Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Eur J Neurol. 2020 Jan;27(1):129-135. doi: 10.1111/ene.14043. Epub 2019 Aug 13.
Data on epilepsy in dementia, particularly on its risk factors, are scarce. Confounding comorbidities and the rising incidence of epilepsy in older age have hampered studies in this field. The occurrence and risk factors for epilepsy in the Swedish Dementia Registry (SveDem), a large cohort of patients with dementia, have been examined.
Information on epilepsy and seizure-related diagnoses, comorbidities and survival were extracted for all individuals in SveDem (n = 81 192) and three randomly selected age- and gender-matched controls from the population register, excluding all with a dementia diagnosis (n = 223 933). The risk of epilepsy following dementia diagnosis was estimated with Kaplan-Meier curves, and Cox proportional hazard modelling was used to identify risk factors and adjust for comorbidities.
A diagnosis of epilepsy was found more frequently amongst dementia patients [4.0%, 95% confidence interval (CI) 3.8-4.1] than controls (1.9%, 95% CI 1.9-2.0). The risk of incident epilepsy after dementia was 2.1% (95% CI 1.9-2.3) at 5 years and 4.0% (95%CI 3.4-4.6) at 10 years, compared to 0.8% (95% CI 0.8-0.8) and 1.6% (95% CI 1.4-1.8) respectively for controls. The risk was greatest for early-onset Alzheimer's disease. In multivariate analysis, dementia was associated with a hazard ratio of 2.52 (95% CI 2.31-2.74) for epilepsy. Young age, male sex, stroke, brain trauma, brain tumour and low Mini-Mental State Examination score significantly increased the risk.
Dementia, particularly young-onset Alzheimer's disease, increases the risk of subsequent epilepsy. Further studies are needed to determine optimal management and the impact of epilepsy on prognosis.
关于痴呆患者中癫痫的相关数据，尤其是关于其风险因素的信息，目前十分匮乏。混杂的合并症以及老年人群中癫痫发病率的上升，阻碍了该领域的研究进展。本研究旨在对瑞典痴呆登记处（SveDem）中大量痴呆患者的癫痫发生情况及其相关风险因素进行分析。
本研究对 SveDem 中所有患者（n=81192）和从人口登记处随机选择的 3 名与年龄和性别相匹配的对照者（排除所有痴呆诊断患者，n=223933）的癫痫和与癫痫相关的诊断、合并症和生存信息进行提取。使用 Kaplan-Meier 曲线估计痴呆诊断后癫痫的发病风险，采用 Cox 比例风险模型确定风险因素，并对合并症进行调整。
痴呆患者中癫痫的诊断率高于对照组[4.0%（95%CI 3.8-4.1）比 1.9%（95%CI 1.9-2.0）]。与对照组相比，痴呆患者在确诊痴呆后 5 年和 10 年发生新发癫痫的风险分别为 2.1%（95%CI 1.9-2.3）和 4.0%（95%CI 3.4-4.6），而对照组的相应风险分别为 0.8%（95%CI 0.8-0.8）和 1.6%（95%CI 1.4-1.8）。早发性阿尔茨海默病患者的风险最大。多变量分析显示，痴呆患者癫痫的风险比为 2.52（95%CI 2.31-2.74）。年龄较小、男性、卒中、脑外伤、脑肿瘤和简易精神状态检查评分较低显著增加了癫痫的发病风险。
痴呆，尤其是早发性阿尔茨海默病，会增加后续癫痫的发病风险。还需要进一步的研究来确定最佳管理方案以及癫痫对预后的影响。
