抗癫痫药物治疗癫痫前驱期阿尔茨海默病：癫痫发作和认知的中期结果。

Epileptic Prodromal Alzheimer's Disease Treated with Antiseizure Medications: Medium-Term Outcome of Seizures and Cognition.

机构信息

Centre Mémoire, de Ressources et de Recherche d'Alsace (Strasbourg-Colmar), Strasbourg, France.

Service de Neurologie, Hospices Civils de Colmar, Colmar, France.

出版信息

J Alzheimers Dis. 2023;94(3):1057-1074. doi: 10.3233/JAD-221197.

DOI:10.3233/JAD-221197

PMID:37355889

Abstract

BACKGROUND

The medium term outcome (over more than one year) of epileptic prodromal AD (epAD) patients treated with antiseizure medications (ASMs) is unknown in terms of seizure response, treatment tolerability, and cognitive and functional progression.

OBJECTIVE

To describe such medium term outcome over a mean of 5.1±2.1 years.

METHODS

We retrospectively compared 19 epAD patients with 16 non-epileptic prodromal AD (nepAD) patients: 1) at baseline for demographics, medical history, cognitive fluctuations (CFs), psychotropic medications, MMSE scores, visually rated hippocampal atrophy, CSF neurodegenerative biomarkers, and standard EEG recordings; 2) during follow-up (FU) for psychotropic medications, MMSE progression, and conversion to dementia. In the epAD group, we analyzed baseline and FU types of seizures as well as each line of ASM with the corresponding efficacy and tolerability.

RESULTS

At baseline, the epAD group had more CFs than the nepAD group (58% versus 20%, p = 0.03); focal impaired awareness seizures were the most common type (n = 12, 63.1%), occurring at a monthly to quarterly frequency (89.5%), and were well controlled with monotherapy in 89.5% of cases (including 63.1% seizure-free individuals). During FU, treated epAD patients did not differ significantly from nepAD patients in MMSE progression or in conversion to dementia.

CONCLUSION

Epilepsy is commonly controlled with ASMs over the medium term in epAD patients, with similar functional and cognitive outcomes to nepAD patients. Pathophysiologically, epilepsy is likely to be an ASM-modifiable cognitive aggravating factor at this stage of AD.

摘要

背景

接受抗癫痫药物（ASM）治疗的癫痫前驱期 AD（epAD）患者的中期结局（超过一年）在癫痫发作反应、治疗耐受性以及认知和功能进展方面尚不清楚。

目的

描述这种中期结局，平均随访时间为 5.1±2.1 年。

方法

我们回顾性比较了 19 名 epAD 患者和 16 名非癫痫前驱期 AD（nepAD）患者：1）基线时比较人口统计学、病史、认知波动（CFs）、精神药物、MMSE 评分、视觉评估海马萎缩、CSF 神经退行性生物标志物和标准 EEG 记录；2）在随访期间（FU）比较精神药物、MMSE 进展和向痴呆的转变。在 epAD 组中，我们分析了基线和 FU 的癫痫发作类型以及每种 ASM 的类型及其相应的疗效和耐受性。

结果

基线时，epAD 组的 CFs 比 nepAD 组多（58%比 20%，p=0.03）；局灶性意识障碍发作是最常见的类型（n=12，63.1%），每月至每季度发作一次（89.5%），在 89.5%的病例中，单一药物治疗可很好地控制发作（包括 63.1%的无发作个体）。在 FU 期间，接受治疗的 epAD 患者的 MMSE 进展或向痴呆的转变与 nepAD 患者无显著差异。