum AK. Overview of acute seizure management in US nursing homes. Epilepsy Behav 2024; 158:109913. [PMID: 38959744 DOI: 10.1016/j.yebeh.2024.109913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION Residents in NH are more likely to be diagnosed with epilepsy or seizures, which are associated with higher mortality and complicate care. This setting provides unique challenges in the treatment of seizures however, little is known about current management practices in NH. Most studies in the literature concentrate on the use of antiseizure medications (ASMs) but little is known about the management of the acute seizure and clinical guidance is needed to ensure the safety of this vulnerable population. The objective of this study was to survey current practices, identifying knowledge deficits and inform future educational endeavors, including acute seizure action plans (ASAPs). METHODS A survey was developed pertaining to a broad spectrum of clinical aspects in the management of acute seizures in NH, distinguishing first time seizures from those in the setting of a known seizure disorder. It was sent to NH medical directors throughout the US and data was gathered from those who had at least one new case of new onset/epilepsy in the last 3 years. RESULTS Ninety-one NH directors responded with 52 % having a seizure protocol. Nurses are responsible in the majority of cases for protocol activation. Regardless of the patient's seizure history, rescue medications are given in the majority of cases, oral benzodiazepines, followed by intravenous and then rectal benzodiazepines. Newer intranasal and intramuscular formulations of benzodiazepines were less frequently prescribed. The most commonly prescribed ASM is levetiracetam, followed by lamotrigine, valproic acid and phenytoin. Staff training and in-service education occur infrequently. Respondents thought no-cost seizure education would be highly beneficial. CONCLUSIONS AND IMPLICATIONS Only approximately half of NH have protocols for the acute management of seizures. Rescue medications are given regardless of seizure history and often older ASMs are used for long-term management. Our study highlights areas of knowledge deficits and treatment areas for improvement, identifying the need and potential for ASAPs in NHs.
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Affiliation(s)
- Rebecca O'Dwyer
- Department of Neurological Science, Rush University Medical Center, Chicago, IL, USA.
| | - Ilo E Leppik
- Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA; Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Pam Eads
- UCB Pharmaceuticals, Smyrna, GA, USA
| | - Yuhan Long
- Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Angela K Birnbaum
- Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
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Li E, Benitez C, Boggess SC, Koontz M, Rose IV, Martinez D, Draeger N, Teter OM, Samelson AJ, Pierce N, Ullian EM, Kampmann M. CRISPRi-based screens in iAssembloids to elucidate neuron-glia interactions. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.04.26.538498. [PMID: 37163077 PMCID: PMC10168378 DOI: 10.1101/2023.04.26.538498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The sheer complexity of the brain has complicated our ability to understand the cellular and molecular mechanisms underlying its function in health and disease. Genome-wide association studies have uncovered genetic variants associated with specific neurological phenotypes and diseases. In addition, single-cell transcriptomics have provided molecular descriptions of specific brain cell types and the changes they undergo during disease. Although these approaches provide a giant leap forward towards understanding how genetic variation can lead to functional changes in the brain, they do not establish molecular mechanisms. To address this need, we developed a 3D co-culture system termed iAssembloids (induced multi-lineage assembloids) that enables the rapid generation of homogenous neuron-glia spheroids. We characterize these iAssembloids with immunohistochemistry and single-cell transcriptomics and combine them with large-scale CRISPRi-based screens. In our first application, we ask how glial and neuronal cells interact to control neuronal death and survival. Our CRISPRi-based screens identified that GSK3β inhibits the protective NRF2-mediated oxidative stress response in the presence of reactive oxygen species elicited by high neuronal activity, which was not previously found in 2D monoculture neuron screens. We also apply the platform to investigate the role of APOE-ε4, a risk variant for Alzheimer's Disease, in its effect on neuronal survival. We find that APOE-ε4-expressing astrocytes may promote more neuronal activity as compared to APOE-ε3-expressing astrocytes. This platform expands the toolbox for the unbiased identification of mechanisms of cell-cell interactions in brain health and disease.
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Affiliation(s)
- Emmy Li
- Institute for Neurodegenerative Diseases, University of California, San Francisco, San Francisco, CA, USA
- Biomedical Sciences Graduate Program, University of California, San Francisco, San Francisco, CA, USA
| | - Camila Benitez
- Tetrad Graduate Program, University of California, San Francisco, San Francisco, CA, USA
| | - Steven C. Boggess
- Institute for Neurodegenerative Diseases, University of California, San Francisco, San Francisco, CA, USA
| | - Mark Koontz
- Department of Ophthalmology, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Indigo V.L. Rose
- Institute for Neurodegenerative Diseases, University of California, San Francisco, San Francisco, CA, USA
- Neuroscience Graduate Program, University of California, San Francisco, San Francisco, CA, USA
| | - Delsy Martinez
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | - Nina Draeger
- Institute for Neurodegenerative Diseases, University of California, San Francisco, San Francisco, CA, USA
| | - Olivia M. Teter
- Institute for Neurodegenerative Diseases, University of California, San Francisco, San Francisco, CA, USA
- UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, San Francisco, San Francisco, CA, USA
| | - Avi J. Samelson
- Institute for Neurodegenerative Diseases, University of California, San Francisco, San Francisco, CA, USA
| | - Na’im Pierce
- Institute for Neurodegenerative Diseases, University of California, San Francisco, San Francisco, CA, USA
| | - Erik M. Ullian
- Department of Ophthalmology, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Martin Kampmann
- Institute for Neurodegenerative Diseases, University of California, San Francisco, San Francisco, CA, USA
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
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Zhu Y, Williams J, Beyene K, Trani JF, Babulal GM. Traumatic Brain Injury, Seizures, and Cognitive Impairment Among Older Adults. JAMA Netw Open 2024; 7:e2426590. [PMID: 39115844 PMCID: PMC11310819 DOI: 10.1001/jamanetworkopen.2024.26590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 06/11/2024] [Indexed: 08/11/2024] Open
Abstract
Importance Traumatic brain injury (TBI), seizures, and dementia increase with age. There is a gap in understanding the associations of TBI, seizures, and medications such as antiseizure and antipsychotics with the progression of cognitive impairment across racial and ethnic groups. Objective To investigate the association of TBI and seizures with the risk of cognitive impairment among cognitively normal older adults and the role of medications in moderating the association. Design, Setting, and Participants This multicenter cohort study was a secondary analysis of the Uniform Data Set collected between June 1, 2005, and June 30, 2020, from the National Alzheimer's Coordination Center. Statistical analysis was performed from February 1 to April 3, 2024. Data were collected from participants from 36 Alzheimer's Disease Research Centers in the US who were 65 years or older at baseline, cognitively normal at baseline (Clinical Dementia Rating of 0 and no impairment based on a presumptive etiologic diagnosis of AD), and had complete information on race and ethnicity, age, sex, educational level, and apolipoprotein E genotype. Exposure Health history of TBI, seizures, or both conditions. Main Outcomes and Measures Progression to cognitive impairment measured by a Clinical Dementia Rating greater than 0. Results Among the cohort of 7180 older adults (median age, 74 years [range, 65-102 years]; 4729 women [65.9%]), 1036 were African American or Black (14.4%), 21 were American Indian or Alaska Native (0.3%), 143 were Asian (2.0%), 332 were Hispanic (4.6%), and 5648 were non-Hispanic White (78.7%); the median educational level was 16.0 years (range, 1.0-29.0 years). After adjustment for selection basis using propensity score weighting, seizure was associated with a 40% higher risk of cognitive impairment (hazard ratio [HR], 1.40; 95% CI, 1.19-1.65), TBI with a 25% higher risk of cognitive impairment (HR, 1.25; 95% CI, 1.17-1.34), and both seizure and TBI were associated with a 57% higher risk (HR, 1.57; 95% CI, 1.23-2.01). The interaction models indicated that Hispanic participants with TBI and seizures had a higher risk of cognitive impairment compared with other racial and ethnic groups. The use of antiseizure medications (HR, 1.23; 95% CI, 0.99-1.53), antidepressants (HR, 1.32; 95% CI, 1.17-1.50), and antipsychotics (HR, 2.15; 95% CI, 1.18-3.89) was associated with a higher risk of cognitive impairment, while anxiolytic, sedative, or hypnotic use (HR, 0.88; 95% CI, 0.83-0.94) was associated with a lower risk. Conclusions and Relevance This study highlights the importance of addressing TBI and seizures as risk factors for cognitive impairment among older adults. Addressing the broader social determinants of health and bridging the health divide across various racial and ethnic groups are essential for the comprehensive management and prevention of dementia.
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Affiliation(s)
- Yiqi Zhu
- School of Social Work, Adelphi University, Garden City, New York
| | - Jonathan Williams
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Kebede Beyene
- Department of Pharmaceutical and Administrative Sciences, University of Health Sciences and Pharmacy in St Louis, St Louis, Missouri
| | - Jean-Francois Trani
- National Conservatory of Arts and Crafts, Paris, France
- Institute of Public Health, Washington University School of Medicine, St Louis, Missouri
- Department of Psychology, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
- Brown School of Social Work, Washington University in St Louis, St Louis, Missouri
| | - Ganesh M. Babulal
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
- Institute of Public Health, Washington University School of Medicine, St Louis, Missouri
- Department of Psychology, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, DC
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Kalyvas AC, Dimitriou M, Ioannidis P, Grigoriadis N, Afrantou T. Alzheimer's Disease and Epilepsy: Exploring Shared Pathways and Promising Biomarkers for Future Treatments. J Clin Med 2024; 13:3879. [PMID: 38999445 PMCID: PMC11242231 DOI: 10.3390/jcm13133879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/25/2024] [Accepted: 06/29/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Alzheimer's disease (AD) and epilepsy represent two complex neurological disorders with distinct clinical manifestations, yet recent research has highlighted their intricate interplay. This review examines the association between AD and epilepsy, with particular emphasis on late-onset epilepsy of unknown etiology, increasingly acknowledged as a prodrome of AD. It delves into epidemiology, pathogenic mechanisms, clinical features, diagnostic characteristics, treatment strategies, and emerging biomarkers to provide a comprehensive understanding of this relationship. Methods: A comprehensive literature search was conducted, identifying 128 relevant articles published between 2018 and 2024. Results: Findings underscore a bidirectional relationship between AD and epilepsy, indicating shared pathogenic pathways that extend beyond traditional amyloid-beta and Tau protein pathology. These pathways encompass neuroinflammation, synaptic dysfunction, structural and network alterations, as well as molecular mechanisms. Notably, epileptic activity in AD patients may exacerbate cognitive decline, necessitating prompt detection and treatment. Novel biomarkers, such as subclinical epileptiform activity detected via advanced electroencephalographic techniques, offer promise for early diagnosis and targeted interventions. Furthermore, emerging therapeutic approaches targeting shared pathogenic mechanisms hold potential for disease modification in both AD and epilepsy. Conclusions: This review highlights the importance of understanding the relationship between AD and epilepsy, providing insights into future research directions. Clinical data and diagnostic methods are also reviewed, enabling clinicians to implement more effective treatment strategies.
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Affiliation(s)
- Athanasios-Christos Kalyvas
- 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, GR54636 Thessaloniki, Greece
| | - Maria Dimitriou
- 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, GR54636 Thessaloniki, Greece
| | - Panagiotis Ioannidis
- 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, GR54636 Thessaloniki, Greece
| | - Nikolaos Grigoriadis
- 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, GR54636 Thessaloniki, Greece
| | - Theodora Afrantou
- 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, GR54636 Thessaloniki, Greece
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Punia V, Bhansali S, Tsai C. Late-onset epilepsy clinic: From clinical diagnostics to biomarkers. Seizure 2024:S1059-1311(24)00192-4. [PMID: 38944548 DOI: 10.1016/j.seizure.2024.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/01/2024] Open
Abstract
The unique patho-clinical entity of late-onset epilepsy (LOE), distinguished by its distinct natural history, from its onset to the prognosis it portends, necessitates specialized care. We lack a universally accepted definition, but LOE is typically identified as epilepsy onset after the age of 60 or 65. Unlike epilepsy in younger individuals, LOE is almost by default focal in origin, secondary to acquired etiologies, and presents unique diagnostic and management challenges due to its atypical semiology, higher comorbidity burden, frailty, and increased risks of subsequent stroke and dementia. LOE clinics have been established to address these challenges, providing a multidisciplinary approach to optimize outcomes in patients with new-onset seizures beyond the fifth decade of life. LOE clinics are essential for comprehensive care, offering not only seizure management but also monitoring and addressing associated comorbidities. The care model involves collaboration among neurologists, primary care providers, cardiologists, mental health professionals, and social workers to manage LOE patients' complex needs effectively. The prevalence of cognitive dysfunction in LOE patients underscores the need for regular cognitive assessments and interventions. Biomarker research, particularly involving amyloid beta, offers promising avenues for early diagnosis and a better understanding of the interplay between LOE and Alzheimer's disease. Establishing LOE clinics in major referral centers can enhance provider expertise, improve patient outcomes, and facilitate research to advance diagnostic and therapeutic strategies. In conclusion, LOE clinics play a critical role in addressing the multifaceted needs of older adults with epilepsy, tailored to local resources and challenges, thus enhancing epilepsy care in an aging global population.
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Affiliation(s)
- Vineet Punia
- Epilepsy Center, Cleveland Clinic, Cleveland, OH 44113, USA.
| | - Sakhi Bhansali
- Epilepsy Center, Cleveland Clinic, Cleveland, OH 44113, USA
| | - Carolyn Tsai
- Epilepsy Center, Cleveland Clinic, Cleveland, OH 44113, USA
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Carosella CM, Gottesman RF, Kucharska-Newton A, Lutsey PL, Spira AP, Punjabi NM, Schneider ALC, Full KM, Johnson EL. Sleep apnea, hypoxia, and late-onset epilepsy: the Atherosclerosis Risk in Communities study. Sleep 2024; 47:zsad233. [PMID: 37672002 PMCID: PMC11168763 DOI: 10.1093/sleep/zsad233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/07/2023] [Indexed: 09/07/2023] Open
Abstract
STUDY OBJECTIVE Sleep apnea is associated with unexplained epilepsy in older adults in small studies. We sought to determine the relationship between sleep apnea and additional sleep characteristics and late-onset epilepsy (LOE), adjusting for comorbidities, using data from the large, prospective Atherosclerosis Risk in Communities (ARIC) Study cohort. METHODS We used Medicare claims to identify cases of LOE in ARIC participants. We used polysomnography data from 1309 ARIC participants who also participated in the Sleep Heart Health Study in 1995-1998, and demographic and comorbidity data from ARIC. Later risk of LOE was evaluated using survival analysis with a competing risk of death. We also used survival analysis in 2672 ARIC participants to identify the association between self-reported obstructive sleep apnea (2011-2013), and the risk of subsequent LOE. RESULTS Late-midlife oxygen desaturation to less than 80% during sleep was associated with subsequent development of LOE, adjusted subhazard ratio 3.28 (1.18-9.08), but the apnea-hypopnea index was not related. Participant report of diagnosis of sleep apnea in 2011-2013 was also associated with subsequent LOE, adjusted subhazard ratio 2.59 (1.24-5.39). CONCLUSIONS Sleep apnea and oxygen saturation nadir during sleep are associated with LOE, independently of hypertension and other comorbidities. These potentially modifiable risk factors could have large clinical implications for LOE.
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Affiliation(s)
| | - Rebecca F Gottesman
- National Institutes of Health, National Institute for Neurologic Disorders and Stroke Intramural Research Program, Bethesda, MD, USA
| | - Anna Kucharska-Newton
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, University of Kentucky, Lexington, KY, USA
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Johns Hopkins Center on Aging and Health, Baltimore, MD, USA
| | - Naresh M Punjabi
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Miami, Miami, FL, USA
| | - Andrea L C Schneider
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics Philadelphia, University of Pennsylvania, PA, USA
| | - Kelsie M Full
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Emily L Johnson
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Oveisgharan S, Grodstein F, Evia AM, James BD, Capuano AW, Chen Y, Arfanakis K, Schneider JA, Bennett DA. Association of Age-Related Neuropathologic Findings at Autopsy With a Claims-Based Epilepsy Diagnosis in Older Adults. Neurology 2024; 102:e209172. [PMID: 38478792 PMCID: PMC11383919 DOI: 10.1212/wnl.0000000000209172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/08/2023] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Epilepsy is 1 of the 3 most common neurologic diseases of older adults, but few studies have examined its underlying pathologies in older age. We examined the associations of age-related brain pathologies with epilepsy in older persons. METHODS Clinical and pathologic data came from 2 ongoing clinical pathologic cohort studies of community-dwelling older adults. Epilepsy was ascertained using Medicare fee-for-service Parts A and B claims data that were linked to data from the cohort studies. The postmortem pathologic assessment collected indices of 9 pathologies including Alzheimer disease, hippocampal sclerosis, macroinfarcts, and cerebral amyloid angiopathy. The fixed brain hemisphere was imaged using 3T MRI scanners before the pathologic assessments in a subgroup of participants. RESULTS The participants (n = 1,369) were on average 89.3 (6.6) years at death, and 67.0% were women. Epilepsy was identified in 58 (4.2%) participants. Cerebral amyloid angiopathy (odds ratio [OR] = 2.21, 95% CI 1.24-3.95, p = 0.007) and cortical macroinfarcts (OR = 2.74, 95% CI 1.42-5.28, p = 0.003) were associated with a higher odds of epilepsy. Of note, hippocampal sclerosis and Alzheimer disease pathology were not associated with epilepsy (both p's > 0.25), although hippocampal sclerosis was not common and thus hard to examine with the modest number of epilepsy cases here. In 673 participants with MRI data, the association of cerebral amyloid angiopathy and cortical macroinfarcts with epilepsy did not change after controlling for cortical gray matter atrophy, which was independently associated with a higher odds of epilepsy (OR = 1.06, 95% CI 1.02-1.10, p = 0.003). By contrast, hippocampal volume was not associated with epilepsy. DISCUSSION Cerebrovascular pathologies and cortical atrophy were associated with epilepsy in older persons.
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Affiliation(s)
- Shahram Oveisgharan
- From the Rush Alzheimer's Disease Center (S.O., F.G., A.M.E., B.D.J., A.W.C., Y.C., K.A., J.A.S., D.A.B.); Department of Neurological Sciences (S.O., A.W.C., J.A.S., D.A.B.); Department of Internal Medicine (F.G., B.D.J., Y.C.); Department of Diagnostic Radiology and Nuclear Medicine (A.M.E., K.A.), Rush University Medical Center; Department of Biomedical Engineering (K.A.), Illinois Institute of Technology; and Department of Pathology (J.A.S.), Rush University Medical Center, Chicago, IL
| | - Francine Grodstein
- From the Rush Alzheimer's Disease Center (S.O., F.G., A.M.E., B.D.J., A.W.C., Y.C., K.A., J.A.S., D.A.B.); Department of Neurological Sciences (S.O., A.W.C., J.A.S., D.A.B.); Department of Internal Medicine (F.G., B.D.J., Y.C.); Department of Diagnostic Radiology and Nuclear Medicine (A.M.E., K.A.), Rush University Medical Center; Department of Biomedical Engineering (K.A.), Illinois Institute of Technology; and Department of Pathology (J.A.S.), Rush University Medical Center, Chicago, IL
| | - Arnold M Evia
- From the Rush Alzheimer's Disease Center (S.O., F.G., A.M.E., B.D.J., A.W.C., Y.C., K.A., J.A.S., D.A.B.); Department of Neurological Sciences (S.O., A.W.C., J.A.S., D.A.B.); Department of Internal Medicine (F.G., B.D.J., Y.C.); Department of Diagnostic Radiology and Nuclear Medicine (A.M.E., K.A.), Rush University Medical Center; Department of Biomedical Engineering (K.A.), Illinois Institute of Technology; and Department of Pathology (J.A.S.), Rush University Medical Center, Chicago, IL
| | - Bryan D James
- From the Rush Alzheimer's Disease Center (S.O., F.G., A.M.E., B.D.J., A.W.C., Y.C., K.A., J.A.S., D.A.B.); Department of Neurological Sciences (S.O., A.W.C., J.A.S., D.A.B.); Department of Internal Medicine (F.G., B.D.J., Y.C.); Department of Diagnostic Radiology and Nuclear Medicine (A.M.E., K.A.), Rush University Medical Center; Department of Biomedical Engineering (K.A.), Illinois Institute of Technology; and Department of Pathology (J.A.S.), Rush University Medical Center, Chicago, IL
| | - Ana W Capuano
- From the Rush Alzheimer's Disease Center (S.O., F.G., A.M.E., B.D.J., A.W.C., Y.C., K.A., J.A.S., D.A.B.); Department of Neurological Sciences (S.O., A.W.C., J.A.S., D.A.B.); Department of Internal Medicine (F.G., B.D.J., Y.C.); Department of Diagnostic Radiology and Nuclear Medicine (A.M.E., K.A.), Rush University Medical Center; Department of Biomedical Engineering (K.A.), Illinois Institute of Technology; and Department of Pathology (J.A.S.), Rush University Medical Center, Chicago, IL
| | - Yi Chen
- From the Rush Alzheimer's Disease Center (S.O., F.G., A.M.E., B.D.J., A.W.C., Y.C., K.A., J.A.S., D.A.B.); Department of Neurological Sciences (S.O., A.W.C., J.A.S., D.A.B.); Department of Internal Medicine (F.G., B.D.J., Y.C.); Department of Diagnostic Radiology and Nuclear Medicine (A.M.E., K.A.), Rush University Medical Center; Department of Biomedical Engineering (K.A.), Illinois Institute of Technology; and Department of Pathology (J.A.S.), Rush University Medical Center, Chicago, IL
| | - Konstantinos Arfanakis
- From the Rush Alzheimer's Disease Center (S.O., F.G., A.M.E., B.D.J., A.W.C., Y.C., K.A., J.A.S., D.A.B.); Department of Neurological Sciences (S.O., A.W.C., J.A.S., D.A.B.); Department of Internal Medicine (F.G., B.D.J., Y.C.); Department of Diagnostic Radiology and Nuclear Medicine (A.M.E., K.A.), Rush University Medical Center; Department of Biomedical Engineering (K.A.), Illinois Institute of Technology; and Department of Pathology (J.A.S.), Rush University Medical Center, Chicago, IL
| | - Julie A Schneider
- From the Rush Alzheimer's Disease Center (S.O., F.G., A.M.E., B.D.J., A.W.C., Y.C., K.A., J.A.S., D.A.B.); Department of Neurological Sciences (S.O., A.W.C., J.A.S., D.A.B.); Department of Internal Medicine (F.G., B.D.J., Y.C.); Department of Diagnostic Radiology and Nuclear Medicine (A.M.E., K.A.), Rush University Medical Center; Department of Biomedical Engineering (K.A.), Illinois Institute of Technology; and Department of Pathology (J.A.S.), Rush University Medical Center, Chicago, IL
| | - David A Bennett
- From the Rush Alzheimer's Disease Center (S.O., F.G., A.M.E., B.D.J., A.W.C., Y.C., K.A., J.A.S., D.A.B.); Department of Neurological Sciences (S.O., A.W.C., J.A.S., D.A.B.); Department of Internal Medicine (F.G., B.D.J., Y.C.); Department of Diagnostic Radiology and Nuclear Medicine (A.M.E., K.A.), Rush University Medical Center; Department of Biomedical Engineering (K.A.), Illinois Institute of Technology; and Department of Pathology (J.A.S.), Rush University Medical Center, Chicago, IL
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Tan Z, Wang FY, Wu WP, Yu LZX, Wu JC, Wang L. Bidirectional relationship between late-onset epilepsy (LOE) and dementia: A systematic review and meta-analysis of cohort studies. Epilepsy Behav 2024; 153:109723. [PMID: 38490119 DOI: 10.1016/j.yebeh.2024.109723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/23/2024] [Accepted: 02/25/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE To explore the bidirectional relationship of late-onset epilepsy (LOE) with dementia and Alzheimer's disease (AD). METHODS Using the common electronic databases, including PubMed, Cochrane Library databases and EMBASE, we systematically reviewed published cohort studies that assessed the risk of LOE in individuals comorbid with dementia or AD, and those with dementia or AD comorbid with LOE that had been published up to 31 March 2023. The data extraction process was carried out independently by two authors. The summary adjusted relative ratio (aRR) was calculated by employing Rev Man 5.3 for the inclusion of studies. To investigate the origins of heterogeneity, we conducted both subgroup and sensitivity analyses. In the presence of heterogeneity, a random-effects model was employed. To evaluate potential publication bias, we utilized the funnel plot and conducted Begg's and Egger's tests. RESULTS We included 20 eligible studies in the final analysis after a rigorous screening process. Pooled results indicated that LOE was association with an increased risk of all-cause dementia (aRR: 1.34, 95% confidence interval [CI]: 1.13-1.59) and AD (aRR: 2.49, 95% CI: 1.16-5.32). In addition, the pooled effect size for LOE associated with baseline AD and all-cause dementia were 3.51 (95% CI: 3.47-3.56) and 2.53 (95% CI: 2.39-2.67), respectively. Both sensitivity and subgroup analyses showed that these positive correlations persisted. According to the results of the Egger's and Begg's tests, as well as visual inspection of funnel plots, none of the studies appeared to be biased by publication. CONCLUSION The findings suggested that LOE is a potential risk factor for dementia and AD, and vice versa, dementia and AD are both potential risk indicators for LOE. Since there is substantial heterogeneity among the cohorts analyzed and more cohort studies should be conducted to confirm the correlations found in the current study.
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Affiliation(s)
- Zheng Tan
- Department of Neurology, Hefei Hospital Affiliated to Anhui Medical University (The Second People's Hospital of Hefei), Hefei, Anhui 230011, China; The Fifth Clinical Medical College of Anhui Medical University, Hefei, Anhui 230032, China
| | - Fu-Yu Wang
- Department of Pharmacy, The Second People's Hospital of Hefei, Hefei, Anhui 230011, China
| | - Wen-Pei Wu
- Department of Neurology, Hefei Hospital Affiliated to Anhui Medical University (The Second People's Hospital of Hefei), Hefei, Anhui 230011, China; The Fifth Clinical Medical College of Anhui Medical University, Hefei, Anhui 230032, China
| | - Liu-Zhen-Xiong Yu
- Department of Neurology, Hefei Hospital Affiliated to Anhui Medical University (The Second People's Hospital of Hefei), Hefei, Anhui 230011, China; The Fifth Clinical Medical College of Anhui Medical University, Hefei, Anhui 230032, China
| | - Jun-Cang Wu
- Department of Neurology, Hefei Hospital Affiliated to Anhui Medical University (The Second People's Hospital of Hefei), Hefei, Anhui 230011, China.
| | - Long Wang
- Department of Neurology, Hefei Hospital Affiliated to Anhui Medical University (The Second People's Hospital of Hefei), Hefei, Anhui 230011, China.
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11
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Chen L, Yang W, Yang F, Yu Y, Xu T, Wang D, Zhao Q, Wu Q, Han Y. The crosstalk between epilepsy and dementia: A systematic review and meta-analysis. Epilepsy Behav 2024; 152:109640. [PMID: 38301455 DOI: 10.1016/j.yebeh.2024.109640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 01/06/2024] [Accepted: 01/10/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Epilepsy and dementia are bidirectional. The purpose of this review was to investigate the epidemiological characteristics of and to identify the risk factors for epilepsy in patients with dementia and dementia in patients with epilepsy. METHODS We retrieved the PubMed, Embase, Cochrane and Web of Science databases through January 2023. Two individuals screened the articles, extracted the data, and used a random effects model to pool the estimates and 95% confidence intervals (CIs). RESULTS From 3475 citations, 25 articles were included. The prevalence of seizures/epilepsy was 4% among dementia patients and 3% among Alzheimer's disease (AD) patients. For vascular dementia, Lewy body dementia, and frontotemporal dementia, the pooled period prevalence of seizures/epilepsy was 6%, 3%, and 2%, respectively. Baseline early-onset AD was associated with the highest risk of 5-year epilepsy (pooled hazard ratios: 4.06; 95% CI: 3.25-5.08). Dementia patients had a 2.29-fold greater risk of seizures/epilepsy than non-dementia patients (95% CI: 1.37-3.83). Moreover, for baseline epilepsy, the pooled prevalence of dementia was 17% (95% CI: 10-25%), and that of AD was 15% (95% CI: 9-21%). The pooled results suggested that epilepsy is associated with a greater risk of dementia (risk ratio: 2.83, 95% CI: 1.64-4.88). CONCLUSIONS There are still gaps in epidemiology regarding the correlation between dementia types and epilepsy, vascular risk factors, and the impact of antiseizure medication or cognitive improvement drugs on epilepsy and AD comorbidity.
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Affiliation(s)
- Lu Chen
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Wenqian Yang
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Fei Yang
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Yanying Yu
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Tingwan Xu
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Dan Wang
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Qingqing Zhao
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Qian Wu
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Yanbing Han
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China.
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12
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Kamondi A, Grigg-Damberger M, Löscher W, Tanila H, Horvath AA. Epilepsy and epileptiform activity in late-onset Alzheimer disease: clinical and pathophysiological advances, gaps and conundrums. Nat Rev Neurol 2024; 20:162-182. [PMID: 38356056 DOI: 10.1038/s41582-024-00932-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/16/2024]
Abstract
A growing body of evidence has demonstrated a link between Alzheimer disease (AD) and epilepsy. Late-onset epilepsy and epileptiform activity can precede cognitive deterioration in AD by years, and its presence has been shown to predict a faster disease course. In animal models of AD, amyloid and tau pathology are linked to cortical network hyperexcitability that precedes the first signs of memory decline. Thus, detection of epileptiform activity in AD has substantial clinical importance as a potential novel modifiable risk factor for dementia. In this Review, we summarize the epidemiological evidence for the complex bidirectional relationship between AD and epilepsy, examine the effect of epileptiform activity and seizures on cognition in people with AD, and discuss the precision medicine treatment strategies based on the latest research in human and animal models. Finally, we outline some of the unresolved questions of the field that should be addressed by rigorous research, including whether particular clinicopathological subtypes of AD have a stronger association with epilepsy, and the sequence of events between epileptiform activity and amyloid and tau pathology.
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Affiliation(s)
- Anita Kamondi
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary.
- Department of Neurology, Semmelweis University, Budapest, Hungary.
| | | | - Wolfgang Löscher
- Department of Experimental Otology of the ENT Clinics, Hannover Medical School, Hannover, Germany
| | - Heikki Tanila
- A. I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Andras Attila Horvath
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
- Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
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13
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Vicente M, Addo-Osafo K, Vossel K. Latest advances in mechanisms of epileptic activity in Alzheimer's disease and dementia with Lewy Bodies. Front Neurol 2024; 15:1277613. [PMID: 38390593 PMCID: PMC10882721 DOI: 10.3389/fneur.2024.1277613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/12/2024] [Indexed: 02/24/2024] Open
Abstract
Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) stand as the prevailing sources of neurodegenerative dementia, impacting over 55 million individuals across the globe. Patients with AD and DLB exhibit a higher prevalence of epileptic activity compared to those with other forms of dementia. Seizures can accompany AD and DLB in early stages, and the associated epileptic activity can contribute to cognitive symptoms and exacerbate cognitive decline. Aberrant neuronal activity in AD and DLB may be caused by several mechanisms that are not yet understood. Hyperexcitability could be a biomarker for early detection of AD or DLB before the onset of dementia. In this review, we compare and contrast mechanisms of network hyperexcitability in AD and DLB. We examine the contributions of genetic risk factors, Ca2+ dysregulation, glutamate, AMPA and NMDA receptors, mTOR, pathological amyloid beta, tau and α-synuclein, altered microglial and astrocytic activity, and impaired inhibitory interneuron function. By gaining a deeper understanding of the molecular mechanisms that cause neuronal hyperexcitability, we might uncover therapeutic approaches to effectively ease symptoms and slow down the advancement of AD and DLB.
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Affiliation(s)
- Mariane Vicente
- Mary S. Easton Center for Alzheimer's Research and Care, Department of Neurology, David Geffen School of Medicine at University of California, Los Angeles, CA, United States
| | - Kwaku Addo-Osafo
- Mary S. Easton Center for Alzheimer's Research and Care, Department of Neurology, David Geffen School of Medicine at University of California, Los Angeles, CA, United States
| | - Keith Vossel
- Mary S. Easton Center for Alzheimer's Research and Care, Department of Neurology, David Geffen School of Medicine at University of California, Los Angeles, CA, United States
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14
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Khat'kova SE, Pogorel'tseva OA. [Algorithms for the diagnosis and treatment of cognitive impairment and dysphagia in stroke patients]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:100-107. [PMID: 38696158 DOI: 10.17116/jnevro2024124042100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Stroke is a socially significant neurological disease, the second most common cause of disability and mortality. A wide range of neurological problems that occur after stroke: cognitive, motor, speech, and language disfunction, neuropsychiatric, swallowing disorders and others, complicate rehabilitation, impair social and everyday adaptation, and reduce the quality of life of patients and their caregivers. Cognitive impairment (CI) is one of the most significant and common complications of stroke. Stroke increases the risk of their development by 5-8 times. Dysphagia is also a common symptom of stroke, the cause of aspiration complications (pneumonia), and nutritional imbalance. It increases the possibility of developing CI and dementia, and contributes to an increase in mortality. Older adults with CI are at a higher risk of developing dysphagia, therefore the early symptoms of dysphagia (presbyphagia) should be diagnosed. In recent years, the connection between CI and dysphagia has been actively studied. It is extremely important to identify CI and swallowing disorders as early as possible in patients both before and at all stages after stroke; as well as to develop combined multidisciplinary protocols for the rehabilitation of patients with these disorders with pharmacological support for the process.
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15
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Costa C, Nardi Cesarini E, Eusebi P, Franchini D, Casucci P, De Giorgi MF, Calvello C, Paolini Paoletti F, Romoli M, Parnetti L. Incidence and Risk Factors Epilepsy in Patients with Dementia: A Population-Based Study Using Regional Healthcare Databases in Umbria. J Alzheimers Dis 2024; 98:1533-1542. [PMID: 38607757 DOI: 10.3233/jad-231309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Background Dementia is prevalent among the elderly, also representing a risk for seizures/epilepsy. Estimations of epilepsy risk in dementia patients are not widely available. Objective Our research aims to ascertain the incidence of epilepsy and its associated risk factors in subjects with dementia in the Umbria region, based on data from healthcare databases. Methods In this retrospective study based on the healthcare administrative database of Umbria, we identified all patients diagnosed with dementia from 2013 to 2017, based on ICD-9-CM codes. For epilepsy ascertainment, we used a validated algorithm that required an EEG and the prescription of one or more anti-seizure medications post-dementia diagnosis. A case-control analysis was conducted, matching five non-dementia subjects by gender and age to each dementia patient. Cox proportional hazards models were then utilized in the analysis. Results We identified 7,314 dementia cases, also including 35,280 age- and sex-matched control subjects. Out of patients with dementia, 148 individuals (2.02%) were diagnosed with epilepsy. We observed a progressive increase in the cumulative incidence of seizures over time, registering 1.45% in the first year following the diagnosis, and rising to 1.96% after three years. Analysis using Cox regression revealed a significant association between the development of epilepsy and dementia (HR = 4.58, 95% CI = 3.67-5.72). Additional risk factors were male gender (HR = 1.35, 95% CI = 1.07-1.69) and a younger age at dementia onset (HR = 1.03, 95% CI=1.02-1.04). Conclusions Dementia increases epilepsy risk, especially with early onset and male gender. Clinicians should have a low threshold to suspect seizures in dementia cases.
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Affiliation(s)
- Cinzia Costa
- Department of Medicine and Surgery, Neurology Clinic, University of Perugia, S.M. Misericordia Hospital, Perugia, Italy
| | - Elena Nardi Cesarini
- Department of Medicine and Surgery, Neurology Clinic, University of Perugia, S.M. Misericordia Hospital, Perugia, Italy
- UOC Neurologia, Ospedali Riuniti Marche Nord, Fano-Pesaro, Italy
| | - Paolo Eusebi
- Department of Medicine and Surgery, Neurology Clinic, University of Perugia, S.M. Misericordia Hospital, Perugia, Italy
| | - David Franchini
- Health ICT Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Paola Casucci
- Health ICT Service, Regional Health Authority of Umbria, Perugia, Italy
| | | | - Carmen Calvello
- Department of Medicine and Surgery, Neurology Clinic, University of Perugia, S.M. Misericordia Hospital, Perugia, Italy
- UOC Neurologia, SM Goretti, Latina, Italy
| | - Federico Paolini Paoletti
- Department of Medicine and Surgery, Neurology Clinic, University of Perugia, S.M. Misericordia Hospital, Perugia, Italy
| | - Michele Romoli
- Neurology and Stroke Unit, Bufalini Hospital, Cesena, Italy
| | - Lucilla Parnetti
- Department of Medicine and Surgery, Neurology Clinic, University of Perugia, S.M. Misericordia Hospital, Perugia, Italy
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Helmstaedter C, Lutz T, Wolf V, Witt JA. Prevalence of dementia in a level 4 university epilepsy center: how big is the problem? Front Neurol 2023; 14:1217594. [PMID: 37928163 PMCID: PMC10623304 DOI: 10.3389/fneur.2023.1217594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/27/2023] [Indexed: 11/07/2023] Open
Abstract
Background The relationship between epilepsy and dementia is currently a topic of great interest. Our study aimed to determine the prevalence of dementia diagnoses among patients of a large level 4 university epilepsy center. Methods In this retrospective monocentric study conducted at the Department of Epileptology of the University Hospital Bonn, we searched for dementia-related terms in a total of 145,501 medical letters from 40,360 adult patients who were seen between 2003 and 2021. Files with at least one hit were selected and analyzed with regard to diagnoses, age, age at epilepsy onset, and the question as to whether epilepsy preceded or followed the dementia diagnosis. Results Among the medical letters of 513 patients, dementia-related terms were found. The letters of 12.7% of these patients stated a dementia diagnosis, 6.6% were suspected of having dementia, 4.9% had mild cognitive impairment, and 6.6% had other neurodegenerative diseases without dementia. Taking all 40,360 patients into account, the prevalence of diagnosed or suspected dementia was 0.25%. An older age (≥60 years) and late-onset epilepsy (≥60 years), but not a longer epilepsy duration, increased the odds of dementia by 6.1 (CI 3.5-10.7) and 2.9 (CI 1.7-4.7), respectively. Additionally, vascular, metabolic, inflammatory, and behavioral mood-related comorbidities were commonly observed. Epilepsy tended to precede (23.2%) rather than follow (8.1%) the dementia diagnosis. Conclusion Despite the clear limitations of a selection bias and the potential underdiagnosis of dementia and underestimation of its prevalence when relying on the medical letters from a specialized center which rather focuses on epilepsy-related issues, the findings of this study offer valuable insights from the perspective of an epilepsy center. In this setting, the prevalence of dementia in epilepsy is rather low. However, physicians should be aware that the risk of dementia is higher in the elderly, in late-onset epilepsies, and when comorbid risk factors exist. Seizures can also be an early sign of a neurodegenerative disease. Future research should explicitly screen for dementia in patients with epilepsy and stratify them according to their underlying pathologies and comorbidities.
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Lee KW, Chung HW, Hsieh HM, Tsao YH, Hung CH, Feng MC, Hung CH. Post-stroke dysphagia and ambient air pollution are associated with dementia. Front Aging Neurosci 2023; 15:1272213. [PMID: 37881359 PMCID: PMC10597701 DOI: 10.3389/fnagi.2023.1272213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/25/2023] [Indexed: 10/27/2023] Open
Abstract
Introduction This cohort study aimed to explore the potential association between ambient air pollution and dementia incidence in adults who have experienced a stroke. Additionally, the study aimed to determine dysphagia as a predictive factor for the subsequent development of dementia in patients with stroke. Materials and methods This retrospective nested case-control study used data from the Kaohsiung Medical University Hospital Database in Taiwan. Data collected include average ambient air pollution concentrations within 3 months and 1 year after the index dysphagia date. The primary outcome includes incident dementia in patients with or without dysphagia. Logistic regression analysis was performed to examine the association between significant air pollution exposure and the risk of dementia while controlling for baseline demographic characteristics (age and sex), and comorbidities. Results The univariable regression models revealed a higher likelihood of dementia diagnosis in patients with dysphagia (odds ratio = 1.493, 95% confidence interval = 1.000-2.228). The raw odds ratios indicated a potential link between air pollution exposure and elevated dementia risks in the overall study population and patients with stroke without dysphagia, except for O3. Particulate matter (PM)2.5 and nitrogen oxides (NOx) exhibited significant effects on the risk of dementia in the stepwise logistic regression models. Conclusion The presence of dysphagia following a stroke may pose a risk of developing dementia. Additionally, PM2.5 and NOx exposure appears to elevate the risk of dementia in patients with stroke.
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Affiliation(s)
- Kuo-Wei Lee
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hao-Wei Chung
- Department of Pediatrics, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Biological Science and Technology, National Yang Ming Chiao-Tung University, Hsinchu, Taiwan
- Department of Pediatrics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Min Hsieh
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Medical Statistics and Bioinformatics, Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Hsiang Tsao
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Medical Statistics and Bioinformatics, Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chih-Hsien Hung
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Chu Feng
- Department of Dysphagia Functional Reconstructive Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Nursing, Fooyin University, Kaohsiung, Taiwan
| | - Chih-Hsing Hung
- Department of Pediatrics, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Pediatrics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Kaohsiung Medical University, Kaohsiung, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Pediatrics, Faculty of Pediatrics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Hickman LB, Stern JM, Silverman DHS, Salamon N, Vossel K. Clinical, imaging, and biomarker evidence of amyloid- and tau-related neurodegeneration in late-onset epilepsy of unknown etiology. Front Neurol 2023; 14:1241638. [PMID: 37830092 PMCID: PMC10565489 DOI: 10.3389/fneur.2023.1241638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/05/2023] [Indexed: 10/14/2023] Open
Abstract
Accumulating evidence suggests amyloid and tau-related neurodegeneration may play a role in development of late-onset epilepsy of unknown etiology (LOEU). In this article, we review recent evidence that epilepsy may be an initial manifestation of an amyloidopathy or tauopathy that precedes development of Alzheimer's disease (AD). Patients with LOEU demonstrate an increased risk of cognitive decline, and patients with AD have increased prevalence of preceding epilepsy. Moreover, investigations of LOEU that use CSF biomarkers and imaging techniques have identified preclinical neurodegeneration with evidence of amyloid and tau deposition. Overall, findings to date suggest a relationship between acquired, non-lesional late-onset epilepsy and amyloid and tau-related neurodegeneration, which supports that preclinical or prodromal AD is a distinct etiology of late-onset epilepsy. We propose criteria for assessing elevated risk of developing dementia in patients with late-onset epilepsy utilizing clinical features, available imaging techniques, and biomarker measurements. Further research is needed to validate these criteria and assess optimal treatment strategies for patients with probable epileptic preclinical AD and epileptic prodromal AD.
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Affiliation(s)
- L. Brian Hickman
- Mary S. Easton Center for Alzheimer’s Research and Care, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Neurology, UCLA Seizure Disorder Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - John M. Stern
- Department of Neurology, UCLA Seizure Disorder Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Daniel H. S. Silverman
- Mary S. Easton Center for Alzheimer’s Research and Care, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Noriko Salamon
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Keith Vossel
- Mary S. Easton Center for Alzheimer’s Research and Care, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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Johnson EL, Sullivan KJ, Schneider ALC, Simino J, Mosley TH, Kucharska-Newton A, Knopman DS, Gottesman RF. Association of Plasma Aβ 42/Aβ 40 Ratio and Late-Onset Epilepsy: Results From the Atherosclerosis Risk in Communities Study. Neurology 2023; 101:e1319-e1327. [PMID: 37541842 PMCID: PMC10558158 DOI: 10.1212/wnl.0000000000207635] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/30/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The objective of this study was to determine the relationship between plasma β-amyloid (Aβ), specifically the ratio of 2 Aβ peptides (the Aβ42/Aβ40 ratio, which correlates with increased accumulation of Aβ in the CNS), and late-onset epilepsy (LOE). METHODS We used Medicare fee-for-service claims codes from 1991 to 2018 to identify cases of LOE among 1,424 Black and White men and women enrolled in the Atherosclerosis Risk in Communities (ARIC) study cohort. The Aβ42/Aβ40 ratio was calculated from plasma samples collected from ARIC participants in 1993-1995 (age 50-71 years) and 2011-2013 (age 67-90 years). We used survival analysis accounting for the competing risk of death to determine the relationship between late-life plasma Aβ42/Aβ40, and its change from midlife to late life, and the subsequent development of epilepsy. We adjusted for demographics, the apolipoprotein e4 genotype, and comorbidities, including stroke, dementia, and head injury. A low plasma ratio of 2 Aβ peptides, the Aβ42/Aβ40 ratio, correlates with low CSF Aβ42/Aβ40 and with increased accumulation of Aβ in the CNS. RESULTS Decrease in plasma Aβ42/Aβ40 ratio from midlife to late life, but not an isolated measurement of Aβ42/Aβ40, was associated with development of epilepsy in later life. For every 50% reduction in Aβ42/Aβ40, there was a 2-fold increase in risk of epilepsy (adjusted subhazard ratio 2.30, 95% CI 1.27-4.17). DISCUSSION A reduction in plasma Aβ42/Aβ40 is associated with an increased risk of subsequent epilepsy. Our observations provide a further validation of the link between Aβ, hyperexcitable states, and LOE.
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Affiliation(s)
- Emily L Johnson
- From the Department of Neurology (E.L.J.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (K.J.S., T.H.M.), University of Mississippi Medical Center, Jackson; Departments of Neurology (A.L.C.S.) and Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Philadelphia; Department of Data Science and Memory Impairment and Neurodegenerative Dementia (MIND) Center (J.S.), University of Mississippi Medical Center, Jackson, MD; Department of Epidemiology (A.K.-N.), University of North Carolina Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and National Institute for Neurologic Disorders and Stroke Intramural Research Program (R.F.G.), National Institutes of Health, Bethesda, MD.
| | - Kevin J Sullivan
- From the Department of Neurology (E.L.J.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (K.J.S., T.H.M.), University of Mississippi Medical Center, Jackson; Departments of Neurology (A.L.C.S.) and Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Philadelphia; Department of Data Science and Memory Impairment and Neurodegenerative Dementia (MIND) Center (J.S.), University of Mississippi Medical Center, Jackson, MD; Department of Epidemiology (A.K.-N.), University of North Carolina Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and National Institute for Neurologic Disorders and Stroke Intramural Research Program (R.F.G.), National Institutes of Health, Bethesda, MD
| | - Andrea Lauren Christman Schneider
- From the Department of Neurology (E.L.J.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (K.J.S., T.H.M.), University of Mississippi Medical Center, Jackson; Departments of Neurology (A.L.C.S.) and Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Philadelphia; Department of Data Science and Memory Impairment and Neurodegenerative Dementia (MIND) Center (J.S.), University of Mississippi Medical Center, Jackson, MD; Department of Epidemiology (A.K.-N.), University of North Carolina Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and National Institute for Neurologic Disorders and Stroke Intramural Research Program (R.F.G.), National Institutes of Health, Bethesda, MD
| | - Jeannette Simino
- From the Department of Neurology (E.L.J.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (K.J.S., T.H.M.), University of Mississippi Medical Center, Jackson; Departments of Neurology (A.L.C.S.) and Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Philadelphia; Department of Data Science and Memory Impairment and Neurodegenerative Dementia (MIND) Center (J.S.), University of Mississippi Medical Center, Jackson, MD; Department of Epidemiology (A.K.-N.), University of North Carolina Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and National Institute for Neurologic Disorders and Stroke Intramural Research Program (R.F.G.), National Institutes of Health, Bethesda, MD
| | - Tom H Mosley
- From the Department of Neurology (E.L.J.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (K.J.S., T.H.M.), University of Mississippi Medical Center, Jackson; Departments of Neurology (A.L.C.S.) and Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Philadelphia; Department of Data Science and Memory Impairment and Neurodegenerative Dementia (MIND) Center (J.S.), University of Mississippi Medical Center, Jackson, MD; Department of Epidemiology (A.K.-N.), University of North Carolina Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and National Institute for Neurologic Disorders and Stroke Intramural Research Program (R.F.G.), National Institutes of Health, Bethesda, MD
| | - Anna Kucharska-Newton
- From the Department of Neurology (E.L.J.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (K.J.S., T.H.M.), University of Mississippi Medical Center, Jackson; Departments of Neurology (A.L.C.S.) and Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Philadelphia; Department of Data Science and Memory Impairment and Neurodegenerative Dementia (MIND) Center (J.S.), University of Mississippi Medical Center, Jackson, MD; Department of Epidemiology (A.K.-N.), University of North Carolina Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and National Institute for Neurologic Disorders and Stroke Intramural Research Program (R.F.G.), National Institutes of Health, Bethesda, MD
| | - David S Knopman
- From the Department of Neurology (E.L.J.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (K.J.S., T.H.M.), University of Mississippi Medical Center, Jackson; Departments of Neurology (A.L.C.S.) and Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Philadelphia; Department of Data Science and Memory Impairment and Neurodegenerative Dementia (MIND) Center (J.S.), University of Mississippi Medical Center, Jackson, MD; Department of Epidemiology (A.K.-N.), University of North Carolina Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and National Institute for Neurologic Disorders and Stroke Intramural Research Program (R.F.G.), National Institutes of Health, Bethesda, MD
| | - Rebecca F Gottesman
- From the Department of Neurology (E.L.J.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine (K.J.S., T.H.M.), University of Mississippi Medical Center, Jackson; Departments of Neurology (A.L.C.S.) and Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Philadelphia; Department of Data Science and Memory Impairment and Neurodegenerative Dementia (MIND) Center (J.S.), University of Mississippi Medical Center, Jackson, MD; Department of Epidemiology (A.K.-N.), University of North Carolina Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and National Institute for Neurologic Disorders and Stroke Intramural Research Program (R.F.G.), National Institutes of Health, Bethesda, MD
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Lam AD. Linking Late-Onset Epilepsy With Alzheimer Disease: Insights From Plasma Amyloid Measurements. Neurology 2023; 101:551-552. [PMID: 37541840 DOI: 10.1212/wnl.0000000000207683] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 08/06/2023] Open
Affiliation(s)
- Alice D Lam
- From the Department of Neurology (A.D.L.), Massachusetts General Hospital; and Harvard Medical School (A.D.L.), Boston, MA.
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Zhang X, Ahmed R, Thayer Z, Breen N, McMillan J, Fulham M, Nikpour A. Late-onset epilepsy with cognitive symptoms: Comparison of cognitive and imaging profiles with probable Alzheimer's disease. Epilepsy Behav 2023; 146:109371. [PMID: 37556966 DOI: 10.1016/j.yebeh.2023.109371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE We aimed to (i) compare the clinical, neuropsychological, and neuroimaging characteristics of unprovoked late-onset epilepsy (LOE) patients with cognitive symptoms against probable Alzheimer's disease (AD) patients; (ii) clarify how neurodegeneration and other processes could be implicated in the cognitive symptoms of unprovoked LOE patients; and (iii) characterize the longitudinal trajectory of unprovoked LOE patients with cognitive symptoms. METHODS Twenty-six unprovoked LOE patients with cognitive symptoms and 26 probable AD were retrospectively recruited from epilepsy and memory clinics at a single tertiary referral center. The patients underwent comprehensive clinical, neuropsychological, and 18Fluorodeoxyglucose PET-CT assessments. All LOE patients had clinical follow-up and a subset of 17 patients had repeat neuropsychological assessments. RESULTS At baseline, 18% of LOE patients with cognitive symptoms had dementia-range cognitive impairment and one received a diagnosis of probable AD. Compared with the probable AD group, the LOE group did not perform significantly better in global measures of cognition (total ACE-III), neuropsychological tests for fluency, working memory, language, attention, or executive function, but performed better in naming, memory, and visuospatial ability. The commonest patterns of cognitive impairment in the LOE group were frontal and left temporal, whereas all AD patients exhibited parietotemporal patterns. The AD group had more 18Fluorodeoxyglucose PET-CT hypometabolism in the parietal and occipital, but not the temporal and frontal lobes. During the 3.0 ± 3.2 years follow-up, improved seizure frequency in the LOE group covaried with improved total ACE-III score, there was no further conversion to probable AD and no group-level cognitive decline. CONCLUSION Unprovoked LOE patients with cognitive symptoms had varying severities of cognitive impairment, and different patterns of cognitive and imaging abnormalities compared with AD patients. They were rarely diagnosed with probable AD at presentation or follow-up. Cognitive outcome in LOE may be related to seizure control. Cerebral small vessel disease may play a role in LOE-associated cognitive impairment.
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Affiliation(s)
- Xin Zhang
- Department of Neurology, Royal Prince Alfred Hospital, Missenden Road, Camperdown 2050, Australia; The University of Sydney, Faculty of Medicine and Health, Camperdown 2050, Australia.
| | - Rebekah Ahmed
- Department of Neurology, Royal Prince Alfred Hospital, Missenden Road, Camperdown 2050, Australia; The University of Sydney, Brain and Mind Centre, 94 Mallett Street, Camperdown 2050, Australia
| | - Zoe Thayer
- Department of Neurology, Royal Prince Alfred Hospital, Missenden Road, Camperdown 2050, Australia
| | - Nora Breen
- Macquarie University Hospital, 3 Technology Pl, Macquarie University, NSW 2109, Australia
| | - Jillian McMillan
- Macquarie University Hospital, 3 Technology Pl, Macquarie University, NSW 2109, Australia
| | - Michael Fulham
- Department of Neurology, Royal Prince Alfred Hospital, Missenden Road, Camperdown 2050, Australia; Department of Molecular Imaging, Royal Prince Alfred Hospital, Missenden Road, Camperdown 2050, NSW, Australia
| | - Armin Nikpour
- Department of Neurology, Royal Prince Alfred Hospital, Missenden Road, Camperdown 2050, Australia; Department of Molecular Imaging, Royal Prince Alfred Hospital, Missenden Road, Camperdown 2050, NSW, Australia; The University of Sydney, Faculty of Medicine and Health, Camperdown 2050, Australia
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22
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Reyes A, Schneider ALC, Kucharska-Newton AM, Gottesman RF, Johnson EL, McDonald CR. Cognitive phenotypes in late-onset epilepsy: results from the atherosclerosis risk in communities study. Front Neurol 2023; 14:1230368. [PMID: 37745655 PMCID: PMC10513940 DOI: 10.3389/fneur.2023.1230368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 08/02/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Cognitive phenotyping is a widely used approach to characterize the heterogeneity of deficits in patients with a range of neurological disorders but has only recently been applied to patients with epilepsy. In this study, we identify cognitive phenotypes in older adults with late-onset epilepsy (LOE) and examine their demographic, clinical, and vascular profiles. Further, we examine whether specific phenotypes pose an increased risk for progressive cognitive decline. Methods Participants were part of the Atherosclerosis Risk in Communities Study (ARIC), a prospective longitudinal community-based cohort study of 15,792 individuals initially enrolled in 1987-1989. LOE was identified from linked Centers for Medicare and Medicaid Services claims data. Ninety-one participants with LOE completed comprehensive testing either prior to or after seizure onset as part of a larger cohort in the ARIC Neurocognitive Study in either 2011-2013 or 2016-2017 (follow-up mean = 4.9 years). Cognitive phenotypes in individuals with LOE were derived by calculating test-level impairments for each participant (i.e., ≤1 SD below cognitively normal participants on measures of language, memory, and executive function/processing speed); and then assigning participants to phenotypes if they were impaired on at least two tests within a domain. The total number of impaired domains was used to determine the cognitive phenotypes (i.e., Minimal/No Impairment, Single Domain, or Multidomain). Results At our baseline (Visit 5), 36.3% met criteria for Minimal/No Impairment, 35% for Single Domain Impairment (with executive functioning/ processing speed impaired in 53.6%), and 28.7% for Multidomain Impairment. The Minimal/No Impairment group had higher education and occupational complexity. There were no differences in clinical or vascular risk factors across phenotypes. Of those participants with longitudinal data (Visit 6; n = 24), 62.5% declined (i.e., progressed to a more impaired phenotype) and 37.5% remained stable. Those who remained stable were more highly educated compared to those that declined. Discussion Our results demonstrate the presence of identifiable cognitive phenotypes in older adults with LOE. These results also highlight the high prevalence of cognitive impairments across domains, with deficits in executive function/processing speed the most common isolated impairment. We also demonstrate that higher education was associated with a Minimal/No Impairment phenotype and lower risk for cognitive decline over time.
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Affiliation(s)
- Anny Reyes
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Andrea L. C. Schneider
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Anna M. Kucharska-Newton
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Rebecca F. Gottesman
- National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD, United States
| | - Emily L. Johnson
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Carrie R. McDonald
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, La Jolla, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
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23
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Tai XY, Torzillo E, Lyall DM, Manohar S, Husain M, Sen A. Association of Dementia Risk With Focal Epilepsy and Modifiable Cardiovascular Risk Factors. JAMA Neurol 2023; 80:445-454. [PMID: 36972059 PMCID: PMC10043806 DOI: 10.1001/jamaneurol.2023.0339] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/26/2023] [Indexed: 03/29/2023]
Abstract
Importance Epilepsy has been associated with cognitive impairment and potentially dementia in older individuals. However, the extent to which epilepsy may increase dementia risk, how this compares with other neurological conditions, and how modifiable cardiovascular risk factors may affect this risk remain unclear. Objective To compare the differential risks of subsequent dementia for focal epilepsy compared with stroke and migraine as well as healthy controls, stratified by cardiovascular risk. Design, Setting, and Participants This cross-sectional study is based on data from the UK Biobank, a population-based cohort of more than 500 000 participants aged 38 to 72 years who underwent physiological measurements and cognitive testing and provided biological samples at 1 of 22 centers across the United Kingdom. Participants were eligible for this study if they were without dementia at baseline and had clinical data pertaining to a history of focal epilepsy, stroke, or migraine. The baseline assessment was performed from 2006 to 2010, and participants were followed up until 2021. Exposures Mutually exclusive groups of participants with epilepsy, stroke, and migraine at baseline assessment and controls (who had none of these conditions). Individuals were divided into low, moderate, or high cardiovascular risk groups based on factors that included waist to hip ratio, history of hypertension, hypercholesterolemia, diabetes, and smoking pack-years. Main Outcomes and Measures Incident all-cause dementia; measures of executive function; and brain total hippocampal, gray matter, and white matter hyperintensity volumes. Results Of 495 149 participants (225 481 [45.5%] men; mean [SD] age, 57.5 [8.1] years), 3864 had a diagnosis of focal epilepsy only, 6397 had a history of stroke only, and 14 518 had migraine only. Executive function was comparable between participants with epilepsy and stroke and worse than the control and migraine group. Focal epilepsy was associated with a higher risk of developing dementia (hazard ratio [HR], 4.02; 95% CI, 3.45 to 4.68; P < .001), compared with stroke (HR, 2.56; 95% CI, 2.28 to 2.87; P < .001), or migraine (HR, 1.02; 95% CI, 0.85 to 1.21; P = .94). Participants with focal epilepsy and high cardiovascular risk were more than 13 times more likely to develop dementia (HR, 13.66; 95% CI, 10.61 to 17.60; P < .001) compared with controls with low cardiovascular risk. The imaging subsample included 42 353 participants. Focal epilepsy was associated with lower hippocampal volume (mean difference, -0.17; 95% CI, -0.02 to -0.32; t = -2.18; P = .03) and lower total gray matter volume (mean difference, -0.33; 95% CI, -0.18 to -0.48; t = -4.29; P < .001) compared with controls. There was no significant difference in white matter hyperintensity volume (mean difference, 0.10; 95% CI, -0.07 to 0.26; t = 1.14; P = .26). Conclusions and Relevance In this study, focal epilepsy was associated with a significant risk of developing dementia, to a greater extent than stroke, which was magnified substantially in individuals with high cardiovascular risk. Further findings suggest that targeting modifiable cardiovascular risk factors may be an effective intervention to reduce dementia risk in individuals with epilepsy.
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Affiliation(s)
- Xin You Tai
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
| | - Emma Torzillo
- Epilepsy Department, National Hospital for Neurology and Neurosurgery, University College London, London, United Kingdom
| | - Donald M. Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Sanjay Manohar
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Masud Husain
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Arjune Sen
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
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Neligan A, Adan G, Nevitt SJ, Pullen A, Sander JW, Bonnett L, Marson AG. Prognosis of adults and children following a first unprovoked seizure. Cochrane Database Syst Rev 2023; 1:CD013847. [PMID: 36688481 PMCID: PMC9869434 DOI: 10.1002/14651858.cd013847.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Epilepsy is clinically defined as two or more unprovoked epileptic seizures more than 24 hours apart. Given that, a diagnosis of epilepsy can be associated with significant morbidity and mortality, it is imperative that clinicians (and people with seizures and their relatives) have access to accurate and reliable prognostic estimates, to guide clinical practice on the risks of developing further unprovoked seizures (and by definition, a diagnosis of epilepsy) following single unprovoked epileptic seizure. OBJECTIVES 1. To provide an accurate estimate of the proportion of individuals going on to have further unprovoked seizures at subsequent time points following a single unprovoked epileptic seizure (or cluster of epileptic seizures within a 24-hour period, or a first episode of status epilepticus), of any seizure type (overall prognosis). 2. To evaluate the mortality rate following a first unprovoked epileptic seizure. SEARCH METHODS We searched the following databases on 19 September 2019 and again on 30 March 2021, with no language restrictions. The Cochrane Register of Studies (CRS Web), MEDLINE Ovid (1946 to March 29, 2021), SCOPUS (1823 onwards), ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). CRS Web includes randomized or quasi-randomized, controlled trials from PubMed, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP), the Cochrane Central Register of Controlled Trials (CENTRAL), and the Specialized Registers of Cochrane Review Groups including Epilepsy. In MEDLINE (Ovid) the coverage end date always lags a few days behind the search date. SELECTION CRITERIA We included studies, both retrospective and prospective, of all age groups (except those in the neonatal period (< 1 month of age)), of people with a single unprovoked seizure, followed up for a minimum of six months, with no upper limit of follow-up, with the study end point being seizure recurrence, death, or loss to follow-up. To be included, studies must have included at least 30 participants. We excluded studies that involved people with seizures that occur as a result of an acute precipitant or provoking factor, or in close temporal proximity to an acute neurological insult, since these are not considered epileptic in aetiology (acute symptomatic seizures). We also excluded people with situational seizures, such as febrile convulsions. DATA COLLECTION AND ANALYSIS Two review authors conducted the initial screening of titles and abstracts identified through the electronic searches, and removed non-relevant articles. We obtained the full-text articles of all remaining potentially relevant studies, or those whose relevance could not be determined from the abstract alone and two authors independently assessed for eligibility. All disagreements were resolved through discussion with no need to defer to a third review author. We extracted data from included studies using a data extraction form based on the checklist for critical appraisal and data extraction for systematicreviews of prediction modelling studies (CHARMS). Two review authors then appraised the included studies, using a standardised approach based on the quality in prognostic studies (QUIPS) tool, which was adapted for overall prognosis (seizure recurrence). We conducted a meta-analysis using Review Manager 2014, with a random-effects generic inverse variance meta-analysis model, which accounted for any between-study heterogeneity in the prognostic effect. We then summarised the meta-analysis by the pooled estimate (the average prognostic factor effect), its 95% confidence interval (CI), the estimates of I² and Tau² (heterogeneity), and a 95% prediction interval for the prognostic effect in a single population at three various time points, 6 months, 12 months and 24 months. Subgroup analysis was performed according to the ages of the cohorts included; studies involving all ages, studies that recruited adult only and those that were purely paediatric. MAIN RESULTS Fifty-eight studies (involving 54 cohorts), with a total of 12,160 participants (median 147, range 31 to 1443), met the inclusion criteria for the review. Of the 58 studies, 26 studies were paediatric studies, 16 were adult and the remaining 16 studies were a combination of paediatric and adult populations. Most included studies had a cohort study design with two case-control studies and one nested case-control study. Thirty-two studies (29 cohorts) reported a prospective longitudinal design whilst 15 studies had a retrospective design whilst the remaining studies were randomised controlled trials. Nine of the studies included presented mortality data following a first unprovoked seizure. For a mortality study to be included, a proportional mortality ratio (PMR) or a standardised mortality ratio (SMR) had to be given at a specific time point following a first unprovoked seizure. To be included in the meta-analysis a study had to present clear seizure recurrence data at 6 months, 12 months or 24 months. Forty-six studies were included in the meta-analysis, of which 23 were paediatric, 13 were adult, and 10 were a combination of paediatric and adult populations. A meta-analysis was performed at three time points; six months, one year and two years for all ages combined, paediatric and adult studies, respectively. We found an estimated overall seizure recurrence of all included studies at six months of 27% (95% CI 24% to 31%), 36% (95% CI 33% to 40%) at one year and 43% (95% CI 37% to 44%) at two years, with slightly lower estimates for adult subgroup analysis and slightly higher estimates for paediatric subgroup analysis. It was not possible to provide a summary estimate of the risk of seizure recurrence beyond these time points as most of the included studies were of short follow-up and too few studies presented recurrence rates at a single time point beyond two years. The evidence presented was found to be of moderate certainty. AUTHORS' CONCLUSIONS Despite the limitations of the data (moderate-certainty of evidence), mainly relating to clinical and methodological heterogeneity we have provided summary estimates for the likely risk of seizure recurrence at six months, one year and two years for both children and adults. This provides information that is likely to be useful for the clinician counselling patients (or their parents) on the probable risk of further seizures in the short-term whilst acknowledging the paucity of long-term recurrence data, particularly beyond 10 years.
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Affiliation(s)
- Aidan Neligan
- Homerton University Hospital, NHS Foundation Trust, London, UK
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Guleed Adan
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Sarah J Nevitt
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | | | - Josemir W Sander
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Laura Bonnett
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Anthony G Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
- Liverpool Health Partners, Liverpool, UK
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Sarkis RA, Gale SA, Yang HS, Lam AD, Singhal T, Cicero S, Willment K, McGinnis SM. Utility of Amyloid Positron Emission Tomography Imaging in Older Adults With Epilepsy and Cognitive Decline. Am J Alzheimers Dis Other Demen 2023; 38:15333175231160005. [PMID: 36892007 PMCID: PMC10580726 DOI: 10.1177/15333175231160005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
In older adults with cognitive decline and epilepsy, diagnosing the etiology of cognitive decline is challenging. We identified 6 subjects enrolled in the Imaging Dementia-Evidence of Amyloid Imaging Scanning (IDEAS) study and nonlesional epilepsy. Three cognitive neurologists reviewed each case to determine the likelihood of underlying Alzheimer's disease (AD) pathology. Their impressions were compared to amyloid PET findings. In 3 cases the impression was concordant with PET findings. In 2 cases "possibly suggestive," the PET reduced diagnostic uncertainty, with 1 having a PET without elevated amyloid and the other PET with intermediate amyloid. In the remaining case with lack of reviewer concordance, the significance of PET with elevated amyloid remains uncertain. This case series highlights that in individuals with a history of epilepsy and cognitive decline, amyloid PET can be a useful tool in evaluating the etiology of cognitive decline when used in an appropriate context.
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Affiliation(s)
- Rani A. Sarkis
- Department of Neurology, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA
| | - Seth A. Gale
- Department of Neurology, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA
| | - Hyun-Sik Yang
- Department of Neurology, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Alice D. Lam
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Tarun Singhal
- Department of Neurology, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA
| | - Steven Cicero
- Department of Neurology, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA
| | - Kim Willment
- Department of Neurology, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA
| | - Scott M. McGinnis
- Department of Neurology, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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Meta-analysis of the risk of dementia in elderly patients with late-onset epilepsy. Clin Neurol Neurosurg 2022; 223:107499. [DOI: 10.1016/j.clineuro.2022.107499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 10/16/2022] [Accepted: 10/19/2022] [Indexed: 11/23/2022]
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27
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Epilepsy in Older Persons. Neurol Clin 2022; 40:891-905. [DOI: 10.1016/j.ncl.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Lekoubou A, Ba DM, Nguyen C, Liu G, Leslie DL, Bonilha L, Vernon CM. Poststroke Seizures and the Risk of Dementia Among Young Stroke Survivors. Neurology 2022; 99:e385-e392. [PMID: 35584925 PMCID: PMC9421769 DOI: 10.1212/wnl.0000000000200736] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 03/30/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The effect of new-onset seizures in young stroke survivors on the subsequent development of dementia is poorly understood. This study aimed to assess the association between new onset of seizure and dementia in a population-based study of patients with stroke. METHODS The IBM Watson Health MarketScan Commercial Claims and Encounters database for the years 2005-2014 served as the data source for this study. Using the International Classification of Diseases, Ninth Revision (ICD-9), we identified patients aged 18-60 years with ischemic strokes (ISs; 433.x1, 434.x1, and 436) and hemorrhagic strokes (HSs; 430, 431, 432.0, 432.1, and 432.9) between January 1, 2006, and December 31, 2009, which constituted our baseline study cohort. At baseline, all included participants were free of claims for dementia, brain tumors, toxin exposure, traumatic brain injury, and neuroinfectious diseases, identified using ICD-9 codes. They had at least 1-year continuous enrollment before the index stroke diagnosis and 5 years after, with no seizure claims within 1 year after the index date. The exposure of interest was seizures: a time-dependent variable. The study outcome of interest was dementia (ICD-9: 290.0, 290.10-13, 290.20-21, 290.3, 290.40-43, 291.2, 292.82, 294.10-11, 294.20-21, 294.8, 331.0, 331.11, 331.19, and 331.82), which occurred during the follow-up period from January 1, 2010, to December 31, 2014. A Cox proportional hazards regression model was applied to calculate the hazard ratio (HR) and 95% CI for the independent association of seizures with the occurrence of dementia. RESULTS At the end of the baseline period, we identified 23,680 patients with stroke (IS: 20,642 and HS: 3,038). The cumulative incidence of seizure was 6.7%, 6.4%, and 8.3% for all strokes, IS, and HS, respectively. The cumulative incidence of dementia was 1.3%, 1.4%, and 0.9% for all strokes, IS, and HS, respectively. After multivariable adjustment, young patients with stroke who developed seizures had a greater risk of dementia compared with those without seizures (all strokes adjusted HR: 2.53, 95% CI 1.84-3.48; IS: 2.52, 1.79-3.53; HS: 2.80, 1.05-7.43). DISCUSSION These findings suggest that the onset of seizures in young stroke survivors is associated with a 2.53 times increased risk of developing dementia. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that poststroke seizures increase the probability of dementia in young stroke survivors.
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Affiliation(s)
- Alain Lekoubou
- From the Department of Neurology (A.L., C.N.), Penn State University, Hershey Medical Center; Department of Public Health Sciences (D.M.B., G.L., D.L.L., C.M.V.), Penn State College of Medicine, Hershey; and Department of Neurology (L.B.), Medical University of South Carolina, Charleston.
| | - Djibril M Ba
- From the Department of Neurology (A.L., C.N.), Penn State University, Hershey Medical Center; Department of Public Health Sciences (D.M.B., G.L., D.L.L., C.M.V.), Penn State College of Medicine, Hershey; and Department of Neurology (L.B.), Medical University of South Carolina, Charleston
| | - Clever Nguyen
- From the Department of Neurology (A.L., C.N.), Penn State University, Hershey Medical Center; Department of Public Health Sciences (D.M.B., G.L., D.L.L., C.M.V.), Penn State College of Medicine, Hershey; and Department of Neurology (L.B.), Medical University of South Carolina, Charleston
| | - Guodong Liu
- From the Department of Neurology (A.L., C.N.), Penn State University, Hershey Medical Center; Department of Public Health Sciences (D.M.B., G.L., D.L.L., C.M.V.), Penn State College of Medicine, Hershey; and Department of Neurology (L.B.), Medical University of South Carolina, Charleston
| | - Douglas L Leslie
- From the Department of Neurology (A.L., C.N.), Penn State University, Hershey Medical Center; Department of Public Health Sciences (D.M.B., G.L., D.L.L., C.M.V.), Penn State College of Medicine, Hershey; and Department of Neurology (L.B.), Medical University of South Carolina, Charleston
| | - Leonardo Bonilha
- From the Department of Neurology (A.L., C.N.), Penn State University, Hershey Medical Center; Department of Public Health Sciences (D.M.B., G.L., D.L.L., C.M.V.), Penn State College of Medicine, Hershey; and Department of Neurology (L.B.), Medical University of South Carolina, Charleston
| | - Chinchilli M Vernon
- From the Department of Neurology (A.L., C.N.), Penn State University, Hershey Medical Center; Department of Public Health Sciences (D.M.B., G.L., D.L.L., C.M.V.), Penn State College of Medicine, Hershey; and Department of Neurology (L.B.), Medical University of South Carolina, Charleston
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Nagino N, Kubota Y, Nakamoto H, Miyao S, Kodama T, Ito S, Oguni H, Chernov M. Non-lesional late-onset epilepsy in the elderly Japanese patients: Presenting characteristics and seizure outcomes with regard to comorbid dementia. J Clin Neurosci 2022; 103:100-106. [PMID: 35868225 DOI: 10.1016/j.jocn.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 10/17/2022]
Abstract
The objective of the present retrospective study was analysis of clinical, radiological, and electrophysiological characteristics of the non-lesional late-onset epilepsy (NLLOE) in the elderly Japanese patients, and comparison of the seizure outcomes in this population with regard to presence of comorbid dementia. The study cohort comprised 89 consecutive patients with NLLOE aged ≥ 65 years. In 49 cases (55%), NLLOE manifested with a single type of seizure. Focal impaired awareness seizures (FIAS) were encountered most often (in 69 patients; 78%). Ten patients (11%) had a history of the status epilepticus. Comorbid dementia was diagnosed in 31 patients (35%). Localized or diffuse white matter hyperintensity was the most common imaging finding (66 cases). Epileptiform discharges in the temporal area represented the most frequent abnormality on interictal EEG (24 cases). Seizure-free status for ≥ 12 months was attained in 46 out of 64 patients (72%), who were followed for ≥ 12 months (range, 12 - 110 months), and 42 of them received monotherapy, mainly with levetiracetam (21 patients), carbamazepine (10 patients), or lacosamide (8 patients). In comparison to their counterparts, the rate of seizure-free status for ≥ 12 months was significantly lower in patients with comorbid dementia (81% vs. 52%; P = 0.0205). In conclusion, the NLLOE among Japanese patients aged ≥ 65 years has variable presenting characteristics, and comorbid dementia is diagnosed in one-third of cases. Seizure-free status for ≥ 12 months may be attained in more than two-thirds of treated patients, but comorbid dementia is associated with significantly worse response to antiseizure therapy.
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Affiliation(s)
- Naoto Nagino
- Epilepsy Center, TMG Asaka Medical Center, Saitama, Japan
| | - Yuichi Kubota
- Epilepsy Center, TMG Asaka Medical Center, Saitama, Japan; Department of Neurosurgery, TMG Asaka Medical Center, Saitama, Japan; Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan.
| | - Hidetoshi Nakamoto
- Epilepsy Center, TMG Asaka Medical Center, Saitama, Japan; Department of Neurosurgery, TMG Asaka Medical Center, Saitama, Japan
| | - Satoru Miyao
- Department of Neurosurgery, TMG Asaka Medical Center, Saitama, Japan
| | | | - Susumu Ito
- Department of Pediatrics, Tokyo Women's Medical University, Tokyo, Japan
| | - Hirokazu Oguni
- Epilepsy Center, TMG Asaka Medical Center, Saitama, Japan
| | - Mikhail Chernov
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
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Zhao N, Chen H, Zhang W, Yao J, Tu Q, Yu X, Sun X. Bidirectional influences between seizures and dementia: A systematic review and meta-analysis. Int J Geriatr Psychiatry 2022; 37. [PMID: 35726376 DOI: 10.1002/gps.5723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/20/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Dementia and seizures often co-exist, but the association between these two disorders is not well established. Therefore, this systematic review and meta-analysis aimed to clarify the relationship between seizures and dementia. METHODS The PubMed, EMBASE, CBM, and CNKI databases were used to search for relevant publications from inception to August 25, 2021. Data extraction was performed by two authors independently. The random-effects model was adopted to evaluate the pooled estimates. RESULTS Two nested case-control studies and 18 cohort studies were included in the meta-analysis. Seizures were associated with the development of dementia and Alzheimer's disease (AD), and the pooled relative risk (RR) was 2.51 [95% confidence intervals (CI) = 1.87-3.36, p < 0.001] and 1.61 (95% CI = 1.42-1.82, p < 0.001), respectively. Pooled RR estimating the effect of dementia on seizures risk was 3.68 (95% CI = 3.05-4.44, p < 0.001). In addition, the pooled effect size of dementia on epilepsy risk was 3.02 (95% CI = 2.16-4.23, p < 0.001). The subgroup analyses suggested that vascular risk factors could confound the associations between these two disorders. Seizures might independently and significantly increase the risk of dementia, and in turn, dementia might predispose an individual to a higher risk of seizures. CONCLUSIONS These results suggested that dementia and seizures share common pathogenesis and might be treated with similar preventive treatment measures. Vascular changes in patients with dementia or seizures should also be examined.
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Affiliation(s)
- Ning Zhao
- Department of Geriatrics, The First Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Haitao Chen
- Department of Geriatrics, The First Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Wenjun Zhang
- Department of Geriatrics, The First Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Jundi Yao
- Department of Geriatrics, The First Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Qianqian Tu
- Department of Geriatrics, The First Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Xiaowen Yu
- Department of Geriatrics, The First Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Xiaomao Sun
- Shanghai Garrison Hongkou Third Retired Cadres Rest House, Shanghai, China
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Huang L, Fu C, Li J, Peng S. Late-onset epilepsy and the risk of dementia: a systematic review and meta-analysis. Aging Clin Exp Res 2022; 34:1771-1779. [PMID: 35428922 DOI: 10.1007/s40520-022-02118-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with dementia have higher risk of epilepsy. However, it remains not comprehensively evaluated if late-onset epilepsy (LOE) is associated with higher risk of dementia. We, therefore, performed a meta-analysis to systematically evaluate the association. METHODS Relevant cohort studies were identified by search of electronic databases including PubMed, Embase, and Web of Science. A randomized-effect model incorporating the possible between-study heterogeneity was used to pool the results. RESULTS Overall, seven cohort studies including 873,438 adults were included, and 16,036 (1.8%) of them had LOE. With a mean follow-up duration of 8.7 years, 33,727 of them were diagnosed as dementia. Pooled results showed that LOE was associated with a higher risk of dementia (risk ratio [RR] 2.39, 95% confidence interval [CI] 2.04-2.81, p < 0.001, I2 = 67%). Results of subgroup analysis showed that the association between LOE and the risk of dementia was stronger in hospital-derived participants (RR 4.23, 95% CI 2.67-6.70, p < 0.001) than that in community-derived population (RR 2.25, 95% CI 1.93-2.63, p < 0.001; p for subgroup difference = 0.01). Pooled results of three studies showed that LOE was associated with a higher risk of Alzheimer's disease (RR 2.35, 95% CI 1.08-5.08, p = 0.03, I2 = 85%). One study suggested a significant association between LOE and risk of vascular dementia (RR 2.0, 95% CI 1.77-2.26, p < 0.001). CONCLUSIONS Evidence from cohort studies suggests that LOE may be a risk factor of dementia.
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Affiliation(s)
- Lei Huang
- Department of Neurology, The First People's Hospital of Yibin, No. 65 Wenxing Street, Cuiping District, Yibin City, 644000, Sichuan, China.
| | - Chi Fu
- Department of Neurology, The First People's Hospital of Yibin, No. 65 Wenxing Street, Cuiping District, Yibin City, 644000, Sichuan, China
| | - Jie Li
- Department of Neurology, The First People's Hospital of Yibin, No. 65 Wenxing Street, Cuiping District, Yibin City, 644000, Sichuan, China
| | - Shijun Peng
- Department of Neurology, The First People's Hospital of Yibin, No. 65 Wenxing Street, Cuiping District, Yibin City, 644000, Sichuan, China
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Mechanisms Involved in Epileptogenesis in Alzheimer's Disease and Their Therapeutic Implications. Int J Mol Sci 2022; 23:ijms23084307. [PMID: 35457126 PMCID: PMC9030029 DOI: 10.3390/ijms23084307] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 12/22/2022] Open
Abstract
Epilepsy and Alzheimer's disease (AD) incidence increases with age. There are reciprocal relationships between epilepsy and AD. Epilepsy is a risk factor for AD and, in turn, AD is an independent risk factor for developing epilepsy in old age, and abnormal AD biomarkers in PET and/or CSF are frequently found in late-onset epilepsies of unknown etiology. Accordingly, epilepsy and AD share pathophysiological processes, including neuronal hyperexcitability and an early excitatory-inhibitory dysregulation, leading to dysfunction in the inhibitory GABAergic and excitatory glutamatergic systems. Moreover, both β-amyloid and tau protein aggregates, the anatomopathological hallmarks of AD, have proepileptic effects. Finally, these aggregates have been found in the resection material of refractory temporal lobe epilepsies, suggesting that epilepsy leads to amyloid and tau aggregates. Some epileptic syndromes, such as medial temporal lobe epilepsy, share structural and functional neuroimaging findings with AD, leading to overlapping symptomatology, such as episodic memory deficits and toxic synergistic effects. In this respect, the existence of epileptiform activity and electroclinical seizures in AD appears to accelerate the progression of cognitive decline, and the presence of cognitive decline is much more prevalent in epileptic patients than in elderly patients without epilepsy. Notwithstanding their clinical significance, the diagnosis of clinical seizures in AD is a challenge. Most are focal and manifest with an altered level of consciousness without motor symptoms, and are often interpreted as cognitive fluctuations. Finally, despite the frequent association of epilepsy and AD dementia, there is a lack of clinical trials to guide the use of antiseizure medications (ASMs). There is also a potential role for ASMs to be used as disease-modifying drugs in AD.
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B. Szabo A, Cretin B, Gérard F, Curot J, J. Barbeau E, Pariente J, Dahan L, Valton L. Sleep: The Tip of the Iceberg in the Bidirectional Link Between Alzheimer's Disease and Epilepsy. Front Neurol 2022; 13:836292. [PMID: 35481265 PMCID: PMC9035794 DOI: 10.3389/fneur.2022.836292] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
The observation that a pathophysiological link might exist between Alzheimer's disease (AD) and epilepsy dates back to the identification of the first cases of the pathology itself and is now strongly supported by an ever-increasing mountain of literature. An overwhelming majority of data suggests not only a higher prevalence of epilepsy in Alzheimer's disease compared to healthy aging, but also that AD patients with a comorbid epileptic syndrome, even subclinical, have a steeper cognitive decline. Moreover, clinical and preclinical investigations have revealed a marked sleep-related increase in the frequency of epileptic activities. This characteristic might provide clues to the pathophysiological pathways underlying this comorbidity. Furthermore, the preferential sleep-related occurrence of epileptic events opens up the possibility that they might hasten cognitive decline by interfering with the delicately orchestrated synchrony of oscillatory activities implicated in sleep-related memory consolidation. Therefore, we scrutinized the literature for mechanisms that might promote sleep-related epileptic activity in AD and, possibly dementia onset in epilepsy, and we also aimed to determine to what degree and through which processes such events might alter the progression of AD. Finally, we discuss the implications for patient care and try to identify a common basis for methodological considerations for future research and clinical practice.
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Affiliation(s)
- Anna B. Szabo
- Centre de Recherches sur la Cognition Animale, Centre de Biologie Intégrative, Université de Toulouse, CNRS, UPS, Toulouse, France
- Centre de Recherche Cerveau & Cognition (CerCo), UMR 5549, CNRS-UPS, Toulouse, France
- *Correspondence: Anna B. Szabo
| | - Benjamin Cretin
- Clinical Neuropsychology Unit, Neurology Department, CM2R (Memory Resource and Research Centre), University Hospital of Strasbourg, Strasbourg, France
- CNRS, ICube Laboratory, UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg, Strasbourg, France
- CMRR d'Alsace, Service de Neurologie des Hôpitaux Universitaires de Strasbourg, Pôle Tête et Cou, Strasbourg, France
| | - Fleur Gérard
- Centre de Recherche Cerveau & Cognition (CerCo), UMR 5549, CNRS-UPS, Toulouse, France
- Neurology Department, Hôpital Purpan Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Jonathan Curot
- Centre de Recherche Cerveau & Cognition (CerCo), UMR 5549, CNRS-UPS, Toulouse, France
- Neurology Department, Hôpital Purpan Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Emmanuel J. Barbeau
- Centre de Recherche Cerveau & Cognition (CerCo), UMR 5549, CNRS-UPS, Toulouse, France
| | - Jérémie Pariente
- Neurology Department, Hôpital Purpan Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Toulouse NeuroImaging Center (ToNIC), INSERM-University of Toulouse Paul Sabatier, Toulouse, France
| | - Lionel Dahan
- Centre de Recherches sur la Cognition Animale, Centre de Biologie Intégrative, Université de Toulouse, CNRS, UPS, Toulouse, France
| | - Luc Valton
- Centre de Recherche Cerveau & Cognition (CerCo), UMR 5549, CNRS-UPS, Toulouse, France
- Neurology Department, Hôpital Purpan Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Luc Valton
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Dun C, Zhang Y, Yin J, Su B, Peng X, Liu L. Bi-directional associations of epilepsy with dementia and Alzheimer's disease: a systematic review and meta-analysis of longitudinal studies. Age Ageing 2022; 51:6548793. [PMID: 35290432 DOI: 10.1093/ageing/afac010] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To assess the bi-directional associations of epilepsy with dementia and Alzheimer's disease (AD). METHODS We searched PubMed, Embase and the Cochrane Library for longitudinal studies assessing the associations of epilepsy with dementia and AD up to 4 August 2021. Two authors independently extracted study characteristics, exposures, outcomes and covariates. Summary hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled using a random effects model. RESULTS From 8,545 articles identified in the initial research, 27 publications describing 20 longitudinal studies were included in the final analyses. There were 10 studies on epilepsy predicting risk of dementia, 5 studies on epilepsy predicting risk of AD, 11 studies on dementia predicting risk of epilepsy, and 6 studies on AD predicting risk of epilepsy. Baseline epilepsy was associated with higher risk of dementia (pooled HR 2.00; 95% CI 1.73-2.33) and AD (pooled HR 1.81; 95% CI 1.19-2.75). The pooled HRs for epilepsy associated with baseline dementia and AD were 2.91 (95% CI) 2.11-4.01) and 3.11 (95% CI 2.47-3.90), respectively. These positive associations persisted in sensitivity and subgroup analyses. CONCLUSIONS Our findings suggested positive and bi-directional associations of epilepsy with dementia and AD. However, these associations should be carefully interpreted due to the presence of substantial heterogeneity, and they need to be verified in additional high-quality studies.
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Affiliation(s)
- Changchang Dun
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yaqi Zhang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jiawei Yin
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Binbin Su
- PKU-APEC Health Science Academy, Institute of Population Research, Peking University, Beijing 100000, China
| | - Xiaobo Peng
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Liegang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Costa C, Vecchio F, Romoli M, Miraglia F, Cesarini EN, Alù F, Calabresi P, Rossini PM. Cognitive Decline Risk Stratification in People with Late-Onset Epilepsy of Unknown Etiology: An Electroencephalographic Connectivity and Graph Theory Pilot Study. J Alzheimers Dis 2021; 88:893-901. [PMID: 34842184 DOI: 10.3233/jad-210350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although people with late onset epilepsy of unknown etiology (LOEU) are at higher risk of cognitive decline compared to the general population, we still lack affordable tools to predict and stratify their risk of dementia. OBJECTIVE This pilot-study investigates the potential application of electroencephalography (EEG) network small-world (SW) properties in predicting cognitive decline among patients with LOEU. METHODS People diagnosed with LOEU and normal cognitive examination at the time of epilepsy diagnosis were included. Cerebrospinal fluid biomarkers, brain imaging, and neuropsychological assessment were performed at the time of epilepsy diagnosis. Baseline EEG was analyzed for SW properties. Patients were followed-up over time with neuropsychological testing to define the trajectory of cognitive decline. RESULTS Over 5.1 years of follow-up, among 24 patients diagnosed with LOEU, 62.5% were female, mean age was 65.3 years, thirteen developed mild cognitive impairment (MCI), and four developed dementia. Patients with LOEU developing MCI had lower values of SW coefficients in the delta (p = 0.03) band and higher SW values in the alpha frequency bands (p = 0.02) compared to patients having normal cognition at last follow-up. The two separate ANOVAs, for low and alpha bands, confirmed an interaction between SW and cognitive decline at follow-up. A similar gradient was confirmed for patients developing dementia compared to those with normal cognitive function as well as to those developing MCI. CONCLUSION Baseline EEG analysis through SW is worth investigating as an affordable, widely available tool to stratify LOEU patients for their risk of cognitive decline.
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Affiliation(s)
- Cinzia Costa
- Neurology Clinic, S. Maria della Misericordia Hospital -University of Perugia, Perugia, Italy
| | - Fabrizio Vecchio
- Brain Connectivity Laboratory, Department of Neuroscience & Neurorehabilition, IRCCS San Raffaele Roma, Roma, Italy.,eCampus University, Novedrate (Como), Italy
| | - Michele Romoli
- Neurology Clinic, S. Maria della Misericordia Hospital -University of Perugia, Perugia, Italy.,UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore C.A. Pizzardi, Bologna, Italy
| | - Francesca Miraglia
- Brain Connectivity Laboratory, Department of Neuroscience & Neurorehabilition, IRCCS San Raffaele Roma, Roma, Italy
| | - Elena Nardi Cesarini
- Neurology Clinic, S. Maria della Misericordia Hospital -University of Perugia, Perugia, Italy.,UOC Neurologia, Ospedale di Senigallia, Senigallia, Italy
| | - Francesca Alù
- Brain Connectivity Laboratory, Department of Neuroscience & Neurorehabilition, IRCCS San Raffaele Roma, Roma, Italy
| | - Paolo Calabresi
- Neurologia, DipartimentoNeuroscienze, Università Cattolica del Sacro Cuore, Roma, Italy.,Neurologia, Fondazione Policlinico Universitario"A. Gemelli" IRCCS, Roma, Italy
| | - Paolo Maria Rossini
- Brain Connectivity Laboratory, Department of Neuroscience & Neurorehabilition, IRCCS San Raffaele Roma, Roma, Italy
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Atrial Fibrillation is Associated With Greater Risk of Dementia in Older Veterans. Am J Geriatr Psychiatry 2021; 29:1092-1098. [PMID: 33663986 PMCID: PMC8349940 DOI: 10.1016/j.jagp.2021.02.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To examine the association of atrial fibrillation (AF) with incident dementia in older veterans and the effect of anticoagulation on that association. METHODS Around 407,871 veterans aged ≥55 years receiving care from US Veterans Health Administration between August 2003 and September 2015 were included in our retrospective study. AF and incident dementia were determined according to ICD-9-CM codes. Logistic regressions with veterans grouped into high-dimensional propensity scores deciles were used, and a mediation analysis was employed to examine the extent of cardio/cerebrovascular diseases that may also account for that association. RESULTS AF was associated with greater dementia risk (odds ratio = 1.14; 95% confidence interval 1.07-1.22), partially mediated by cardio/cerebrovascular disease. Among veterans with AF taking anticoagulants, the risk of dementia was 44% higher (odds ratio =1.44; 95% CI 1.27-1.63) compared to those without anticoagulants, likely related to AF severity. CONCLUSION Our findings underscore the importance of considering cognitive function in the management of AF patients.
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Punia V. Late-Onset Epilepsy: A Distinct Entity that Begins and Ends With the Associated Comorbidities. Epilepsy Curr 2021; 22:43-45. [PMID: 35233198 PMCID: PMC8832339 DOI: 10.1177/15357597211053681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Romoli M, Sen A, Parnetti L, Calabresi P, Costa C. Amyloid-β: a potential link between epilepsy and cognitive decline. Nat Rev Neurol 2021; 17:469-485. [PMID: 34117482 DOI: 10.1038/s41582-021-00505-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 02/05/2023]
Abstract
People with epilepsy - in particular, late-onset epilepsy of unknown aetiology - have an elevated risk of dementia, and seizures have been detected in the early stages of Alzheimer disease (AD), supporting the concept of an epileptic AD prodrome. However, the relationship between epilepsy and cognitive decline remains controversial, with substantial uncertainties about whether epilepsy drives cognitive decline or vice versa, and whether shared pathways underlie both conditions. Here, we review evidence that amyloid-β (Aβ) forms part of a shared pathway between epilepsy and cognitive decline, particularly in the context of AD. People with epilepsy show an increased burden of Aβ pathology in the brain, and Aβ-mediated epileptogenic alterations have been demonstrated in experimental studies, with evidence suggesting that Aβ pathology might already be pro-epileptogenic at the soluble stage, long before plaque deposition. We discuss the hypothesis that Aβ mediates - or is at least a major determinant of - a continuum spanning epilepsy and cognitive decline. Serial cognitive testing and assessment of Aβ levels might be worthwhile to stratify the risk of developing dementia in people with late-onset epilepsy. If seizures are a clinical harbinger of dementia, people with late-onset epilepsy could be an ideal group in which to implement preventive or therapeutic strategies to slow cognitive decline.
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Affiliation(s)
- Michele Romoli
- Neurology Clinic, Department of Medicine and Surgery, University of Perugia - S. Maria della Misericordia Hospital, Perugia, Italy.,Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.,Neurology and Stroke Unit, "Maurizio Bufalini" Hospital, Cesena, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore, Bologna, Italy
| | - Arjune Sen
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Lucilla Parnetti
- Neurology Clinic, Department of Medicine and Surgery, University of Perugia - S. Maria della Misericordia Hospital, Perugia, Italy
| | - Paolo Calabresi
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Neurologia, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Rome, Italy
| | - Cinzia Costa
- Neurology Clinic, Department of Medicine and Surgery, University of Perugia - S. Maria della Misericordia Hospital, Perugia, Italy.
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Subota A, Jetté N, Josephson CB, McMillan J, Keezer MR, Gonzalez-Izquierdo A, Holroyd-Leduc J. Risk factors for dementia development, frailty, and mortality in older adults with epilepsy - A population-based analysis. Epilepsy Behav 2021; 120:108006. [PMID: 33964541 DOI: 10.1016/j.yebeh.2021.108006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/25/2021] [Accepted: 04/12/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Although the prevalence of comorbid epilepsy and dementia is expected to increase, the impact is not well understood. Our objectives were to examine risk factors associated with incident dementia and the impact of frailty and dementia on mortality in older adults with epilepsy. METHODS The CALIBER scientific platform was used. People with incident epilepsy at or after age 65 were identified using Read codes and matched by age, sex, and general practitioner to a cohort without epilepsy (10:1). Baseline cohort characteristics were compared using conditional logistic regression models. Multivariate Cox proportional hazard regression models were used to examine the impact of frailty and dementia on mortality, and to assess risk factors for dementia development. RESULTS One thousand forty eight older adults with incident epilepsy were identified. The odds of having dementia at baseline were 7.39 [95% CI 5.21-10.50] times higher in older adults with epilepsy (n = 62, 5.92%) compared to older adults without epilepsy (n = 88, 0.86%). In the final multivariate Cox model (n = 326), age [HR: 1.20, 95% CI 1.09-1.32], Charlson comorbidity index score [HR: 1.26, 95% CI 1.10-1.44], and sleep disturbances [HR: 2.41, 95% CI 1.07-5.43] at baseline epilepsy diagnosis were significantly associated with an increased hazard of dementia development over the follow-up period. In a multivariate Cox model (n = 1047), age [HR: 1.07, 95% CI 1.03-1.11], baseline dementia [HR: 2.66, 95% CI 1.65-4.27] and baseline e-frailty index score [HR: 11.55, 95% CI 2.09-63.84] were significantly associated with a higher hazard of death among those with epilepsy. Female sex [HR: 0.77, 95% CI 0.59-0.99] was associated with a lower hazard of death. SIGNIFICANCE The odds of having dementia were higher in older adults with incident epilepsy. A higher comorbidity burden acts as a risk factor for dementia, while prevalent dementia and increasing frailty were associated with mortality.
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Affiliation(s)
- Ann Subota
- Department of Medicine, University of Calgary, North Tower, 1403-29 St NW, Calgary, AB T2N 2T9, Canada; Department of Community Health Sciences, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Nathalie Jetté
- Department of Community Health Sciences, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Hotchkiss Brain Institute, University of Calgary, 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1137, New York, NY 10029, USA
| | - Colin B Josephson
- Department of Community Health Sciences, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Department of Clinical Neurosciences, University of Calgary, 1195 1403-29 Street NW, Calgary, AB T2N 2T9, Canada; Hotchkiss Brain Institute, University of Calgary, 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Alberta Health Services, Foothills Medical Centre, 1403-29 St. NW, Calgary, Alberta T2N 2T9, Canada
| | - Jaqueline McMillan
- Department of Medicine, University of Calgary, North Tower, 1403-29 St NW, Calgary, AB T2N 2T9, Canada; Department of Community Health Sciences, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Alberta Health Services, Foothills Medical Centre, 1403-29 St. NW, Calgary, Alberta T2N 2T9, Canada; O'Brien Institute for Public Health, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Mark R Keezer
- Research Center of the Centre Hospitalier de l'Université de Montréal, 1051 Rue Sanguinet, Montréal, QC H2X 3E4, Canada
| | - Arturo Gonzalez-Izquierdo
- Institute of Health Informatics, University College London, 222 Euston Rd, London NW1 2DA, United Kingdom
| | - Jayna Holroyd-Leduc
- Department of Medicine, University of Calgary, North Tower, 1403-29 St NW, Calgary, AB T2N 2T9, Canada; Department of Community Health Sciences, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Hotchkiss Brain Institute, University of Calgary, 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Alberta Health Services, Foothills Medical Centre, 1403-29 St. NW, Calgary, Alberta T2N 2T9, Canada; O'Brien Institute for Public Health, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada.
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Sciaccaluga M, Megaro A, Bellomo G, Ruffolo G, Romoli M, Palma E, Costa C. An Unbalanced Synaptic Transmission: Cause or Consequence of the Amyloid Oligomers Neurotoxicity? Int J Mol Sci 2021; 22:ijms22115991. [PMID: 34206089 PMCID: PMC8199544 DOI: 10.3390/ijms22115991] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 12/18/2022] Open
Abstract
Amyloid-β (Aβ) 1-40 and 1-42 peptides are key mediators of synaptic and cognitive dysfunction in Alzheimer's disease (AD). Whereas in AD, Aβ is found to act as a pro-epileptogenic factor even before plaque formation, amyloid pathology has been detected among patients with epilepsy with increased risk of developing AD. Among Aβ aggregated species, soluble oligomers are suggested to be responsible for most of Aβ's toxic effects. Aβ oligomers exert extracellular and intracellular toxicity through different mechanisms, including interaction with membrane receptors and the formation of ion-permeable channels in cellular membranes. These damages, linked to an unbalance between excitatory and inhibitory neurotransmission, often result in neuronal hyperexcitability and neural circuit dysfunction, which in turn increase Aβ deposition and facilitate neurodegeneration, resulting in an Aβ-driven vicious loop. In this review, we summarize the most representative literature on the effects that oligomeric Aβ induces on synaptic dysfunction and network disorganization.
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Affiliation(s)
- Miriam Sciaccaluga
- Neurology Clinic, Department of Medicine and Surgery, University of Perugia, Santa Maria della Misericordia Hospital, 06132 Perugia, Italy; (A.M.); (G.B.)
- Correspondence: (M.S.); (C.C.); Tel.: +39-0755858180 (M.S.); +39-0755784233 (C.C.)
| | - Alfredo Megaro
- Neurology Clinic, Department of Medicine and Surgery, University of Perugia, Santa Maria della Misericordia Hospital, 06132 Perugia, Italy; (A.M.); (G.B.)
| | - Giovanni Bellomo
- Neurology Clinic, Department of Medicine and Surgery, University of Perugia, Santa Maria della Misericordia Hospital, 06132 Perugia, Italy; (A.M.); (G.B.)
| | - Gabriele Ruffolo
- Department of Physiology and Pharmacology, Istituto Pasteur—Fondazione Cenci Bolognetti, University of Rome Sapienza, 00185 Rome, Italy; (G.R.); (E.P.)
- IRCCS San Raffaele Pisana, 00166 Rome, Italy
| | - Michele Romoli
- Neurology Unit, Rimini “Infermi” Hospital—AUSL Romagna, 47923 Rimini, Italy;
| | - Eleonora Palma
- Department of Physiology and Pharmacology, Istituto Pasteur—Fondazione Cenci Bolognetti, University of Rome Sapienza, 00185 Rome, Italy; (G.R.); (E.P.)
| | - Cinzia Costa
- Neurology Clinic, Department of Medicine and Surgery, University of Perugia, Santa Maria della Misericordia Hospital, 06132 Perugia, Italy; (A.M.); (G.B.)
- Correspondence: (M.S.); (C.C.); Tel.: +39-0755858180 (M.S.); +39-0755784233 (C.C.)
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Sen A, Romoli M. Pathological brain ageing in epilepsy and dementia: two sides of the same coin? Brain 2021; 144:9-11. [PMID: 33578425 DOI: 10.1093/brain/awaa441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
This scientific commentary refers to ‘Atrophy and cognitive profiles in older adults with temporal lobe epilepsy are similar to mild cognitive impairment’, by Kaestneret al. (doi:10.1093/brain/awaa397).
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Affiliation(s)
- Arjune Sen
- Oxford Epilepsy Research Group, National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Michele Romoli
- Neurology Clinic, University of Perugia - S. Maria della Misericordia Hospital, Perugia, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Metropolitan Stroke Network, "C.A. Pizzardi" Maggiore Hospital, Bologna, Italy
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42
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Lamoureux L, Marottoli FM, Tseng KY, Tai LM. APOE4 Promotes Tonic-Clonic Seizures, an Effect Modified by Familial Alzheimer's Disease Mutations. Front Cell Dev Biol 2021; 9:656521. [PMID: 33796539 PMCID: PMC8007905 DOI: 10.3389/fcell.2021.656521] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/23/2021] [Indexed: 11/13/2022] Open
Abstract
Seizures are emerging as a common symptom in Alzheimer's disease (AD) patients, often attributed to high levels of amyloid β (Aβ). However, the extent that AD disease risk factors modulate seizure activity in aging and AD-relevant contexts is unclear. APOE4 is the greatest genetic risk factor for AD and has been linked to seizures independent of AD and Aβ. The goal of the present study was to evaluate the role of APOE genotype in modulating seizures in the absence and presence of high Aβ levels in vivo. To achieve this goal, we utilized EFAD mice, which express human APOE3 or APOE4 in the absence (EFAD-) or presence (EFAD+) of familial AD mutations that result in Aβ overproduction. When quantified during cage change day, we found that unlike APOE3, APOE4 is associated with tonic-clonic seizures. Interestingly, there were lower tonic-clonic seizures in E4FAD+ mice compared to E4FAD- mice. Restraint handing and auditory stimuli failed to recapitulate the tonic-clonic phenotype in EFAD mice that express APOE4. However, after chemical-induction with pentylenetetrazole, there was a higher incidence of tonic-clonic seizures with APOE4 compared to APOE3. Interestingly, the distribution of seizures to the tonic-clonic phenotype was higher with FAD mutations. These data support that APOE4 is associated with higher tonic-clonic seizures in vivo, and that FAD mutations impact tonic-clonic seizures in a paradigm dependent manner.
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Affiliation(s)
- Lorissa Lamoureux
- Biological Resources Laboratory, University of Illinois at Chicago, Chicago, IL, United States
| | - Felecia M Marottoli
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Kuei Y Tseng
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Leon M Tai
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
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Puteikis K, Mameniškienė R, Jurevičienė E. Neurological and Psychiatric Comorbidities in Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2021; 16:553-562. [PMID: 33688180 PMCID: PMC7937394 DOI: 10.2147/copd.s290363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/25/2021] [Indexed: 12/22/2022] Open
Abstract
Background and Purpose Chronic obstructive pulmonary disease (COPD) is often accompanied by different neurological and psychiatric comorbidities. The purpose of this study was to examine which of them are the most frequent and to explore whether their manifestation can be explained by underlying latent variables. Methods Data about patients with COPD and their neurological and psychiatric comorbidities were extracted from an electronic database of the National Health Insurance Fund of Lithuania for the period between January 1, 2012, and June 30, 2014. Exploratory factor analysis (EFA) was used to investigate comorbidity patterns. Results A study sample of 4834 patients with COPD was obtained from the database, 3338 (69.1%) of who were male. The most frequent neurological and psychiatric comorbidities were nerve, nerve root and plexus disorders (n=1439, 29.8%), sleep disorders (n=666, 13.8%), transient ischemic attack (n=545, 11.3%), depression (n=364, 7.5%) and ischemic stroke (n=349, 7.2%). The prevalence of ischemic stroke, transient ischemic attack, Parkinson’s disease, dementia and sleep disorders increased with age. One latent variable outlined during EFA grouped neurological disorders, namely ischemic stroke, transient ischemic attack, epilepsy, dementia and Parkinson’s disease. The second encompassed depression, anxiety, somatoform and sleep disorders. While similar patterns emerged in data from male patients, no clear comorbidity profiles among women with COPD were obtained. Conclusion Our study provides novel insights into the neurological and psychiatric comorbidities in COPD by outlining an association among cerebrovascular, neurodegenerative disorders and epilepsy, and psychiatric and sleep disorders. Future studies could substantiate the discrete pathological mechanism that underlie these comorbidity groups.
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Affiliation(s)
| | | | - Elena Jurevičienė
- Vilnius University, Center for Pulmonology and Allergology, Vilnius, Lithuania
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Ophir K, Ran B, Felix B, Amir G. Ten year cumulative incidence of dementia after late onset epilepsy of unknown etiology. J Clin Neurosci 2021; 86:247-251. [PMID: 33775336 DOI: 10.1016/j.jocn.2021.01.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/16/2020] [Accepted: 01/18/2021] [Indexed: 11/17/2022]
Abstract
Recent epidemiological studies suggest late life onset epilepsy of unknown etiology (LOEU) is a risk factor for future dementia. These studies rely on inclusion and exclusion of multiple diagnostic codes rather than structured data and neuroimaging findings, and thus challenging to interpret clinically. We assessed the cumulative incidence of dementia in patients with LOEU diagnosed through admission data and neuroimaging over a 10-year follow-up and compared baseline characteristics that distinguish group level incident dementia. We screened our hospital records for patients aged 55-69 with new epilepsy, admitted between 2000 and 2008, and excluded patients diagnosed with epilepsy from an underlying cause on medical records or neuroimaging. We used retrospective hospital data to follow patients for incident dementia or mortality at 10 years and compared baseline (demographics, depression or anxiety, vascular risk factors, results of electroencephalogram (EEG) studies, antidepressant use and type of ant seizure medication) and follow up (seizure recurrence, incident cerebrovascular disease) characteristics for patients with and without incident dementia. Fifty-four LOEU cases were screened, age at first seizure was 61 ± 5. The 10-year cumulative incidence of dementia was 22.20% (95% Confidence Interval 22.08-23.10%) and time to dementia diagnosis was 5.4 ± 3.9 years. Patients with incident dementia were more likely to be women (83% vs 38%, p = 0.002), have interictal epileptic form discharges (IED) on baseline EEG (70% vs 29%, p = 0.011) and depression or anxiety (50% vs 18%, p = 0.026). No differences were found in other baseline or follow up characteristics. Our results support recent findings of dementia incidence in LOEU. Prospective studies on LOEU should evaluate phenotypic determinants of individuals with late life epilepsy and the rate of progression to dementia.
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Affiliation(s)
- Keret Ophir
- Global Brain Health Institute at University of California San Francisco, San Francisco, CA, USA.
| | - Brauner Ran
- Department of Neurology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel; Cognitive Neurology Clinic, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Benninger Felix
- Department of Neurology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Glik Amir
- Department of Neurology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel; Cognitive Neurology Clinic, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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45
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Sleep disorders and late-onset epilepsy of unknown origin: Understanding new trajectories to brain amyloidopathy. Mech Ageing Dev 2021; 194:111434. [PMID: 33444630 DOI: 10.1016/j.mad.2021.111434] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/31/2020] [Accepted: 01/07/2021] [Indexed: 12/16/2022]
Abstract
The intertwining between epilepsy, sleep disorders and beta amyloid pathology has been progressively highlighted, as early identification and stratification of patients at high risk of cognitive decline is the need of the hour. Modification of the sleep-wake activity, such as sleep impairment or excessive daytime sleepiness, can critically affect cerebral beta amyloid levels. Both mice models and human studies have demonstrated a substantial increase in the burden of beta amyloid pathology after sleep-deprivation, with potential negative effects partially restored by sleep recovery. The accumulation of beta amyloid has been shown to be an early event in the course of Alzheimer's disease dementia. Beta amyloid accumulation has been linked to epileptic seizures epileptic seizures, with beta amyloid being itself pro-epileptogenic in mice models already at oligomeric stage, well before plaque deposition. Further supporting a potential relationship between beta amyloid and epilepsy: i) seizures happen in 1 out of oofut 10 patients with Alzheimer's disease in the prodromal stage, ii) epileptic activity accelerates cognitive decline in Alzheimer's disease, iii) people with late-onset epilepsy present a critically high risk of developing dementia. In this Review we highlight the role of beta amyloid as a potential shared mechanisms between sleep disorders, late-onset epilepsy, and cognitive decline.
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Adan G, Mitchell JW, Ziso B, Larner AJ. Diagnosis and Management of Seizures in Neurodegenerative Diseases. Curr Treat Options Neurol 2021. [DOI: 10.1007/s11940-020-00656-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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47
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Choi H, Thacker EL, Longstreth WT, Elkind MSV, Boehme AK. Cognitive decline in older adults with epilepsy: The Cardiovascular Health Study. Epilepsia 2020; 62:85-97. [PMID: 33227164 DOI: 10.1111/epi.16748] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Cognitive decline is a major concern for older adults with epilepsy. Whether and how much faster older adults with epilepsy experience cognitive decline beyond expected age-related cognitive change remain unclear. We sought to estimate and compare rates of cognitive decline in older adults with and without epilepsy. METHODS The Cardiovascular Health Study is a population-based longitudinal cohort study of 5888 US adults aged 65+. Cognitive function was assessed annually with Modified Mini-Mental State Exam (3MS) and Digit Symbol Substitution Test (DSST). We used linear mixed models to estimate average rates of decline in 3MS and DSST scores by epilepsy status (prevalent, incident, or no epilepsy), adjusted for risk factors associated with cognitive decline. RESULTS The rate of decline in 3MS was significantly faster in prevalent epilepsy (P < .001) and after incident epilepsy (P = .002) compared with no epilepsy. Prevalent epilepsy and apolipoprotein E gene (APOE) ε4 (ApoE4) had a synergistic interaction, whereby prevalent epilepsy and ApoE4 together were associated with 1.51 points faster annual decline in 3MS than would be expected if prevalent epilepsy and ApoE4 did not interact (P < .001). Older adults with prevalent epilepsy had a significantly lower initial DSST score and faster rate of decline compared to those with no epilepsy (P < .001). SIGNIFICANCE Faster decline in global cognitive ability seen in this study validates concerns of patients. ApoE4 allele status was an effect modifier of the relationship between cognitive decline and prevalent epilepsy. Further research is warranted to explore biological mechanisms and possible interventions to mitigate cognitive decline.
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Affiliation(s)
- Hyunmi Choi
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Evan L Thacker
- Department of Public Health, Brigham Young University, Provo, UT, USA
| | | | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Amelia K Boehme
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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48
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Johnson EL, Krauss GL, Kucharska-Newton A, Albert MS, Brandt J, Walker KA, Yasar S, Knopman DS, Vossel KA, Gottesman RF. Dementia in late-onset epilepsy: The Atherosclerosis Risk in Communities study. Neurology 2020; 95:e3248-e3256. [PMID: 33097597 DOI: 10.1212/wnl.0000000000011080] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/03/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To determine the risk of dementia after the development of late-onset epilepsy. METHODS We used data from the Atherosclerosis Risk in Communities (ARIC) cohort study, which started in 1987 to 1989 with 15,792 mostly Black and White men and women from 4 US communities. We identified late-onset epilepsy (LOE; seizures starting at age 67 or later) from linked Medicare claims data. We used a Cox proportional hazards regression model to evaluate associations between LOE and dementia through 2017 as ascertained from neuropsychological testing, interviews, and hospital discharge surveillance, and we used multinomial logistic regression to assess the risk of dementia and mild cognitive impairment in the subset with full neuropsychological assessments available. We adjusted for demographics and vascular and Alzheimer disease risk factors. RESULTS Of 9,033 ARIC participants with sufficient Medicare coverage data (4,980 [55.1%] female, 1993 [22.1%] Black), 671 met the definition of LOE. Two hundred seventy-nine (41.6%) participants with and 1,408 (16.8%) without LOE developed dementia (p < 0.001). After a diagnosis of LOE, the adjusted hazard ratio for developing subsequent dementia was 3.05 (95% confidence interval 2.65-3.51). The median time to dementia ascertainment after the onset of LOE was 3.66 years (quartile 1-3, 1.28-8.28 years). INTERPRETATION The risk of incident dementia is substantially elevated in individuals with LOE. Further work is needed to explore causes for the increased risk of dementia in this growing population.
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Affiliation(s)
- Emily L Johnson
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis.
| | - Gregory L Krauss
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
| | - Anna Kucharska-Newton
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
| | - Marilyn S Albert
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
| | - Jason Brandt
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
| | - Keenan A Walker
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
| | - Sevil Yasar
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
| | - David S Knopman
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
| | - Keith A Vossel
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
| | - Rebecca F Gottesman
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
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Affiliation(s)
- W Allen Hauser
- From the Department of Neurology and Sergievsky Center (W.A.H.), Vagelos College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, New York, NY; Sant Pau Memory Unit (A.L.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; and Behavioral Neurology (H.S.), Mercy One Des Moines Ruan Neurology Care, IA.
| | - Alberto Lleo
- From the Department of Neurology and Sergievsky Center (W.A.H.), Vagelos College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, New York, NY; Sant Pau Memory Unit (A.L.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; and Behavioral Neurology (H.S.), Mercy One Des Moines Ruan Neurology Care, IA
| | - Heike Schmolck
- From the Department of Neurology and Sergievsky Center (W.A.H.), Vagelos College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, New York, NY; Sant Pau Memory Unit (A.L.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; and Behavioral Neurology (H.S.), Mercy One Des Moines Ruan Neurology Care, IA
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Sarkis RA, Beers L, Farah E, Al-Akaidi M, Zhang Y, Locascio JJ, Properzi MJ, Schultz AP, Chhatwal JP, Johnson KA, Sperling RA, B Pennell P, Marshall GA. The neurophysiology and seizure outcomes of late onset unexplained epilepsy. Clin Neurophysiol 2020; 131:2667-2672. [PMID: 32957039 DOI: 10.1016/j.clinph.2020.08.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/27/2020] [Accepted: 08/10/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate neurophysiologic and neuroimaging characteristics of patients with late onset unexplained epilepsy (LOUE). METHODS We performed a retrospective chart review of elderly patients with ICD9 diagnosis codes consistent with epilepsy/seizures. Inclusion criteria included unprovoked seizures, and absence of cortical lesions on magnetic resonance imaging (MRI). Electroencephalograms (EEGs) findings were also analyzed. MRI images were scored for degree of white matter hyperintensities (Fazekas Scale) and mesial temporal atrophy (MTA). Vascular risk factors, and Framingham Heart Study general cardiovascular disease (FHS-CVD) risk scores were compared to controls from the Harvard Aging Brain study (HABS). RESULTS We identified 224 LOUE patients and 8% were drug resistant. Epileptiform abnormalities were captured on EEG in 35%. The location was temporal with left sided predominance in 49%. Fazekas scale consisted of 25% beginning of confluent lesions, and 10% large confluent lesions. MTA scores consisted of 21% moderate-severe hippocampal atrophy. LOUE patients had on average a 2.3% (adjusted), 7.4% (unadjusted) increased FHS-CVD score. CONCLUSIONS Our findings highlight LOUE as pharmacosensitive and left temporal predominant. Given the higher prevalence of vascular risk factors, investigations are needed to study their role in pathophysiology. SIGNIFICANCE Physicians caring for patients with LOUE should evaluate for vascular risk factors and investigate the presence of hippocampal atrophy.
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Affiliation(s)
- Rani A Sarkis
- Department of Neurology, Edward B. Bromfield Epilepsy Program, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Louis Beers
- Department of Neurology, Edward B. Bromfield Epilepsy Program, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Emile Farah
- Department of Neurology, Edward B. Bromfield Epilepsy Program, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mohammad Al-Akaidi
- Department of Neurology, Edward B. Bromfield Epilepsy Program, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yuxiang Zhang
- Department of Neurology, Edward B. Bromfield Epilepsy Program, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph J Locascio
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, MA, USA
| | - Michael J Properzi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, MA, USA
| | - Aaron P Schultz
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, MA, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, MA, USA
| | - Jasmeer P Chhatwal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, MA, USA; Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Keith A Johnson
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, MA, USA; Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Reisa A Sperling
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, MA, USA; Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Page B Pennell
- Department of Neurology, Edward B. Bromfield Epilepsy Program, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gad A Marshall
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, MA, USA; Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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