Epilepsy at the prodromal stages of neurodegenerative diseases

This review provides a clinically grounded description of the links between epilepsy and early common neurodegenerative diseases (i.e. Alzheimer's disease, Lewy body disease, vascular cognitive impairment, fronto-temporal lobar degeneration). It shows that epilepsy does not only concern demented patients displaying convulsive seizures (whether focal or generalized) and obvious atrophy on brain imaging. On the contrary, unprovoked seizures and epilepsy - commonly involving the temporal lobe - are now reported at the prodromal stages of these diseases, when cognitive complaints are mild or even minimal and brain imaging inconstantly abnormal. Thus epilepsy must be considered as a part of the phenotypic spectrum at any stages of the neurodegenerative diseases. This must be kept in mind in everyday practice, and when defining these diseases with clinic-biological criteria. Such entanglement also explains the growing prevalence of elderly epileptic subjects and the need of a close collaboration between geriatricians, cognitivists and epileptologists.