Interictal epileptiform discharges in Alzheimer's disease: prevalence, relevance, and controversies

Alzheimer's disease (AD) is the most common type of dementia and remains an incurable, progressive disease with limited disease-modifying interventions available. In patients with AD, interictal epileptiform discharges (IEDs) have been identified in up to 54% of combined cohorts of mild cognitive impairment (MCI) or mild dementia and are a marker of a more aggressive disease course. Studies assessing the role of IEDs in AD are limited by the lack of standardization in the definition of IEDs or the different neurophysiologic techniques used to capture them. IEDs are an appealing treatment target given the availability of EEG and anti-seizure medications. There remains uncertainty regarding when to treat IEDs, the optimal drug and dose for treatment, and the impact of treatment on disease course. This review covers the state of knowledge of the field of IEDs in AD, and the steps needed to move the field forward.

Automated summary

Alzheimer's disease (AD) is a common type of dementia and currently has no cure. Interictal epileptiform discharges (IEDs) in AD patients are markers of a more aggressive disease course, but there are challenges in standardizing the definition and capturing methods of IEDs. IEDs are an attractive treatment target, but there is uncertainty about when to treat them, the optimal drugs and doses, and the impact of treatment on the disease course.