Wang Xinshi, Loi Samantha M, Foster Emma, Chen Zhibin, Velakoulis Dennis, Kwan Patrick
Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, VIC, Australia.
Front Aging Neurosci. 2021 Mar 16;13:637260. doi: 10.3389/fnagi.2021.637260. eCollection 2021.
People with neurocognitive disorders (NCDs) have an increased risk of epilepsy. However, most studies investigating the risk of seizures in people with NCDs are limited to those with Alzheimer's disease (AD) and vascular dementia (VD), and those who developed dementia after age 65 years. A knowledge gap exists regarding factors associated with development of epilepsy in people with younger-onset NCD, and those with non-AD and non-VD dementia subtypes. In this study, we aimed to identify the factors associated with the development of epilepsy in people with younger-onset NCDs of varied etiologies, the majority of whom had symptom onset prior to age 65 years. This was a retrospective study reviewing the medical records of consecutive people admitted with cognitive impairment to a tertiary neuropsychiatry unit between 1 January 2004 and 30 April 2019. People diagnosed with primary NCDs were included in the analysis. The prevalence and characteristics of epilepsy were described. The factors associated with developing epilepsy were identified in a binary logistic regression model. A total of 427 people were included. One hundred fourteen had Alzheimer's disease, 104 frontotemporal dementia, 51 vascular dementia, 69 movement disorder-associated dementia, and 89 unspecified NCD. The median age on admission was 59 years (range 33-86) and 75.2% ( = 321/427) had young-onset NCD with onset before 65 years of age. 40/427 (9.4%) people had epilepsy, and epilepsy onset clustered between 2 years before and 6 years after the onset of cognitive decline in 80% ( = 32/40). The most frequent seizure type was focal to bilateral tonic-clonic seizure (35%, = 14/40). Most of the people (94.7%, = 36/38) achieved seizure freedom with one or two antiseizure medications. People with unspecified NCD (compared to frontotemporal dementia and movement disorder-associated dementia, age of onset of NCDs ≤50 years, and current smoking status were independently associated with higher risk of developing epilepsy. Epilepsy is common in people with younger-onset NCDs, and a high index of suspicion is warranted particularly for those with unspecified subtype and smoking status. Smoking reduction or cessation should be further investigated as a potentially modifiable factor for risk reduction.
患有神经认知障碍（NCDs）的人患癫痫的风险增加。然而，大多数调查NCDs患者癫痫发作风险的研究仅限于患有阿尔茨海默病（AD）和血管性痴呆（VD）的患者，以及65岁以后患痴呆症的患者。对于早发性NCD患者以及患有非AD和非VD痴呆亚型的患者中与癫痫发生相关的因素，目前存在知识空白。在本研究中，我们旨在确定不同病因的早发性NCD患者中与癫痫发生相关的因素，其中大多数患者在65岁之前出现症状。这是一项回顾性研究，回顾了2004年1月1日至2019年4月30日期间连续入住三级神经精神科病房且患有认知障碍的患者的病历。分析纳入了被诊断为原发性NCDs的患者。描述了癫痫的患病率和特征。在二元逻辑回归模型中确定了与癫痫发生相关的因素。总共纳入了427人。其中114人患有阿尔茨海默病，104人患有额颞叶痴呆，51人患有血管性痴呆，69人患有运动障碍相关性痴呆，89人患有未特定的NCD。入院时的中位年龄为59岁（范围33 - 86岁），75.2%（n = 321/427）患有早发性NCD且发病年龄在65岁之前。40/427（9.4%）的人患有癫痫，80%（n = 32/40）的癫痫发作集中在认知衰退开始前2年至开始后6年之间。最常见的发作类型是局灶性至双侧强直阵挛发作（35%，n = 14/40）。大多数人（94.7%，n = 36/38）使用一两种抗癫痫药物后实现了无癫痫发作。患有未特定NCD的患者（与额颞叶痴呆和运动障碍相关性痴呆相比）、NCDs发病年龄≤50岁以及当前吸烟状况与癫痫发生风险较高独立相关。癫痫在早发性NCD患者中很常见，对于那些未特定亚型和有吸烟状况的患者尤其需要高度怀疑。应进一步研究减少或戒烟作为降低风险的潜在可改变因素。
