Title:Pharmacological Medical Treatment of Epilepsy in Patients with Dementia: A Systematic Review
Volume: 18
Issue: 9
Author(s): Christian S. Musaeus*, Christer Nilsson, Chris Cooper, Milica G. Kramberger, Ana Verdelho, Elka Stefanova, Dorota Religa, Gunhild Waldemar and Kristian S. Frederiksen
Affiliation:
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital, Rigshospitalet,Denmark
Keywords:
Dementia, Alzheimer's disease, epilepsy, anti-epileptic medication, levetiracetam, older adults.
Abstract:
Background: Patients with dementia have an increased risk of developing epilepsy, especially
in patients with vascular dementia and Alzheimer’s disease. In selecting the optimal anti-
epileptic drug (AED), the possible side effects such as drowsiness and worsening of cognitive
function should be taken into consideration, together with co-morbidities and type of epilepsy.
Objective: The current systematic review investigates the efficacy, tolerability, and changes in cognitive
function after administration of AED in patients with dementia and epilepsy.
Methods: We searched six databases, including MEDLINE and CENTRAL, checked reference
lists, contacted experts, and searched Google Scholar to identify studies reporting randomized
trials. Studies identified were independently screened, data extracted, and quality appraised by two
researchers. A narrative synthesis was used to report findings.
Results: We included one study with 95 patients with Alzheimer’s disease randomized to either levetiracetam,
lamotrigine, or phenobarbital. No significant differences were found for efficacy, but
patients receiving levetiracetam showed an improvement in mini-mental state examination scores
and had fewer adverse events.
Conclusion: High-quality evidence in the form of randomized controlled trials to guide clinicians
in choosing an AED in patients with dementia and concomitant epilepsy remains scarce. However,
levetiracetam has previously been shown to possibly improve cognition in patients with both mild
cognitive impairment and Alzheimer’s disease, is better tolerated in the elderly population, and has
no clinically relevant interaction with either cholinesterase inhibitors or NMDA receptor antagonists.
