Summary: A large new study shows that epileptic seizures are far more common in people with frontotemporal dementia (FTD) than previously recognized. In some cases, seizures appeared up to ten years before the formal FTD diagnosis, suggesting that epilepsy may be an overlooked early sign. The findings underline the importance of screening for seizures in FTD to improve diagnosis, treatment, and patient quality of life.
Researchers analyzed more than 12,000 medical records from Finnish dementia centers and report that epilepsy and antiseizure medication use were significantly higher in patients with FTD than in matched healthy controls and patients with Alzheimer’s disease (AD). The study, coordinated by Neurocenter Finland and conducted by the University of Eastern Finland together with the University of Oulu, was published in JAMA Neurology.
Key Facts:
- Early indicator: Epileptic seizures were identified up to ten years before an FTD diagnosis in some patients, indicating seizures can precede clinical dementia symptoms.
- Elevated prevalence: FTD patients showed higher rates of epilepsy than both Alzheimer’s patients and healthy controls at multiple time points before and after diagnosis.
- Treatment implications: Recognizing and treating epilepsy in FTD patients may improve functional abilities and overall quality of life.
Source: University of Eastern Finland
Overview
While the link between epilepsy and Alzheimer’s disease is established, data on epilepsy in frontotemporal dementia have been limited. This comprehensive case-control study addresses that gap by quantifying how often seizures and antiseizure medicine (ASM) use occur in FTD compared with Alzheimer’s disease and matched healthy controls.
The investigators reviewed records from Kuopio and Oulu university hospitals covering 2010–2021. From 12,490 records they identified 245 patients diagnosed with FTD and 1,326 patients with Alzheimer’s disease, along with 2,416 matched healthy controls. The team tracked documented epilepsy diagnoses using ICD-10 codes and monitored ASM purchases as an additional indicator of seizure treatment.
Doctoral Researcher Annemari Kilpeläinen, the study’s first author, emphasizes that epilepsy was more common among FTD patients at all time points examined and that seizures were sometimes present long before dementia was clinically recognized. “Our results show that epilepsy is considerably more common among those with FTD than those with Alzheimer’s disease or in healthy controls,” she says.
Timing and prevalence
The study assessed epilepsy prevalence from ten years before to five years after the dementia diagnosis. Ten years before diagnosis, epilepsy prevalence was 3.3% in the FTD group versus 0.8% in healthy controls and 1.4% in the AD group. At the year of diagnosis, prevalence rose to 6.5% in FTD patients compared with 1.8% in healthy controls and 5.0% in Alzheimer’s patients. Five years after diagnosis, approximately 11.2% of FTD patients had epilepsy, compared with 2.2% of healthy controls and 6.9% of patients with AD. ASM purchases were also higher in the FTD group at all time points, supporting the diagnosis trends.
Clinical challenges and opportunities
Diagnosing epilepsy in people with FTD can be difficult because some FTD symptoms may resemble epileptic events, which risks underdiagnosis or misattribution. Untreated seizures can worsen cognitive and functional outcomes, so improved detection and timely antiseizure treatment could meaningfully benefit patients.
Associate Professor Eino Solje, principal investigator and Director of the UEF Brain Research Unit, highlights the broader implications: “Identifying epilepsy is important because its treatment can improve patients’ functional capacity and quality of life. This association raises new research questions about whether epilepsy and FTD share pathophysiological mechanisms and whether some FTD symptoms are driven by altered brain electrical activity.”
Collaborative, registry-based research
This study is part of a larger project combining extensive real-world patient records with national registers. It reflects close collaboration between the University of Oulu, the University of Eastern Finland, and university hospitals that participate in the European Reference Network EpiCARE, recognized for epilepsy research and care. The multidisciplinary team includes experts in neurology, epidemiology, and related fields to ensure robust analysis and clinical relevance.
About this epilepsy and FTD research news
Author: Maj Vuorre
Source: University of Eastern Finland
Contact: Maj Vuorre – University of Eastern Finland
Image: The image is credited to Neuroscience News
Original Research: Closed access. “Prevalence of Epilepsy in Frontotemporal Dementia and Timing of Dementia Diagnosis” by Annemari Kilpeläinen et al., JAMA Neurology (DOI provided in the original publication).
Abstract
Prevalence of Epilepsy in Frontotemporal Dementia and Timing of Dementia Diagnosis
Importance
Prior reports suggested a link between epilepsy and frontotemporal dementia (FTD), but systematic, large-scale data were lacking. Understanding seizure prevalence in FTD can inform earlier recognition and management.
Objective
To determine whether epilepsy is more prevalent in patients with FTD than in matched healthy controls (HCs) or patients with Alzheimer disease (AD).
Design, Setting, and Participants
This case-control study compared epilepsy diagnoses and antiseizure medicine purchases among patients with FTD, matched healthy controls, and patients with AD evaluated at two early-onset dementia diagnostic centers in Finland. Diagnoses were made between January 1, 2010, and December 31, 2021, and data analysis was completed in early 2025.
Main Outcomes and Measures
Primary outcomes included the prevalence of epilepsy from 10 years before to 5 years after FTD diagnosis, identified using ICD-10 codes, and the frequency of antiseizure medicine (ASM) purchases.
Results
The cohort comprised 245 patients with FTD (mean age 65.2 years), 2,416 matched healthy controls (mean age 65.0 years), and 1,326 patients with AD (mean age 71.7 years). Epilepsy prevalence was higher in the FTD group than in healthy controls and higher than in the AD group at multiple time points. ASM use was also significantly more frequent among FTD patients and increased during the study period.
Conclusions and Relevance
The study found a higher prevalence of epilepsy and greater ASM use among patients with FTD compared with healthy controls and patients with AD. These results support an association between epileptic abnormalities and FTD pathophysiology and underscore the need for further research to clarify shared mechanisms and improve clinical detection and care.