Prevalence of Epilepsy in Frontotemporal Dementia and Timing of Dementia Diagnosis.

Abstract

Importance: Previous studies have described a potential association between epilepsy and frontotemporal dementia (FTD), but no systematic data are available.

Objective: To determine whether epilepsy is more prevalent in patients with FTD than in healthy controls (HCs) or patients with Alzheimer disease (AD).

Design, setting, and participants: In this case-control study, we compared the prevalence of epilepsy and purchases of antiseizure medicines (ASMs) among patients with FTD, matched HCs, and patients with AD from 2 early-onset dementia diagnostics centers in the same geographic regions of Finland. AD or FTD diagnoses were made between January 1, 2010, and December 31, 2021. Data were analyzed from January 26, 2024, to January 16, 2025.

Main outcomes and measures: The primary outcome was to describe the prevalence of epilepsy in patients with FTD, covering the time period from 10 years before to 5 years after the FTD diagnosis. We used International Statistical Classification of Diseases, Tenth Revision codes to identify all patients with epilepsy and tracked purchases of ASMs.

Results: The study cohort included 245 patients with FTD (121 female [49.4%], 124 male [50.6%]; mean [SD] age, 65.2 [8.7] years), 2416 matched HCs (1190 female [49.3%], 1226 male [50.7%]; mean [SD] age, 65.0 [8.5] years), and 1326 patients with AD (777 female [58.6%], 549 male [41.4%]; mean [SD] age, 71.7 [9.8] years). The prevalence of epilepsy was higher in the FTD group compared with the HC group (3.3% vs 0.8%, respectively; P = .002) and AD group (3.3% vs 1.4%, respectively; P = .01) 10 years before FTD diagnosis. At the year of the diagnosis, the prevalence was 6.5% in patients with FTD, 1.8% in HCs (FTD vs HC difference, 4.7 percentage points [ppt] [95% CI, 2.2-8.6 ppt]; P < .001), and 5.0% in patients with AD (FTD vs AD difference, 1.6 ppt [95% CI, -1.2 to 5.5 ppt]; P = .32); at 5 years after the diagnosis, the prevalence was 11.2% in patients with FTD, 2.2% in HCs (FTD vs HC difference, 9.0 ppt [95% CI, 5.0-14.6 ppt]; P < .001), and 6.9% in patients with AD (FTD vs AD difference, 4.2 ppt [95% CI, 0-10.0 ppt]; P = .05). ASM purchases were made significantly more often among patients with FTD (10.2%) compared with HCs (1.8%) and patients with AD (4.2%) (FTD vs HC difference, 8.4 ppt [95% CI, 5.2-12.9 ppt]; P < .001; FTD vs AD difference, 6.1 ppt [95% CI, 2.6-10.6 ppt]; P < .001) at all time points and increased during the study period.

Conclusions and relevance: This case-control study found a higher prevalence of epilepsy and increased ASM use among patients with FTD compared with HCs and patients with AD , suggesting an association between epileptic abnormalities and the pathophysiology of FTD. Further studies are warranted to investigate a potential overlap in the pathophysiologic mechanisms of epilepsy and FTD.