Pharmacotherapeutic strategies for treating epilepsy in patients with Alzheimer’s disease

ABSTRACT

Introduction: Alzheimer’s disease (AD)-related epileptic comorbidity is now well documented and appears to have been previously underestimated. Prescribing antiepileptic drugs (AEDs) in AD patients aims at preventing seizure-related morbi-mortality and the occurrence of deleterious status epilepticus. At the earlier stages of the disease, some clinicians even expect a disease-modifying effect.

Areas covered: In this review, the author provides a brief overview of the epileptic comorbidity in AD, discusses the appropriate AEDs from a syndromic point of view, reviews the effectiveness and cognitive tolerability of the currently available drugs, and considers the influence of the comorbidities and the age of AD patients in the choice of an AED.

Expert opinion: Given the paucity of current empirical data, much remains to be done to provide good evidence of the efficacy and tolerability of AEDs in the area of AD-related seizures and epilepsy. To our knowledge, lamotrigine and levetiracetam are currently the two best therapeutic options as low-dose monotherapies.

KEYWORDS:

• Alzheimer disease
• Mild cognitive impairment
• focal seizures
• myoclonus
• antiepileptic drugs

Article highlights

• The number of AD subjects is increasing worldwide.

• Seizures are easy and useful to manage at any stage of the disease with low-dose AED treatment, yet they may be difficult to diagnose.

• The purpose of the pharmacological treatment is to provide the greatest effectiveness with the least possible side effects.

• Two optimal therapeutic options are recommended: levetiracetam and lamotrigine

• There is hope for the potentially disease-modifying effect of AEDs at the earliest stages of AD, which must nonetheless be proven in human sporadic AD.

This box summarizes key points contained in the article.

Declaration of interest

B Cretin has 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

One referee has received speakers’ honoraria from Eisai and PeerVoice, payment for consultancy from Eisai, and travel support from Eisai, ITALFARMACO, and UCB Pharma.

Additional information

Funding

This manuscript was not funded.