Diagnosing epileptic seizures in patients with Alzheimer’s disease and deciding on the appropriate treatment plan

ABSTRACT

Introduction

Alzheimer’s disease (AD) is the predominant cause of dementia and a significant contributor to morbidity among the elderly. Patients diagnosed with AD face an increased risk of epileptic seizures.

Areas covered

Herein, the authors review the challenges in the diagnosis of seizures in patients with AD, the risks of seizures related to medications used in AD and the pharmacological treatment of seizures in AD. The authors also provide the reader with their expert opinion on the subject matter and future perspectives.

Expert opinion

Healthcare professionals should maintain a vigilant approach to suspecting seizures in AD patients. Acute symptomatic seizures triggered by metabolic disturbances, infections, toxins, or drug-related factors often have a low risk of recurrence. In such cases, addressing the underlying cause may suffice without initiating antiseizure medications (ASMs). However, unprovoked seizures in certain AD patients carry a higher risk of recurrence over time, warranting the use of ASMs. Although data is limited, both lamotrigine and levetiracetam appear to be reasonable choices for controlling seizures in elderly AD patients. Decisions should be informed by the best available evidence, the treating physician’s clinical experience, and the patient’s preferences.

KEYWORDS:

• Alzheimer’s disease
• antiseizure medications
• diagnosis
• epileptic seizures
• treatment

Article highlights

• There are several factors responsible for underdiagnosis/misdiagnosis of epileptic seizures in Alzheimer’s disease.

• It is important to maintain a low threshold for suspecting seizures in these patients.

• Drugs used to mitigate symptoms of Alzheimer’s disease have various effects on the risk of seizures.

• Lamotrigine and levetiracetam appear to be reasonable options for controlling seizures in patients with Alzheimer’s disease.

• The choice of the most appropriate drug should consider several clinical and pharmacological issues.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.