Can Alzheimer's Disease Be a Cause of Seizures?

Seizure Risk in People with Alzheimer's Disease

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Alzheimer's disease may be a cause of seizures - in addition to causing dementia.  Dementia, a deterioration of intellectual functioning, usually presents itself as a loss of memory and changes in mood. Because of this memory impairment, dementia can interfere with social skills and everyday living. Dementia is mostly found in the elderly population. In fact, it is estimated that 4% to 12 % of people over the age of 65 are suffering from some form of dementia.

Alzheimer's disease is the most common form of dementia, and it is estimated that five million individuals have Alzheimer’s disease in the United States. Having Alzheimer’s disease not only places you at risk for memory loss –- it can also place you at risk of developing a seizure disorder. 

Why Do Seizures Occur With Alzheimer’s Disease?

The development of Alzheimer’s disease (AD) progresses slowly. During this time, a protein called beta amyloid gradually accumulates in the brain and forms a plaque. While more research is needed to determine exactly how this occurs, it has been proposed that this plaque could cause nerve damage in the brain, which could lead to the decline of cognitive and motor function.

Alzheimer's doesn't increase seizure risk because of a direct brain degeneration standpoint; rather, it's thought that beta-amyloid and its breakdown products might cause 'cortical excitability' (essentially overstimulated neurons in the brain that can lead to seizures) and the propagation of abnormal discharges in the brain.

This may be why seizures are more common with Alzheimer's disease than other forms of dementia.

Of course, people with Alzheimer's disease may have other causes of seizures as well, related to other medical conditions.

What Patients With Alzheimer's Have the Greatest Seizure Risk?

Seizures in people with Alzheimer's appear to be more common in those who:

  • Have early onset Alzheimer's disease
  • Have more severe dementia
  • Have a familial presenilin 1 mutation (PSEN1), as well as other genetic abnormalities such as PSEN2, APP, and APP duplication

How Common Are Seizures in People with Alzheimer's Disease?

It's thought that having Alzheimer's disease increases the risk of having a seizure 2 to 6 fold, depending on the study. Looking at this from another angle, 10 to 22% of people with Alzheimer's disease are likely to have at least one unprovoked seizure over the course of their disease. Seizures with AD often occur after the disease has been present for some time, and the average time from onset of Alzheimer's disease to the first seizure is 6 years.

The most common types of seizures seen in individuals with Alzheimer’s disease include partial complex seizures and secondary generalized tonic-clonic seizures. 

Managing Seizures in People with Alzheimer's Disease - Special Considerations

Not everyone with Alzheimer’s disease will experience a seizure; however, this can place them at a higher risk of having one. If someone with Alzheimer’s disease has a seizure, a health care provider will perform a careful assessment that includes blood tests, a CT scan or MRI, and an EEG to assess the seizure type and any other underlying cause for the seizure.

From these tests, an antiepileptic medication will be selected to help control the seizures.

Special Consideration for Seizures Among the Alzheimer's Population

There are several special issues to consider with seizures in people with Alzheimer's disease. 

  1. One is that it is more difficult to get an accurate diagnosis than it is in someone who does not have any cognitive decline.  Unless someone else observes a person with AD have a seizure, getting an accurate history of the episode may be challenging.  Seizures can also be difficult to distinguish from some other behaviors associated with the disease.
  1. Another is that many people with Alzheimer's disease are elderly.  This means that kidney or liver function may be compromised making the use of some drugs a problem.  There is also a much greater risk of drug interactions if someone is on multiple medications (several of the drugs used for epilepsy are known to have multiple drug interactions.)
  2. Yet another problem is that the effects of many of the drugs used for epilepsy can worsen the symptoms of Alzheimer's disease.
  3. Finally, seizure symptoms can add to the problems associated with Alzheimer's disease such as amnestic wondering.

Seizure Medications in People with Alzheimer's Disease

As noted above, one of the concerns in managing Alzheimer's disease in people with Alzheimer's disease is that some of the seizure medications can make the symptoms of dementia worse.  Medications that may cause fewer symptoms include Tegretol (carbamazepine), Depakote (valproic acid), Neurontin (gabapentin), and Lamictal (lamotrigine.)

It's also thought that using the lowest possible dose may be helpful, as well as monitoring blood levels of the drugs for which this is possible.

First Aid Treatment of Seizures

If your loved one with Alzheimer's disease has developed epilepsy, learn how to treat a seizure and how to keep both yourself and your loved one safe from the effects of this disorder.

Seizures in People with Other Forms of Dementia

It's uncertain whether seizures are also more common in people with other forms of dementia.  Since seizures in those with Alzheimer's disease appear to be related to brain excitability related to beta amylase plaques rather than due to brain degeneration (neurodegeneration) per se, it could be that findings with AD are not applicable to those with other forms of dementia.  In a few studies, it's been found that the risk of seizures in people with non-Alzheimer's dementia is lower than that for those with Alzheimer's disease.


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