Epilepsy and Neurodegeneration

Cognitive decline in epilepsy is a significant clinical problem. There is a bidirectional link between late-onset epilepsy and Alzheimer's disease with likely shared mechanisms. MRI studies show progressive cortical thinning and white-matter alterations on diffusion imaging in some epilepsies. Neuropathological studies have begun to explore neuropathological correlates of cognitive decline and MRI findings, including evidence of neurodegenerative proteinopathies, such as phosphorylated tau protein accumulation, chronic traumatic encephalopathy, white matter degeneration, and small vessel disease. A key question is whether disease-specific cellular alterations and neuronal vulnerabilities occur in epilepsy or whether these reflect the impact of an accelerated ageing process. There is a need for biomarkers to identify individuals with epilepsy who are at risk of cognitive decline at earlier stages. Further research integrating modern molecular technologies and genetic risk factors will explore the spectrum of neurodegenerative processes in epilepsy.