Devulder Astrid, Vanderlinden Greet, Cleeren Evy, Goovaerts Valerie, Theys Tom, Van Laere Koen, Van Paesschen Wim
Laboratory for Epilepsy Research, KU Leuven, Belgium.
Department of Neurology, University Hospitals Leuven, Herestraat 49, Leuven, 3000, Belgium.
BMC Neurol. 2024 Dec 18;24(1):478. doi: 10.1186/s12883-024-03979-4.
Neuronal hyperexcitability has been proposed to play a key role in Alzheimer's disease (AD). Understanding the relation between this enhanced excitability and AD pathology could provide a window for therapeutic interventions. However epileptiform activity is often subclinical, hidden on scalp EEG and very challenging to assess with current diagnostic modalities.
A woman in her sixties presented with acute confusion. Despite a normal scalp electroencephalogram (EEG), magnetic resonance imaging (MRI) showed cytotoxic edema of the right mesial temporal lobe and hippocampal hypermetabolism was present on ([F]-fluoro-2-deoxyglucose positron emission tomography (PET). Bilateral foramen ovale (FO) electrodes were placed to directly record mesial temporal activity and revealed continuous mesial temporal epileptic activity, while scalp EEG remained normal. After recovery, a new diagnosis of AD was established on cerebrospinal fluid. The lateralization of the epileptiform activity was congruent with the predominant side of tau pathology in the mesial temporal cortex on F-MK6240 PET. On follow-up MRI, two and five months later, the right hippocampus became atrophic.
This case highlights the significant role of neuronal hyperexcitability in early AD pathogenesis and how shared mechanisms between AD and epilepsy can complicate clinical management.
神经元兴奋性过高被认为在阿尔茨海默病（AD）中起关键作用。了解这种增强的兴奋性与AD病理之间的关系可为治疗干预提供一个窗口。然而，癫痫样活动通常是亚临床的，隐藏在头皮脑电图上，用目前的诊断方法评估非常具有挑战性。
一名60多岁的女性出现急性意识模糊。尽管头皮脑电图（EEG）正常，但磁共振成像（MRI）显示右侧内侧颞叶有细胞毒性水肿，并且在[F]-氟-2-脱氧葡萄糖正电子发射断层扫描（PET）上存在海马体代谢亢进。放置双侧卵圆孔（FO）电极直接记录内侧颞叶活动，结果显示内侧颞叶存在持续性癫痫活动，而头皮EEG仍正常。恢复后，根据脑脊液检查确诊为AD。癫痫样活动的定位与F-MK6240 PET上内侧颞叶皮质tau病理的主要侧相一致。在后续的MRI检查中，分别在两个月和五个月后，右侧海马体出现萎缩。
该病例突出了神经元兴奋性过高在早期AD发病机制中的重要作用，以及AD和癫痫之间的共同机制如何使临床管理复杂化。
