Ask the Doctor: Seizures & AD; Isolated Systolic Hypertension; Modafinil
Q: My 77-year-old wife has Alzheimer’s disease and recently began having seizures. Could the seizures be related to her Alzheimer’s?
A: Seizures are convulsions or muscle spasms associated with abnormal electrical activity in the brain. It is not uncommon for seizures to be associated with advanced Alzheimer’s disease (AD). It is estimated that as many as 22 percent of AD patients experience seizures, although they may not always be obvious. About 55 percent of AD-related seizures involve non-convulsive seizures characterized by symptoms such as amnestic spells, aphasia (difficulty with speech), and psychic and sensory phenomena.
An enzyme called beta-secretase (BACE)—which is involved in the formation of beta-amyloid protein, a hallmark of AD—may be responsible for the AD-seizure connection, according to researchers at the MassGeneral Institute for Neurodegenerative Disorders (MGH-MIND). They found evidence that BACE disrupts the passage of signals into and through cells, thereby triggering seizures. It’s important to determine whether Alzheimer’s disease is the cause of your wife’s symptoms, since seizures can also be linked to a variety of other factors, including head injury, tumor, infectious disease, and fever. For this reason, your wife should have a thorough medical and neurological assessment to rule out any other underlying health issues. Treatment for seizures usually involves the prescribing of antiepileptic medications, such as the anticonvulsants lamotrigine and levetiracetam.
Q: I am 68, and have been told that I have isolated systolic hypertension, or ISH. What is ISH and how is it treated?
A: Isolated systolic hypertension (ISH) is indicated when the top number in a blood pressure reading is consistently higher than 140 mm Hg, while the bottom number remains lower than 90. The incidence of ISH increases with age, and the combination of higher systolic and lower diastolic pressures is thought to be a major determinant of higher risk for chronic kidney disease, heart disease, stroke and dementia. The prevalence of ISH increases with age and is usually related to underlying conditions, such as heart valve problems, hyperthyroidism, or stiffness of the arteries. It is estimated that at leastone-third of older Americans may have ISH, although many of these individuals are not receiving treatment for the condition.
ISH is usually addressed with lifestyle changes designed to help lower blood pressure, such as limiting salt intake and alcohol consumption, losing weight, exercising, and eating a heart-healthy diet. Diuretic medications, often combined with calcium channel blockers, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin receptor blockers (ARBs), are also prescribed. Treatment must be carefully monitored, since research suggests that measures designed to lower systolic blood pressure can increase risk of stroke and cardiovascular events if they cause diastolic blood pressure to drop much below 70 mm Hg.
Q: I am taking the medication modafinil for narcolepsy, but I am worried about reports I have read that the drug can be habit-forming. Does this mean I should stop taking the drug?
A: Modafinil is a non-amphetamine psychostimulant that has, in some studies, been linked to potential for dependence. The drug increases levels of the neurotransmitter dopamine and can be associated with psychoactive and euphoric effects, especially if it is abused. However, the benefits of modafinil are considerable and concern over addiction should not affect the way the medication is prescribed for people with narcolepsy, since these patients are closely monitored by medical professionals.
—Maurizio Fava, MD
The post Ask the Doctor: Seizures & AD; Isolated Systolic Hypertension; Modafinil appeared first on University Health News.
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