Global Brain Health Institute at University of California San Francisco, San Francisco, CA, USA.
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.
J Clin Neurosci. 2021 Apr;86:247-251. doi: 10.1016/j.jocn.2021.01.030. Epub 2021 Feb 16.
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.
最近的流行病学研究表明，病因不明的老年期起病癫痫（LOEU）是未来痴呆的一个危险因素。这些研究依赖于纳入和排除多种诊断代码，而不是结构化数据和神经影像学发现，因此在临床上难以解释。我们评估了通过入院数据和 10 年随访期间的神经影像学诊断的 LOEU 患者的痴呆累积发病率，并比较了区分组级新发痴呆的基线特征。我们筛选了我们医院的记录，寻找年龄在 55-69 岁之间、在 2000 年至 2008 年间新诊断为癫痫的患者，并排除了在病历或神经影像学上诊断为潜在病因的癫痫患者。我们使用回顾性医院数据，对患者在 10 年内新发痴呆或死亡的情况进行随访，并比较了有和无新发痴呆患者的基线（人口统计学、抑郁或焦虑、血管危险因素、脑电图（EEG）研究结果、抗抑郁药使用和抗癫痫药物类型）和随访（癫痫复发、新发脑血管病）特征。筛选出 54 例 LOEU 病例，首次发作年龄为 61 ± 5 岁。痴呆的 10 年累积发病率为 22.20%（95%置信区间 22.08-23.10%），痴呆诊断时间为 5.4 ± 3.9 年。新发痴呆患者更可能为女性（83% vs 38%，p = 0.002），基线 EEG 有发作间期癫痫样放电（IED）（70% vs 29%，p = 0.011）和抑郁或焦虑（50% vs 18%，p = 0.026）。其他基线或随访特征无差异。我们的结果支持 LOEU 中痴呆发病率的最新发现。对 LOEU 的前瞻性研究应评估老年期癫痫患者的表型决定因素和向痴呆进展的速度。
