Epileptic seizures may be a feature of some neurodegenerative dementia syndromes. There is an increased incidence of seizures inAlzheimerâ€™s disease compared to age-matched controls. Seizures also occur in prion disorders and some frontotemporal lobar degenerationsyndromes, whereas parkinsonian dementia disorders seem relatively seizure free. Seizure pathogenesis in these conditions is uncertain,but may relate to neocortical and hippocampal hyperexcitability and synchronised activity, possibly as a consequence of dysfunctionalprotein metabolism, neuronal structural changes, and concurrent cerebrovascular disease. Alzheimerâ€™s disease may be a neuronalnetwork disorder, characterised by both cognitive decline and epileptic activity, in which seizures are an integral part of disease phenotyperather than epiphenomena. Treatment of seizures in dementia syndromes currently remains empirical. Greater understanding of dementiapathogenesis may shed light on mechanisms of epileptogenesis and facilitate more rational approaches to seizure treatment.
A J Larner