Anti-seizure Medication Increases Cognitive Function in Alzheimers

Dr. Vossel showed previously that patients who experience silent epileptic activity in their brains have a more rapid decline in cognitive function.

Levetiracetam, which was approved by the FDA in 1999 and had also performed well in animal models of Alzheimer’s disease. It costs around $70 per year. The dose tested in the trial was 125 mg twice a day, far less than a typical dose used for epilepsy.

In the current study, 54 patients with mild Alzheimer’s symptoms were screened for silent epileptic activity using an electroencephalogram (EEG) to monitor them overnight, as well as an hour-long magnetoencephalogram (MEG) to record magnetic waves generated from electrical activity.

“MEG can pick up epileptic activity that EEGs miss because it’s looking at a different population of brain cells,” Dr. Vossel explained.

34 patients were found to be eligible to participate, with nearly 40% having epileptic activity, and the remainder having no epileptic activity.

These patients were then divided into two groups with one group receiving placebo for four weeks, followed by a 4-week period of receiving no drug and then a 125 mg dose of levetiracetam twice a day for four weeks.

The second group received these same treatments in reverse order. This crossover design allowed the intervention to be tested on all participants with neither the patients nor the researchers knowing whether the patient was taking the actual drug on any given week.

During the study period, the researchers tested skills like the patients’ abilities to problem solve, reason, remember words and how well they could navigate.

Results showed that patients treated with levetiracetam showed trends toward improvement in cognitive function, but when the patients were separated into those with silent epileptic activity and those without, the patients with silent epileptic activity showed clear benefit from being on the drug.

“There were very clear differences between the groups,” Dr. Vossel says. “There’s a subtype of Alzheimer’s disease, consider it an epileptic variant, that’s quite common, occurring in approximately 60% of patients. Patients with this form of Alzheimer’s disease show symptomatic improvement with levetiracetam.”

“There are some clinical features that indicate Alzheimer’s patients are more likely to be having silent epileptic activity,” he says. “The main one is being under the age of 65 when symptoms begin.” In fact, he says, the drug also appeared to benefit younger patients even if they didn’t have detectable epileptic activity.

Patients in the study were already taking approved medications for Alzheimer’s, and levetiracetam improves cognitive function better than current treatments alone. More studies will be needed to find out whether taking the drug long-term can slow disease progression.

“This study was intended to look for cognitive improvement during a short course of treatment,” Dr. Vossel says. “There are other studies that are ongoing to see if the drug can help slow the disease course over longer periods,” adding that future studies at UCLA will focus on recruiting a more diverse study population and testing other anti-seizure medications.

Dr. Vossel began the study in 2014, while he was at the University of California, San Francisco and enrolled patients at UCSF and the University of Minnesota. The research was supported by grants from the Alzheimer’s Association, the National Institutes of Health, and other private gift funds.

Source: Medindia