Carolina Ferreira-Atuesta, MD, MSc, Icahn School of Medicine at Mount Sinai, New York, NY, discusses current theories regarding epilepsy-related neurodegeneration. Imaging studies have demonstrated epilepsy syndrome-specific patterns of cortical volume loss and progressive cortical thinning that cannot be explained by normal ageing alone. Successful epilepsy surgery can reduce the rate of atrophy. In addition, cognitive deficits are common in epilepsy and the prevalence of dementia is around 6-fold higher than in the general older population. The pathological mechanisms underlying cognitive decline and brain atrophy in this setting are poorly understood. Toxic protein accumulation, seizure-dependent degenerative alterations, and cumulative traumatic injuries have all been proposed to contribute to epilepsy-related neurodegeneration. Ongoing work in this area aims to identify the mechanisms that lead to brain atrophy in order to design novel neuroprotective strategies. This interview took place at the American Epilepsy Society (AES) Annual Meeting 2022 in Nashville, TN.
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