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Seizures - Convulsions and Alzheimer's

Epilepsy brain

Note: I do not make specific or individual recommendations on treatments nor drug usage in any specific case. If you find the contents of this page applicable to your situation or your loved ones situation, make your decision based on a discussion with your own doctor or a competent doctor in the field of Geriatrics and Internal Medicine!

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Having Alzheimer’s disease not only causes memory loss –- it may also place one at risk for developing a seizure disorder.

Studies show that approx. 17% or one in six (1 in 6)  Alzheimer's victims will suffer seizures or convulsions in late stages.

Studies indicate that in the later stages of Alzheimer’s disease (AD) epileptic type seizures or convulsions can occur in upward of about 17 percent of people with AD. Alzheimer's causes abnormal electrical activity in the brain, which can result in a seizure. It has been described as an electrical storm in the brain.

Doctors are not sure why some people with Alzheimer's have seizures and others don't. No evidence indicates that people with epilepsy, a chronic seizure disorder, have an increased risk of AD.The development of Alzheimer’s disease progresses slowly. During this time, a protein called beta-amyloid gradually accumulates in the brain and forms a plaque. While more research is needed to determine exactly how or why this occurs, this plaque is thought to cause nerve damage in the brain, which not only leads to the decline of cognitive and motor functions but may also lead to an increased risk of seizures.

Mayo Clinic advises that Alzheimer’s or other Dementia is a leading cause of epilepsy type seizures among older adults. That the Tonic-clonic seizures (also called grand mal), are themost intense of all types of seizures, these are characterized by a loss of consciousness, body stiffening and shaking, and sometimes loss of bladder control and or biting the tongue. Common treatment is an anti-convulsive medication…Finding the right medication and dosage can be complex. The doctor likely will first prescribe a single drug at a relatively low dosage and may increase the dosage gradually until the seizures are well controlled.

The Mayo Clinic recommends that If you see someone having a seizure:

1. Call for medical help… 2. Gently roll the person onto one side and put something soft under his or her head… 3. Loosen tight neckwear… 4. Don't put anything in the mouth — the tongue can't be swallowed and objects placed in the mouth can be bitten or inhaled… 5. Don't try to restrain the person… 6. Look for a medical alert bracelet, which may indicate an emergency contact person and other information…7. Note how long the seizure lasts…A grand mal seizure lasting more than five minutes, or immediately followed by a second seizure, should be considered a medical emergency in most people. If this happens, emergency care should be sought as quickly as possible.

In other words keep them safe and comfortable…

Studies of Seizures and Alzheimer’s

J. Geriatr Psychiatry Neurol - 1994 Oct-Dec;7 (4):230-3. “Seizures in Alzheimer's disease: clinicopathologic study.” Mendez, Catanzaro, Doss, Arguello and Frey - Department of Neurology, St. Paul-Ramsey Medical Center, Minnesota. - Epileptic type seizures occur in patients with Alzheimer's disease (AD), but the nature and underlying reasons for these seizures are unclear. Study identified new-onset, non-symptomatic seizures in 77 (17%) of 446 patients with uncomplicated, definite AD on autopsy. Among these seizure patients, 69 had generalized seizures, and 55 had less than three total seizures. The seizure patients had a younger age of dementia onset than did the remaining AD patients; however, at seizure onset, they averaged 6.8 years into their AD and had advanced dementia. When further compared to 77 AD controls, matched for age of onset and duration, the seizure patients did not differ on medical illnesses, amount of medications, and degree of focal neuropathology. We conclude that a few unprovoked generalized seizures frequently occur late in the course of AD, and that AD patients with a younger age of dementia onset are particularly susceptible to seizures.

H. Michael Arrighi, PhD, of Janssen Alzheimer Immunotherapy Research & Development; Nicole Baker, MPH, Pfizer; and colleagues conducted an observational study to estimate the incidence rate of seizures among a large number of people with Alzheimer's. (Nicole L. Baker, H. Michael Arrighi, et al. Alzheimer's disease is associated with increased incidence of seizures among patients in the United Kingdom, 1988-2009.) - The researchers used anonymized electronic medical records from approx. 400 primary medical practices in the UK. The study included 14,838 people with Alzheimer's aged 50 years or older and a comparison group of 14,838 randomly-selected, age- and sex-matched patients without Alzheimer's. People with Alzheimer's were followed for an average of 2.3 years; non-Alzheimer's patients were followed for an average of 3.4 years. The researchers found that the rate of seizures, per 1,000 people per year, was 9.1 among patients with Alzheimer's disease compared with 1.4 for those without Alzheimer's – an incidence rate that was 6.4 times higher. They found that the incidence rate of seizures was highest among the youngest Alzheimer's patients, and that it decreased with age. Incidence among non-Alzheimer's patients increased slightly with age.

 June’s Seizure History

  June Wellstead Nov 2005 

(June at Wellstead of Rogers - November 2005 - June previously had two seizures late spring-early summer)

For most Americans the 4th of July means American Independence Day but since July 4th 2006 it has been a day of sad memories for me…it was a day of suffering for June. I was called early that morning by the Benedictine Villa to tell me that June had suffered a grand mal seizure. It was the (3rd) third seizure June had experienced after her journey into the late stages of her Alzheimer’s, disease. June was in her 10th year of Alzheimer’s. I thought the seizures had been controlled with medication after the first two in the prior year of 2005 at the Wellstead. Anyone who has witnessed a loved one with such a seizure knows the horror of it. The body gets rigid and shakes uncontrollably from muscle tremors, consciousness is lost. Compound that with the Alzheimer’s victim’s inability to understand and further couple it with the normal daily fear experienced in the late stages of the disease. When the victim regains consciousness they are physically exhausted, confused and fearful.

Later in the day of July 4th 2006, as June was sleeping, and in my sadness, I drove to the Sofitel Hotel. My hope was that I would be able to recapture a glimpse of some of June and my earlier happy days in the lobby of that Hotel. In the old days we would sit at one of the lobby tables and have a glass of our favorite wine, a fruit-cheese plate with French bread and “people watch”.

The trauma of the morning did not allow that to happen. Instead, I sought refuge in writing a poem about June and our home at 6025 Gardena Lanewith a time setting of a few years before Alzheimer’s took over our lives. The year was 1995. My escape year poem was patterned after a similar poem written by a Sherlock Holmes fan called “221B Baker Street” and his escape year was 1895…The link to my poem is on Junes’ website as shown below…

6025 Gardena Lane – June’s Home

My observations indicate that in the area of seizures and convulsions, the nursing staff including the RNs, LPN's and NA’s of most nursing homes and assisted care facilities are poorly trained to understand what is happening or how to properly handle and care for such patients…or even what the connection is between Alzheimer’s and such seizures.

The first time June had a seizure was in the early half of the year 2005 and a few months after she was placed in the care of an assisted living facility. The action taken by the staff was a display of ignorance…instead of making June comfortable, they called for an ambulance take June to the emergency room of closest hospital. The emergency room doctor on duty, a young lady was also out of her depth. When I arrived, a confused and fearful June appeared happy to see me as a friendly face among the strangers. I told the doctor that June had advanced Alzheimer’s and that was the probably cause of the seizure. She did not agree…she had a theory based on occasional occurrences in the elderly where by if they have low blood pressure, are straining on the toilet stool will loose consciousness…the assisted living NA had reported that June was sitting on the commode when she had a seizure…this NA had never before seen a seizure!  I tried to point out to the doctor that June did not have low blood pressure and in fact was on medications for high blood pressure and that this was not a simple case of just loosing consciousness but rather a convulsion…my comments fell on deaf ears…I tried to get June’s regular doctor to prescribe an anticonvulsive medication for June. Instead he decided to accept the emergency room doctor’s evaluation while advising me that should she have another seizure, he would then prescribe such medicine. A medical transfer vehicle took June back to the Assisted Living facility where I agreed to meet them as I had my car with me at the hospital…This drive was so upsetting to June that she vomited en-route back to the facility. When I think of what June went through and the fear she had because of medical ignorance and mismanagement, it brings tears to my eyes.

As I expected, June had another seizure a month later. This time the medical staff at the facility followed my instructions and kept her comfortable. This seizure, like the first one took place in the morning as the staff was getting June up for the day. This 2nd seizure took place as June was coming out of the shower. She fell and received bruises and abrasions on her arms and face. June had bleeding wounds that had not been dressed or cared for by the time I arrived. I had to request this be done 2 times before it was finally taken care of near noon of that day. June again looked confused and fearful. This time, a different doctor agreed with me and prescribed the necessary anti-convulsive medications. This medication (Depakote) was reasonably effective and prevented seizure for a year before June had her third one on July 4th, 2006 as initially described above.

I later learned that studies now reveal that Depakote is not a good selection for Alzheimer’s victims. The drug results in increased loss of brain matter...Below is June’s history with this medication. The initial thinking that this drug would also assist with the normal Alzheimer's symptoms proved to be untrue...

June's Experience with Depakote: (Divalproex Sodium, Valproate, Valproic Acid.)

This drug was approved by the FDA primarily to treat seizures and convulsive disorders. It was also being studied as a treatment for Alzheimer's. Some initial research indicated that it had value for such treatment.

June had 4 seizures during her journey through Alzheimer's. the first two seizures took place a month apart in mid 2005. 5/2/2005 and 6/2005. The third seizure took place on July 4th 2006. The last seizure described as a mild one took place in mid year 2008.

I requested that June be placed on an anti-convulsive drug immediately after the first seizure. I pointed out that seizures while they were not considered an everyday Alzheimer's symptom they were not uncommon with this disease. (June had been taken to the nearby hospital emergency room to check out possible brain tumors etc.) Based on the opinion of the emergency room doctor, the first seizure was not taken seriously and was thought to be an anomaly not a part of the Alzheimer's disease. I did not agree but having no medical credentials, my opinion was ignored. When a second seizure took place a month later, June was immediately placed on Depakote.

June was started on an initial dosage of 250 mgs of Depakote. In order to reach what was considered to be a "Therapeutic level" (50-100 mcg/ml) in the blood stream, June was given gradually increased dosages by increments of 125 mgs until she was receiving 625 mgs per day. This 625 mgs daily dosage was then continued until June passed away on October 23rd, 2008.

This medication appeared to be very effective in preventing seizures. The first seizure following the prescription of Depakote was just over a year later on July 4th 2006. It was my thought that there had been a breakdown on the administration of the medication that caused the July 4th seizure. June due to her advanced Alzheimer's was difficult to feed and administer medications. Not all LPN's assigned with this function were adept to doing so. It was usually mixed with other foods to facilitate the administration. Some of the medication is always lost in this procedure. It is also my thought that this may have been the cause of the mild seizure in 2008. Sometimes there are errors in medication administration. I recall on one occasion when a new duty LPN had administered the morning medication with an improper dosage. I happened to be there at the time, and I suspected that there had been an error. When I questioned the LPN about it, I found she had administered a single pill of 125 mgs instead of 5 - 125 mg pills to give the proper dosage of 625 mgs. If I had not been there to double check, the error would have gone unnoticed.

Research Notes: The initial thoughts of Depakote being of assistance in Alzheimer's treatment has proven to be false and in fact it appears to have a negative result in this regard. The AMDA publication "Caring for the Ages" in the October 2009 issue states: ("Failed Drug Trials Suggest Alzheimer's Shift) "Divalproex treatment over 2 years didn't delay the onset of agitation or psychosis in patients with Alzheimer's disease, and patients taking the anticonvulsant showed significantly more brain volume loss on MRI at year 1 than did those taking the placebo."

There are a number of anticonvulsive medications on the market. There are none specifically approved by the FDA for use on Alzheimer's patients. The decision on an appropriate anticonvulsive medication should be made by a competent neurologist qualified in Alzheimer's treatment. Presently there ae a number of anticonvulsive drugs on the market (Some 30 +)  that are used singly or in combination. Examples of the more common ones would be: Dilantin, Lamictal, Tegretol, Topamax, Gabapentin. See the note below on the drug Levetiracetam.

(8/7/2012) One of the hallmark symptoms of Alzheimer's disease is progressive memory loss. In an animal model of the disease, scientists at the University of California, San Francisco-affiliated Gladstone Institutes have discovered that Levetiracetam - an FDA-approved drug commonly prescribed for patients who suffer from epilepsy, reverses memory loss and alleviates other Alzheimer's-related impairments. In the U.S., Levetiracetam has been in use under the brand name Keppra since 1999. Generic versions of the drug have been available since 2009.

Latest Research...New Drug Brivaracetam may Reverse Memory loss

(5/6/2015) Researchers at the University of British Columbia tested existing and experimental epilepsy drugs and concluded they could be effective in treating Alzheimer’s.

Their new findings build on previous studies, in both mice and humans, that suggested the widely used anticonvulsant drug levetiracetam may slow the progression of Alzheimer’s, namely the damaging effects of memory loss...however a new drug Brivaracetam suggests it is far more effective and may even reverse memory loss

Levetiracetam, sold under the brand name Keppra, is an anticonvulsant drug that works against epilepsy by decreasing abnormal excitement in the brain. 

The Canadian research team tested levetiracetam and brivaracetam, an experimental epilepsy drug that’s similar yet 10 times stronger than levetiracetam. In a phase III randomized triall completed last year, 50 milligrams of brivaracetam resulted in significantly lower frequency of seizures compared with a group of participants taking a placebo.

In the new study, researchers tested the effects of brivaracetam on mice with Alzheimer’s disease and found it completely reversed memory loss.

The exact mechanism that causes this, however, remains a mystery to researchers.

 

 

 

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 June's Passing

June 1994

 

June had battled Alzheimer's for almost 12 years when God took her home on 23 October 2008.  June's funeral notice as published in the Minneapolis Star in October 2008 can be seen on this website under the "In Memoriam" label - or Click on:

 

"June K. (Rolstad) Berg - In Memoriam"