Objective:

This systematic review and meta-analysis aimed to quantify the burden of epileptic seizures among patients with frontotemporal dementia (FTD).

Background:

Neurodegenerative diseases represent a significant cause of recurrent seizures among older adults. While there is a well-established association between epilepsy and Alzheimer’s disease, other variants of dementia, such as FTD, remain understudied. FTD is a progressive degeneration of the frontal and temporal lobes with varying clinical presentations and has not been systematically investigated in this context.

Design/Methods:

We searched MEDLINE, Embase, Cochrane Library, LILACS, and ClinicalTrials.gov for observational studies on epilepsy prevalence in FTD-spectrum disorders. From 11,728 identified records, two authors independently screened studies. After a full-text review of 21 articles, 11 studies were included for analysis. Random-effects meta-analyses were employed to pool prevalence estimates, and subgroup analyses examined FTD subtypes and seizure onset relative to diagnosis.

Results:

The 11 included studies, comprising data from 3182 participants, were analyzed. Random-effects meta-analysis showed an overall seizure prevalence of 6.1% (95%CI: 3.5–10.4, k=11). Prevalence did not differ by seizure onset relative to FTD diagnosis (p=0.111) but varied significantly by FTD subtype (p=0.019). Behavioral variant FTD (k=3) had the lowest prevalence at 2.1% (95%CI: 0.5–8.7), followed by primary progressive aphasia at 6.7% (95%CI: 0.45–53, k=3), and unspecified FTD at 7.1% (95%CI: 3.5–14.0, k=7). 

Conclusions:

 This investigation found that approximately 6% of patients with FTD experience seizures, with notable variation across disease phenotypes. These differences highlight the need for tailored screening protocols and further research to elucidate the underlying mechanisms. Although underrecognized, epileptogenesis in FTD may provide critical insights into disease onset and progression.