1. Seizures in Alzheimer’s disease
Vikas Dhikav,
MBBS (Rohtak), MD (3-years AIIMS) , PhD (Neurology, PGIMER Delhi), Fellowship Clinical Neuropsychopharmacology,
Director, Memory Clinic Delhi,
Seizures in Alzheimer’s disease

2. Alzheimer’s disease Most common cause of dementia.
Affects around 1 Crore people in India!
PrecursorMild Cognitive Impairment (MCI)

3. Risk AD  upto 10-fold increased risk of developing seizures.
Seziurescommon in AD  
Hesdorffer DC et al., Neurology. 1996;46:727–730.

4. Incidence
AD and other neurode-generative conditions presumed etiology 10% of new onset epilepsy in patients older than 65 years.
Hauser WA, Annegers JF, Kurland LT.  Epilepsia. 1993;34:453–468.

5. Prevalence Lifetime prevalence seizures with AD1.5 to 64 percent
Hauser HA, Neurology, 1986

6. Why AD has seizures?
AD risk for late-onset seizures and neuronal network abnormalities. 
Born, Neuroscience, 2014

7. Sporadic Vs Familial
More common in sporadic form of AD. 

8. Common problem!
 Nonconvulsive network abnormalities, seizures and other electroencephalographic abnormalities, more commonly found in patients than previously thought. 
Hauser HA, Neurology, 1986

9. Genetics
More common imutations in PSEN1, PSEN2, or APP, as well as with APP duplication
Born, Neuroscience, 2014

10. Pathophysiology
The amyloid-β possible link AD and seizures. 

11. Seizures worsen AD
Seizures contribute to cognitive impairments characteristic of AD, such as amnestic wandering. 

12. Experimental evidence
Antiepileptic drugs rescue cognitive deficits in AD mouse models and human patients.

13. Epilepsy and AD
Epilepsy
Alzheimer’s disease
Potential research area

14. Potential Rx targets Better Treatment
Alzheimer’s disease
Neuronal hyperexcitability
Neuronal abnormalities
Nikolas et al., Arch Neurol. 2009; 66(8): 992–997.

15. World experience
Occur in about 10%, 10 times more common than reference population.
Can occur anytime.
Generalized seizures occur early.
Myoclonuslate seziures.
Hauser HA, Neurology, 1986

16. Indian experience Category Sample size (n) =171 Age (Years) Sex MMSEAD 75
75±5
M:F=60:15
18±5
MCI 96
67±7
M:F=76:20
24±2

17. Proportion of seizures in AD/MCI

18. Indian experience… Category Seizures Duration of illness (Years)
Drug Treatment AD
GTCS (7), Partial (2)
3.6±3
Valproate/Levitiracetam
MCI
GTCS (4), Partial (2)
2.5 ±2

19. Epilepsy and AD overlap
Do epilepsy and AD share pathophysiology?
Dionysios Pandis, Epilepsy Curr. 2012; 12(5): 184–187.

20. Manifestations
The diagnosis of seizures in AD not easyunderestimation.
“Funny” or “unusual” behaviors of demented patients seizuresoverestimation of seizure rates.

21. Seizure types
Generalizedmost common
Partial seizures

22. Predictors Seizure prevalence increase with AD duration.
Onset of seizures later stages of the disease.

23. Be aware!
 Patients with dementia nonepileptic episodes of inattention or confusion as well as syncope or near-syncope.
Nikolas et al., Arch Neurol. 2009; 66(8): 992–997.

24. Treatment
Choice of AEDs empirical based on side effect profiles.