Effect of Levetiracetam on Cognition in Patients With Alzheimer Disease With and Without Epileptiform Activity

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BrianR
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Effect of Levetiracetam on Cognition in Patients With Alzheimer Disease With and Without Epileptiform Activity

Post by BrianR »

I learned that there exists a sub-type of AD patients who have "silent" epileptic activity in their brains. And that the epilepsy drug Levetiracetam is beneficial in improving their AD symptoms. I guess time will tell if this is just a "duh ..." kind of thing, where the epilepsy is more or less unrelated, or if there is a distinct path to dementia which includes development of this non-obvious epileptic behavior, for which treatment may improve general AD outcomes.

Science Daily explainer: https://www.sciencedaily.com/releases/2 ... 172926.htm

Paywalled paper: https://jamanetwork.com/journals/jamane ... ct/2784539
Effect of Levetiracetam on Cognition in Patients With Alzheimer Disease With and Without Epileptiform ActivityA Randomized Clinical Trial
Keith Vossel, MD, MSc1,2,3,4,5; Kamalini G. Ranasinghe, MBBS, PhD1; Alexander J. Beagle, MD1; et al
JAMA Neurol. Published online September 27, 2021.
DOI: 10.1001/jamaneurol.2021.3310
Key Points

Question What is the effect of 4 weeks of treatment with low-dose levetiracetam on cognitive function in patients with Alzheimer disease (AD)?

Findings In this randomized clinical trial of 34 adults with AD, treatment with levetiracetam did not significantly modify cognitive function. However, the treatment did improve executive function and spatial memory among participants with AD who had seizures or subclinical epileptiform activity that was identified through extended neurophysiological recordings.

Meaning This study’s findings indicated that extended neurophysiological assessments are important to identify patients with AD who could benefit from antiseizure approaches and that levetiracetam treatment could improve cognitive symptoms in the estimated 60% of patients with AD who have seizures and subclinical epileptiform activity.
Abstract

Importance Network hyperexcitability may contribute to cognitive dysfunction in patients with Alzheimer disease (AD).

Objective To determine the ability of the antiseizure drug levetiracetam to improve cognition in persons with AD.
...
Conclusions and Relevance In this randomized clinical trial, levetiracetam was well tolerated and, although it did not improve the primary outcome, in prespecified analysis, levetiracetam improved performance on spatial memory and executive function tasks in patients with AD and epileptiform activity. These exploratory findings warrant further assessment of antiseizure approaches in AD.
See also this talk summary from Fiver:Alzheimer’s disease and epilepsy: what can we learn from their similarities?
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