Anti-epileptic Therapy Not Linked to Increased Dementia Risk, Study Reports

Use of anti-epileptic therapy is not linked to an increased risk of dementia, according to the results of a real-world study with more than 100,000 patients followed in general and neuropsychiatrist practices in Germany.

However, generic forms of the anti-epileptic medicine levetiracetam may potentially have a deleterious effect on cognition.

The study, “Is There an Association Between Antiepileptic Drug Use and Dementia Risk? A Case-Control Study,” was published in the Journal of Alzheimer’s Disease.

Previous research has reported a bidirectional relationship between epilepsy and dementia. One study reported that epilepsy was associated with a 1.5-fold increase in the risk of developing dementia; another one found that Alzheimer’s was a significant predictor of epileptic seizures.

The association between epilepsy and dementia could be “explained by the fact that these two conditions share common vascular risk factors (e.g., coronary artery disease, stroke, hypertension),” researchers wrote.

As such, anti-epileptic drugs (AEDs) could be an effective strategy to prevent cognitive decline and dementia in people with epilepsy.

However, recent research has suggested a link between the use of AEDs and dementia, with authors claiming that AEDs can affect cognition by interfering with the communication between nerve cells.

Nonetheless, there have been some concerns about the generalizability of its findings, because in the study “authors did not use a strict definition for the diagnosis of dementia,” researchers said.

To analyze the possible association between AED use and dementia risk, researchers from Germany and France performed a retrospective case-control study using data from German patients stored in the Disease Analyzer database (IQVIA), which includes drug prescriptions, diagnoses, and medical and demographic data obtained anonymously from computer systems used in the practices of general practitioners and specialists. The database has been used in the past for dementia research.

Patients were 60 or older and their first dementia diagnosis was documented between January 2013 and December 2017. Controls without dementia, observed during that same period of time, were matched for age, gender, physician (general practitioner or neuropsychiatrist) and diagnosis of mild cognitive impairment.

In total, the team analyzed 50,575 cases with dementia and 50,575 controls without dementia. Participants’ mean age was 81; 61.5 percent of the patients were women.

Overall, the results showed no association between the use of AEDS and increased risk for dementia. Also, the duration of AED therapy was not associated with a risk of dementia.

However, when the most frequently prescribed AEDs were analyzed separately, researchers saw that levetiracetam generic brands were associated with an increased risk of dementia, with no link found for the original levetiracetam (originally developed by UCB Pharmaceuticals and marketed under the name Keppra).

Valproate, another common AED sold under the brand name Depakene, among others, showed no significant association with dementia, both the original and generic brands.

Overall, the study showed no significant relationship between AED use and dementia risk.

“The major message of this study is an all-clear for epilepsy patients, who should not fear that their AED use will result in a higher risk of dementia,” Louis Jacob, PhD, and the study’s first author, said in a press release.

“However, it is possible that some of the newest generic brands of levetiracetam may have negative effects on cognitive function in older individuals with epilepsy, and these effects have not yet been investigated,” Jacob said.

“These findings must be interpreted with great caution, and more research should be conducted to corroborate these results before any conclusions are drawn,” researchers concluded.