Blog #166: POST-TRAUMATIC EPILEPSY IS ASSOCIATED WITH HIGHER RISK FOR DEMENTIA

 

 

 

 

As I have written in earlier monthly blogs, most people are surprised to learn that the commonest onset of epilepsy is in the older age-group and not in the pediatric population Why? We are living longer.

 

The epilepsy population is one percent of all people. In only half of these people can a cause for their epilepsy be identified. In the other half no cause can be found, in other words, these people have idiopathic epilepsy. In those for whom a cause can be identified, they have what is called symptomatic epilepsy. Usually, the cause is a structural abnormality in the brain associated with scars from trauma, scars from strokes, brain tumors, brain infections, abnormal blood vessels etc.

 

This blog highlights a summary edited by Susan Kreimer in the Neurology Today April 4, 2024, issue. It addresses the higher incidence of dementia in those with post-traumatic epilepsy¹. Post-traumatic epilepsy (PTE) is associated over a 25-year follow-up of developing dementia compared with epilepsy without a history of head trauma. A combination of epilepsy and head injury places the person at an increased risk of developing dementia.

 

Although some patients experiencing significant head injury are placed on anticonvulsant medications even before a seizure occurs, usually for short periods, as seizure prophylaxis, this has not been found to alter the risk of eventually developing PTE. Even mild traumatic brain injury can result in PTE up to a year after the head injury.

 

Researchers collected 12,558 individuals aged 45-64. The average age at baseline was 54 years. Nearly 58% were female and 28% were Black. Of this group 14.4 reported past head injury, 5.1% had seizure/epilepsy and 1.2 % had PTE. After follow-up spanning a median of 25 years, 19.9 of the participants developed dementia. Dementia risk factors may vary among population subgroups. The researchers adjusted for vascular and genetic risk factors.

 

Approximately 5-8% of the American population over 65 has dementia. Neurologists are encouraged to have a lower threshold to suspect cognitive impairment and dementia in their patients with PTE. Screen the patients themselves rather than rely on reports of caregivers to identify such patients for greater diagnostic accuracy. Have them undergo neuropsychological testing to confirm dementia if it appears.

 

We conclude that being aware of this group of PTE patients and of assessing them periodically for their higher risk of developing dementia can lead to better health outcomes.

 

 

1)     Schneider KCA, Law CA, Gottesman RF et. al.  Post-traumatic Epilepsy and dementia risk. JAMA Neurol 2024; Epub 2024 Feb 26

 

 Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School

of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is

told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation

on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review,

DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles

Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now

available in eBook, audiobook, soft and hard cover editions.

Blog #163 February: ALZHEIMER'S DISEASE AND EPILEPSY

Articles are ubiquitous in the media on Alzheimer's Disease (AD). It is estimated that Alzheimer's currently affects 5 million Americans. In 2050 ten percent of us will be affected according to Harvard.edu.

Increasing knowledge based on multiple studies (meta-analysis) shows a link between AD and epilepsy. People with epilepsy had a 1.8-fold increased risk of AD. Patients with AD had a 3.1- fold higher risk of epilepsy, both generalized and focal seizures with impaired awareness (complex partial epileptic seizures). Temporal lobe epilepsy and AD share some pathologic features such as both show hippocampal sclerosis in the temporal lobe tip. The study populations to confirm this information is interesting but it is inconclusive due to the relatively small populations in the studies.1 

Increased chemical amyloid compounds are found in the brains of patients with AD. Elderly people who may be intellectually normal all have some amyloid in their brains, too, but this chemical compound is more prolific in AD dementia. It appears that amyloid pathology increases the propensity to generalized seizures. There is an association between AD and focal seizures, too, with hippocampal sclerosis (scarring) in the temporal lobes.

1. Fang Y, Xiaoli S, Jial W, et. al. Alzheimer Disease and Epilepsy. Neurology;2023 101:e 399-e409. Doi:10.1212 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions

Blog # 157: Cognition and dementia in older patients with epilepsy

 

Today’s health care practices have resulted in a substantial rise in the number of older adults with epilepsy. In America we have one percent of our population, three million, suffering with epilepsy. In the rest of the developed world, the elderly over 65 also have the highest incidence of epilepsy. It no longer is the pediatric population that develops the most cases of epilepsy (See my Blog # 15, Epilepsy is most common in the Elderly, at LanceFogan.com)

Older people are more likely to have cognitive decline with epilepsy. There seems to be a relationship between epilepsy and dementia. Epidemiological findings reveal that people with late-onset epilepsy and individuals with Alzheimer’s disease share common risk factors. Medical science isn’t conclusively settled on the cause of Alzheimer’s nor who will develop it but it seems in some people to be mediated by underlying vascular changes in the aging brain. Contributing to their development of epilepsy is their survival after brain trauma, strokes and various diseases.¹

The authors  Sen, Capelli, et.al., suggest that there is considerable intersection between epilepsy, Alzheimer’s disease and cerebrovascular disease raising the possibility that better understanding of shared mechanisms in these conditions might help to ameliorate not just seizures, but also epileptogenesis and cognitive dysfunction.

 

1.     A. Sen, V. Capelli, M. Husain. Cognition and dementia in older patients with epilepsy Brain, Volume 141, Issue 6, June 2018, Pages 1592–1608,  https://doi.org/10.1093/brain/awy022

 

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.