%0 Journal Article %J J Alzheimers Dis %D 2017 %T Adult-Onset Epilepsy in Presymptomatic Alzheimer's Disease: A Retrospective Study. %A DiFrancesco, Jacopo C %A Tremolizzo, Lucio %A Polonia, Valeria %A Giussani, Giorgia %A Bianchi, Elisa %A Franchi, Carlotta %A Nobili, Alessandro %A Appollonio, Ildebrando %A Beghi, Ettore %A Ferrarese, Carlo %X

BACKGROUND: The prevalence of epilepsy with onset in adulthood increases with age, mainly due to the accumulation of brain damage. However, a significant proportion of patients experience seizures of unknown cause. Alzheimer's disease (AD) is associated with an increased risk of seizures. Seizure activity is interpreted as a secondary event related to hyperexcitability caused by amyloid-β aggregation.

OBJECTIVE: Since neurodegenerative processes begin several years before clinical symptoms, epilepsy could be more frequent in the presymptomatic stages of dementia.

METHODS: We retrospectively reviewed the prevalence of epilepsy of unknown origin with adult onset before cognitive decline in a large cohort of AD patients (EPS-AD) recruited based on clinical and neuropsychological data. Data of patients with epilepsy followed by AD were compared with two control groups: patients with AD without seizures (no EPS-AD) and a large reference population (RP).

RESULTS: In AD patients, the prevalence of epilepsy of unknown origin, with onset in the adulthood before cognitive decline is 17.1 times higher compared with the RP (95% CI: 10.3-28.3). In EPS-AD, seizures begin on average 4.6 years (median 2.0) before the onset of cognitive symptoms and cognitive decline starts 3.6 years earlier compared with noEPS-AD.

CONCLUSIONS: Neurodegenerative processes of dementia could play a key role in the pathogenesis of epilepsy in a subgroup of individuals intended to develop cognitive decline. Adult-onset epilepsy of undefined cause could thus represent a risk factor for the ongoing neurodegenerative damage, even preceding by years the onset of clinical symptoms of dementia.

%B J Alzheimers Dis %V 60 %P 1267-1274 %8 2017 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/28968234?dopt=Abstract %R 10.3233/JAD-170392