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Introdução: Em populações com mais de 65 anos, as doenças neurodegenerativas foram consideradas como causa de 10% dos casos de epilepsia. Há vários estudos a entrelaçar a clínica flutuante na demência e a presença de atividade epilética, não havendo certezas quanto à sua prevalência. Estas crises podem principiar-se numa fase inicial da demência, e pensa-se que o aparecimento da demência em idades mais jovens possa ser um fator de risco para o seu desenvolvimento. Por sua vez, as alterações imagiológicas e eletroencefalográficas encontradas em pacientes com Doença de Alzheimer (DA) e Demência mista (DM) permanecem interrogadas como eventuais preditores. O objetivo deste estudo é entender quais as variáveis associadas ao surgimento de epilepsia em pacientes com demência.
Métodos: Recolheram-se dados epidemiológicos, clínicos, eletroencefalográficos e imagiológicos de pacientes com DA e DM que frequentavam a consulta de Neurologia do Hospital Pêro da Covilhã entre janeiro de 2012 e dezembro de 2017. Excluíram-se doentes diagnosticados com outras demências, com histórias prévias de epilepsia ou acidente vascular cerebral, quando a epilepsia foi atribuída a outra causa, não apresentaram um seguimento na consulta, ou mostraram anomalias na tomografia computorizada crânio-encefálica para além de atrofia, leucoencefalopatia isquémica e lesões vasculares.
Resultados: A amostra era composta por 183 pessoas, 145 destas com um diagnóstico provável de DA e 38 de DM (p=0,690). Verificou-se perda transitória de consciência (p=0,000) em 33 pessoas, 21,21% devido a crises convulsivas. Somou-se 3 situações clínicas de crise epilética sem perda de consciência, perfazendo um total de 10 casos de pacientes com epilepsia (5,5% da amostra), sendo as crises epiléticas focais as mais comuns. A idade de início da demência para o grupo com epilepsia foi significativamente inferior (p=0,026) comparada com os controlos, por outro lado, não houve associação com a duração e a severidade da demência. Dos fatores de risco cardiovascular e fármacos antidemenciais analisados, não se encontrou uma significância estatística. Relativamente ao eletroencefalograma, 3 pacientes sem clínica sugestiva de epilepsia mostravam atividade epileptiforme (p=1,000), 50,7% dos pacientes sem epilepsia apresentavam uma base difusamente lenta e 47,9% exibiam uma atividade lenta dos lobos temporais. Das alterações imagiológicas, apesar de se ter verificado uma média de espessura mínima dos lobos temporais mediais inferior no grupo com epilepsia, esta variável não foi estatisticamente significativa.
Conclusão: Conclui-se que, das variáveis avaliadas neste estudo, o início mais precoce da demência pode ser um preditor de futuras crises epiléticas em pacientes com DA ou DM, vincando ainda mais o provável papel da deposição de beta-amiloide, que ocorre desde as fases iniciais da doença, na geração de atividade excitatória anormal.
Introduction: In populations older than 65 years, neurodegenerative diseases were considered to be the cause of 10% of the cases of epilepsy. There are several studies connecting the floating clinic in dementia and the presence of epileptic activity, but there are no certainties relatively to its prevalence. These seizures may begin early in dementia, and it is thought that the onset of dementia at younger ages may be a risk factor for their development. In turn, the imaging and electroencephalographic alterations found in patients with Alzheimer’s Disease (DA) and Mixed Dementia (DM) remain interrogated as predictors for the development of epilepsy. The aim of this study is to understand which variables are associated with the appearance of epilepsy in patients with dementia. Methods: Epidemiological, clinical, electroencephalographic and imaging data were collected from patients with DA and DM from the neurology department of Hospital Pêro da Covilhã between January 2012 and December 2017. It excludes patients diagnosed with other dementias, with previous histories of epilepsy or stroke, when epilepsy was attributed to another cause, when they didn’t have a follow-up, or showed abnormalities on the cranio-encephalic computed tomography scan in addition to atrophy, ischemic leukoencephalopathy and vascular lesions. Results: The sample consisted of 183 people, 145 of whom had a diagnosis of probable DA and 38 of DM (p = 0.690). There was transient loss of consciousness (p = 0.000) in 33 people, 21.21% due to seizures. There were 3 clinical situations of seizures without loss of consciousness, making a total of 10 cases of patients with epilepsy (5.5% of the sample), with focal epileptic seizures being the most common. The age of onset of dementia for the epilepsy group was significantly lower (p = 0.026) compared to the controls, on the other hand, there was no association with the duration and severity of dementia. Of the cardiovascular risk factors and anti-dementia drugs analyzed, no statistical significance was found. Regarding the electroencephalogram, 3 patients without epilepsy showed epileptiform activity (p = 1,000), 50.7% of patients without epilepsy had a diffusely slow base, and 47.9% had slow temporal lobes activity. Concerning the imaging alterations, although a mean minimum thickness of the medial temporal lobes was lower in the epilepsy group, this variable was not statistically significant. Conclusion: In conclusion, from the variables evaluated in this study, the earliest onset of dementia may be a predictor of future epileptic seizures in patients with DA or DM, further enhancing the probable role of amyloid beta deposition, which occurs since the initial phases of the disease, in the generation of abnormal excitatory activity.
Introduction: In populations older than 65 years, neurodegenerative diseases were considered to be the cause of 10% of the cases of epilepsy. There are several studies connecting the floating clinic in dementia and the presence of epileptic activity, but there are no certainties relatively to its prevalence. These seizures may begin early in dementia, and it is thought that the onset of dementia at younger ages may be a risk factor for their development. In turn, the imaging and electroencephalographic alterations found in patients with Alzheimer’s Disease (DA) and Mixed Dementia (DM) remain interrogated as predictors for the development of epilepsy. The aim of this study is to understand which variables are associated with the appearance of epilepsy in patients with dementia. Methods: Epidemiological, clinical, electroencephalographic and imaging data were collected from patients with DA and DM from the neurology department of Hospital Pêro da Covilhã between January 2012 and December 2017. It excludes patients diagnosed with other dementias, with previous histories of epilepsy or stroke, when epilepsy was attributed to another cause, when they didn’t have a follow-up, or showed abnormalities on the cranio-encephalic computed tomography scan in addition to atrophy, ischemic leukoencephalopathy and vascular lesions. Results: The sample consisted of 183 people, 145 of whom had a diagnosis of probable DA and 38 of DM (p = 0.690). There was transient loss of consciousness (p = 0.000) in 33 people, 21.21% due to seizures. There were 3 clinical situations of seizures without loss of consciousness, making a total of 10 cases of patients with epilepsy (5.5% of the sample), with focal epileptic seizures being the most common. The age of onset of dementia for the epilepsy group was significantly lower (p = 0.026) compared to the controls, on the other hand, there was no association with the duration and severity of dementia. Of the cardiovascular risk factors and anti-dementia drugs analyzed, no statistical significance was found. Regarding the electroencephalogram, 3 patients without epilepsy showed epileptiform activity (p = 1,000), 50.7% of patients without epilepsy had a diffusely slow base, and 47.9% had slow temporal lobes activity. Concerning the imaging alterations, although a mean minimum thickness of the medial temporal lobes was lower in the epilepsy group, this variable was not statistically significant. Conclusion: In conclusion, from the variables evaluated in this study, the earliest onset of dementia may be a predictor of future epileptic seizures in patients with DA or DM, further enhancing the probable role of amyloid beta deposition, which occurs since the initial phases of the disease, in the generation of abnormal excitatory activity.
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Keywords
Demência Mista Doença de Alzheimer Eletroencefalograma. Epilepsia