Epileptic Prodromal Alzheimer's Disease, a Retrospective Study of 13 New Cases: Expanding the Spectrum of Alzheimer's Disease to an Epileptic Variant?
Aside from rare case reports, only one study, with 12 patients, has addressed the phenotypic presentation of epilepsy in clinically defined amnestic mild cognitive impairment (aMCI, presumed to correspond to the AD prodromal stage): the authors highlighted a pharmacosensitive non-convulsive partial epileptic syndrome most probably related to the temporal or temporo-frontal cortices.



The objective of this study was to verify the existence and the syndromic features of epileptic prodromal AD in a tertiary Memory Clinic.



We conducted a retrospective, single-center study of the electro-radio-clinical features of 13 cases of epileptic prodromal AD patients (3.1% of a cohort of MCI, n = 430 subjects), selected on both clinical criteria and CSF biomarkers.



In our patients, a pharmacosensitive temporal lobe epilepsy syndrome, inaugurating prodromal AD, started at a mean age of 63 years (±12.8 years) and preceded MCI diagnosis by 4 to 7 years. At the stage of aMCI, median MMSE score was 26 and imaging showed mild hippocampal atrophy. After almost one year under treatment, cognitive complaints were not relieved but the MMSE score remained stable at 26 for 11 patients (2 patients were excluded from analysis because of the onset of aphasic or neurovisual symptoms altering MMSE scoring).



Our data, in conjunction with those of the 12 previously described subjects, suggest the existence of a currently unrecognized inaugural epilepsy syndrome of sporadic AD. Such a syndrome could be called the epileptic variant of AD because seizures are its sole feature for more than 2.5 years.
Unité de Neuropsychologie, Service de Neurologie des Hôpitaux Universitaires de Strasbourg, Strasbourg, France.|Centre Mémoire, de Ressources et de Recherche d'Alsace (Strasbourg-Colmar), France.|University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), team IMIS/Neurocrypto Strasbourg, France.|Centre de Compétences des démences rares des Hôpitaux Universitaires de Strasbourg, France.
Benjamin
B
Cretin
Centre Mémoire, de Ressources et de Recherche d'Alsace (Strasbourg-Colmar), France.|Service de Neurologie, Hospices Civils de Colmar, France.|Unité INSERM U-1118, Faculté de Médecine de Strasbourg, France.
François
F
Sellal
Unité de Neuropsychologie, Service de Neurologie des Hôpitaux Universitaires de Strasbourg, Strasbourg, France.|Centre Mémoire, de Ressources et de Recherche d'Alsace (Strasbourg-Colmar), France.|University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), team IMIS/Neurocrypto Strasbourg, France.|Centre de Compétences des démences rares des Hôpitaux Universitaires de Strasbourg, France.
Nathalie
N
Philippi
Centre Mémoire, de Ressources et de Recherche d'Alsace (Strasbourg-Colmar), France.|Unité de biochimie spécialisée, Laboratoire de biologie des Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Olivier
O
Bousiges
Unité de Neuropsychologie, Service de Neurologie des Hôpitaux Universitaires de Strasbourg, Strasbourg, France.|Centre Mémoire, de Ressources et de Recherche d'Alsace (Strasbourg-Colmar), France.|University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), team IMIS/Neurocrypto Strasbourg, France.|Centre de Compétences des démences rares des Hôpitaux Universitaires de Strasbourg, France.
Laure
L
Di Bitonto
Centre Mémoire, de Ressources et de Recherche d'Alsace (Strasbourg-Colmar), France.
Catherine
C
Martin-Hunyadi
Unité de Neuropsychologie, Service de Neurologie des Hôpitaux Universitaires de Strasbourg, Strasbourg, France.|Centre Mémoire, de Ressources et de Recherche d'Alsace (Strasbourg-Colmar), France.|University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), team IMIS/Neurocrypto Strasbourg, France.|Centre de Compétences des démences rares des Hôpitaux Universitaires de Strasbourg, France.
Frederic
F
Blanc
D000368:Aged; D000544:Alzheimer Disease / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging*; D016229:Amyloid beta-Peptides / Q000134:cerebrospinal fluid; D000927:Anticonvulsants / Q000627:therapeutic use; D015331:Cohort Studies; D018450:Disease Progression; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D009483:Neuropsychological Tests; D062706:Prodromal Symptoms
D016229:Amyloid beta-Peptides; D000927:Anticonvulsants
Alzheimer’s disease; mild cognitive impairment; partial seizures; temporal lobe epilepsy