Background: Aside from rare case reports, only one study, with 12 patients, has addressed the phenotypic presentation of epilepsy in clinically defined amnestic mild cognitive impairment (aMCI, presumed to correspond to the AD prodromal stage): the authors highlighted a pharmacosensitive non-convulsive partial epileptic syndrome most probably related to the temporal or temporo-frontal cortices.
Objective: The objective of this study was to verify the existence and the syndromic features of epileptic prodromal AD in a tertiary Memory Clinic.
Methods: We conducted a retrospective, single-center study of the electro-radio-clinical features of 13 cases of epileptic prodromal AD patients (3.1% of a cohort of MCI, n = 430 subjects), selected on both clinical criteria and CSF biomarkers.
Results: In our patients, a pharmacosensitive temporal lobe epilepsy syndrome, inaugurating prodromal AD, started at a mean age of 63 years (±12.8 years) and preceded MCI diagnosis by 4 to 7 years. At the stage of aMCI, median MMSE score was 26 and imaging showed mild hippocampal atrophy. After almost one year under treatment, cognitive complaints were not relieved but the MMSE score remained stable at 26 for 11 patients (2 patients were excluded from analysis because of the onset of aphasic or neurovisual symptoms altering MMSE scoring).
Conclusion: Our data, in conjunction with those of the 12 previously described subjects, suggest the existence of a currently unrecognized inaugural epilepsy syndrome of sporadic AD. Such a syndrome could be called the epileptic variant of AD because seizures are its sole feature for more than 2.5 years.
BergAT, BerkovicSF, BrodieMJ, BuchhalterJ, CrossJH, van Emde BoasW, EngelJ, FrenchJ, GlauserTA, MathernGW, MoshéSL, NordliD, PlouinP, SchefferIE (2010) Revised terminology and concepts for organization of seizures and epilepsies: Report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia51, 676–685.
7.
MartinRC, FaughtE, RichmanJ, FunkhouserE, KimY, ClementsK, PisuM (2014) Psychiatric and neurologic risk factors for incident cases of new-onset epilepsy in older adults: Data from U.S. Medicare beneficiaries. Epilepsia55, 1120–1127.
8.
GauthierS, ReisbergB, ZaudigM, PetersenRC, RitchieK, BroichK, BellevilleS, BrodatyH, BennettD, ChertkowH, CummingsJL, de LeonM, FeldmanH, GanguliM, HampelH, ScheltensP, TierneyMC, WhitehouseP, WinbladB (2006) International Psychogeriatric Association Expert Conference on mild cognitive impairment. Lancet367, 1262–1270.
9.
ScheltensP, LeysD, BarkhofF, HugloD, WeinsteinHC, VermerschP, KuiperM, SteinlingM, WoltersEC, ValkJ (1992) Atrophy of medial temporal lobes on MRI in “probable” Alzheimer’s disease and normal ageing: Diagnostic value and neuropsychological correlates. J Neurol Neurosurg Psychiatry55, 967–972.
10.
AlbertMS, DeKoskyST, DicksonD, DuboisB, FeldmanHH, FoxNC, GamstA, HoltzmanDM, JagustWJ, PetersenRC, SnyderPJ, CarrilloMC, ThiesB, PhelpsCH (2011) The diagnosis of mild cognitive impairment due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement7, 270–279.
11.
SauvéeM, Didier LaurentG, LatarcheC, EscanyéMC, OlivierJL, Malaplate-ArmandC (2014) Additional use of Aβ42/Aβ40 ratio with cerebrospinal fluid biomarkers P-Tau and Aβ42 increases the level of evidence of Alzheimer’s disease pathophysiological process in routine practice. J Alzheimers Dis41, 377–386.
12.
BlankL, BaxterS, BairdW, ReuberM (2013) Understanding referral patterns to an epilepsy clinic: Professional perceptions of factors influencing the referral of older adults. Seizure22, 698–702.
13.
PacagnellaD, LopesTM, MoritaME, YasudaCL, CappabiancoFA, BergoF, BalthazarML, CoanAC, CendesF (2014) Memory impairment is not necessarily related to seizure frequency in mesial temporal lobe epilepsy with hippocampal sclerosis. Epilepsia55, 1197–1204.
14.
VingerhoetsG (2006) Cognitive effects of seizures. Seizure15, 221–226.
