Seizures and epileptiform activity in the early stages of Alzheimer disease.
Seizures and epileptiform activity in the early stages of Alzheimer disease.
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DOI：
10.1001/jamaneurol.2013.136
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发表时间：
2013-09-01
期刊：
影响因子：
29
通讯作者：
Mucke, Lennart
中科院分区：
文献类型：
--
作者：
Vossel, Keith A.;Beagle, Alexander J.;Rabinovici, Gil D.;Shu, Huidy;Lee, Suzee E.;Naasan, Georges;Hegde, Manu;Cornes, Susannah B.;Henry, Maya L.;Nelson, Alexandra B.;Seeley, William W.;Geschwind, Michael D.;Gorno-Tempini, Maria L.;Shih, Tina;Kirsch, Heidi E.;Garcia, Paul A.;Miller, Bruce L.;Mucke, Lennart
与阿尔茨海默病（AD）相关的癫痫活动值得更多关注，因为它对这些患者有有害影响，很容易不被察觉和未得到治疗，并且可能反映出也对该疾病其他方面有影响的致病过程。我们报告了与AD相关的癫痫发作和癫痫样活动的关键特征，这些特征对临床实践具有指导意义，并强调了AD与该疾病的转基因动物模型之间的相似性。
描述伴有癫痫或亚临床癫痫样活动的遗忘型轻度认知障碍（aMCI）或早期AD患者的常见临床特征和治疗结果。
2007年至2012年的回顾性观察研究。
美国加州大学旧金山分校记忆与衰老中心。
我们研究了54名患者，其中诊断为aMCI合并癫痫的有12名，AD合并癫痫的有35名，AD合并亚临床癫痫样活动的有7名。
临床和人口统计学数据、脑电图（EEG）读数以及对抗癫痫药物的治疗反应。
伴有癫痫的aMCI患者出现认知下降症状比不伴有癫痫的aMCI患者早6.8年（64.3岁对71.1岁；P = 0.02）。伴有癫痫的AD患者出现认知下降比不伴有癫痫的AD患者早5.5年（64.8岁对70.3岁；P = 0.001）。伴有亚临床癫痫样活动的AD患者也有认知下降的早期发作（58.9岁）。aMCI和AD患者癫痫发作的时间不一致（P < 0.001），集中在认知下降开始附近。癫痫发作最常见的是复杂部分性发作（47%），且超过一半是非惊厥性的（55%）。连续或延长的脑电图监测在检测发作间期和亚临床癫痫样活动方面似乎比常规脑电图更有效。癫痫病灶主要是单侧的且位于颞叶。在最常用的抗癫痫药物中，拉莫三嗪和左乙拉西坦的治疗效果似乎比苯妥英更好。
在我们中心，伴有aMCI或AD相关癫痫的患者的常见临床特征包括认知下降发病年龄早、疾病过程中癫痫发作出现早、通过连续/延长脑电图检测到单侧颞叶癫痫病灶、短暂性认知功能障碍以及使用拉莫三嗪和左乙拉西坦能良好控制癫痫发作且耐受性好。仔细识别和治疗这类患者的癫痫可能会改善他们的临床病程。
Epileptic activity associated with Alzheimer disease (AD) deserves increased attention because it has a harmful impact on these patients, can easily go unrecognized and untreated, and may reflect pathogenic processes that also contribute to other aspects of the illness. We report key features of AD-related seizures and epileptiform activity that are instructive for clinical practice and highlight similarities between AD and transgenic animal models of the disease. To describe common clinical characteristics and treatment outcomes of patients with amnestic mild cognitive impairment (aMCI) or early AD who also have epilepsy or subclinical epileptiform activity. Retrospective observational study from 2007 to 2012. Memory and Aging Center, University of California, San Francisco. We studied 54 patients with a diagnosis of aMCI plus epilepsy (n = 12), AD plus epilepsy (n = 35), and AD plus subclinical epileptiform activity (n = 7). Clinical and demographic data, electroencephalogram (EEG) readings, and treatment responses to antiepileptic medications. Patients with aMCI who had epilepsy presented with symptoms of cognitive decline 6.8 years earlier than patients with aMCI who did not have epilepsy (64.3 vs 71.1 years; P = .02). Patients with AD who had epilepsy presented with cognitive decline 5.5 years earlier than patients with AD who did not have epilepsy (64.8 vs 70.3 years; P = .001). Patients with AD who had subclinical epileptiform activity also had an early onset of cognitive decline (58.9 years). The timing of seizure onset in patients with aMCI and AD was nonuniform (P < .001), clustering near the onset of cognitive decline. Epilepsies were most often complex partial seizures (47%) and more than half were nonconvulsive (55%). Serial or extended EEG monitoring appeared to be more effective than routine EEG at detecting interictal and subclinical epileptiform activity. Epileptic foci were predominantly unilateral and temporal. Of the most commonly prescribed antiepileptics, treatment outcomes appeared to be better for lamotrigine and levetiracetam than for phenytoin. Common clinical features of patients with aMCI- or AD-associated epilepsy at our center included early age at onset of cognitive decline, early incidence of seizures in the disease course, unilateral temporal epileptic foci detected by serial/extended EEG, transient cognitive dysfunction, and good seizure control and tolerability with lamotrigine and levetiracetam. Careful identification and treatment of epilepsy in such patients may improve their clinical course.
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影响因子：
5.6
作者：
MCAREAVEY, MJ;BALLINGER, BR;FENTON, GW
通讯作者：
FENTON, GW
DOI：
10.1073/pnas.1206171109
发表时间：
2012-05-29
影响因子：
11.1
作者：
Busche, Marc Aurel;Chen, Xiaowei;Konnerth, Arthur
通讯作者：
Konnerth, Arthur
影响因子：
4.2
作者：
Ball, M;Braak, H;Khachaturian, Z
通讯作者：
Khachaturian, Z
影响因子：
16.2
作者：
Bakker A;Krauss GL;Albert MS;Speck CL;Jones LR;Stark CE;Yassa MA;Bassett SS;Shelton AL;Gallagher M
通讯作者：
Gallagher M
影响因子：
5.6
作者：
Berg, Anne T.;Berkovic, Samuel F.;Scheffer, Ingrid E.
通讯作者：
Scheffer, Ingrid E.