IEC 2025 | The potential link between amyloid and epilepsy
Rani Sarkis, MD, Brigham and Women’s Hospital, Boston, MA, comments on the potential link between amyloid buildup and epilepsy, suggesting that amyloid may be pro-epileptogenic. Dr Sarkis notes that asymmetric amyloid buildup could explain why some patients present with seizures on one hemisphere, and that similar data have been observed for tau. This interview took place at the 36th International Epilepsy Congress (IEC) in Lisbon, Portugal.
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Transcript
There’s been a lot of interest in amyloid and epilepsy. We’ve come to realize that amyloid is pro-epileptogenic, that people who experience amyloid buildup in the brain are probably more likely to develop seizures over time. And that could explain why patients with Alzheimer’s disease pathology are at higher risk of seizures. There are also some interesting studies done in Finland where they looked at patients who had epilepsy during childhood and then had an amyloid PET decades later and were found to have a higher amyloid burden...
There’s been a lot of interest in amyloid and epilepsy. We’ve come to realize that amyloid is pro-epileptogenic, that people who experience amyloid buildup in the brain are probably more likely to develop seizures over time. And that could explain why patients with Alzheimer’s disease pathology are at higher risk of seizures. There are also some interesting studies done in Finland where they looked at patients who had epilepsy during childhood and then had an amyloid PET decades later and were found to have a higher amyloid burden. So one of the concerns is that seizures could trigger amyloid buildup, and then amyloid buildup in turn could lower your seizure threshold. So you might end up in this vicious cycle of seizures and amyloid buildup. And the concern is that that could lead to a more aggressive disease course and accelerated cognitive decline. The other thing we’ve been interested in is how to explain why some patients might end up with only one seizure focus when they are presenting at an epilepsy clinic. And that’s where amyloid might play a role. If you have asymmetric buildup of the amyloid, that could be why you’re presenting with a seizure on one hemisphere versus the other. We’ve also seen similar data for tau. The data for tau is actually a bit stronger in terms of the asymmetry. But both of those proteins we now view as pro-epileptogenic. And the natural question becomes, can we do something about this? Should we be going after the amyloid if it is one of the reasons someone is seizing right now? And that is currently an open question. All of the treatments approved for amyloid have been to target memory decline rather than seizures.
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