Treatment strategies for alzheimer’s disease-associated epilepsy: Past, present, and future approaches

Numerous studies have established a probable bidirectional relationship between Alzheimer’s disease (AD) and epilepsy due to shared pathophysiological processes although their underlying mechanisms remain obscure. Accordingly, the anatomopathological hallmarks of AD, amyloid plaques (Aβ), and aggregated tau protein have pro-epileptic effects. Literature evidence demonstrated that there is an increased risk of epilepsy development in patients with AD, regardless of the seizure types and AD stages. Seizures can hasten cognitive decline and increase fatality in AD, leading to greater medical and economic burdens. Therefore, it is clinically pivotal for the early detection and treatment of seizures in patients with AD. In the context of AD-associated epilepsy, anti-seizure medications (ASMs) are the core therapy that aims at impeding morbidity and mortality related to seizure, and the manifestation of status epilepticus. ASMs could also potentially be used as disease-modifying drugs, especially in the earlier stage of AD. However, there are still inadequate studies in guiding ASMs usage in AD-associated epilepsy despite their frequent occurrence. This chapter aims to outline and discuss the appropriateness, effectiveness, and safety of currently available drugs for AD-associated epilepsy, along with possible alternative treatment strategies for future therapeutic opportunities.