Vossel Keith A, Tartaglia Maria C, Nygaard Haakon B, Zeman Adam Z, Miller Bruce L
Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA.
Department of Neurology, University of Toronto, ON, Canada.
Lancet Neurol. 2017 Apr;16(4):311-322. doi: 10.1016/S1474-4422(17)30044-3.
Epileptic activity is frequently associated with Alzheimer's disease; this association has therapeutic implications, because epileptic activity can occur at early disease stages and might contribute to pathogenesis. In clinical practice, seizures in patients with Alzheimer's disease can easily go unrecognised because they usually present as non-motor seizures, and can overlap with other symptoms of the disease. In patients with Alzheimer's disease, seizures can hasten cognitive decline, highlighting the clinical relevance of early recognition and treatment. Some evidence indicates that subclinical epileptiform activity in patients with Alzheimer's disease, detected by extended neurophysiological monitoring, can also lead to accelerated cognitive decline. Treatment of clinical seizures in patients with Alzheimer's disease with select antiepileptic drugs (AEDs), in low doses, is usually well tolerated and efficacious. Moreover, studies in mouse models of Alzheimer's disease suggest that certain classes of AEDs that reduce network hyperexcitability have disease-modifying properties. These AEDs target mechanisms of epileptogenesis involving amyloid β and tau. Clinical trials targeting network hyperexcitability in patients with Alzheimer's disease will identify whether AEDs or related strategies could improve their cognitive symptoms or slow decline.
癫痫活动常与阿尔茨海默病相关；这种关联具有治疗意义，因为癫痫活动可在疾病早期出现并可能促成发病机制。在临床实践中，阿尔茨海默病患者的癫痫发作很容易被忽视，因为它们通常表现为非运动性发作，且可能与该疾病的其他症状重叠。在阿尔茨海默病患者中，癫痫发作会加速认知衰退，这凸显了早期识别和治疗的临床相关性。一些证据表明，通过延长神经生理监测检测到的阿尔茨海默病患者的亚临床癫痫样活动也会导致认知衰退加速。用低剂量的某些抗癫痫药物（AEDs）治疗阿尔茨海默病患者的临床癫痫发作，通常耐受性良好且有效。此外，对阿尔茨海默病小鼠模型的研究表明，某些能降低网络兴奋性过高的AEDs具有疾病修饰特性。这些AEDs针对涉及淀粉样β蛋白和tau蛋白的癫痫发生机制。针对阿尔茨海默病患者网络兴奋性过高的临床试验将确定AEDs或相关策略是否能改善他们的认知症状或减缓衰退。
