Prevalence of epilepsy in frontotemporal dementia: a systematic review and meta-analysis

Abstract

Background: Seizures and epilepsy have been increasingly recognized in neurodegenerative diseases, yet their burden in frontotemporal dementia (FTD) has not been systematically quantified. Objective: To estimate the pooled prevalence of epilepsy or seizures in FTD, assess the comparative odds of epilepsy or seizures in FTD relative to control populations, and examine variation across clinical subtypes. Methods: Data Sources: MEDLINE/PubMed, Embase, Cochrane Library, LILACS, and ClinicalTrials.gov were searched from database inception to August 15, 2025, without language restrictions. Study Selection: Observational studies reporting epilepsy or clinical seizures in adults with FTD or providing sufficient data for calculation were included. Two reviewers independently screened studies and resolved discrepancies by consensus. Data Extraction and Synthesis: Data were extracted independently by two reviewers following PRISMA reporting guidelines. Risk of bias was assessed using Joanna Briggs Institute checklists. Random-effects meta-analyses were performed to pool prevalence estimates and odds ratios. Main Outcomes and Measures: The primary outcome was the prevalence of epilepsy or seizures in FTD. Secondary outcomes included comparative odds of epilepsy or seizures relative to control populations and variation across clinical subtypes. Results: Eleven studies including 3,182 individuals with FTD were included in the meta-analysis. The pooled prevalence of epilepsy or seizures was 7% (95% CI, 4%–12%; I² = 80.7%). Prevalence differed across clinical variants (P=0.008), being 3% (95% CI, 1%–11%) in behavioral-variant FTD and 9% (95% CI, 0%–69%) in primary progressive aphasia. Studies reporting epilepsy showed a pooled prevalence of 9% (95% CI, 4%–17%), and those reporting seizures 7% (95% CI, 4%–12%). In 3 studies with comparative data, FTD was associated with higher odds of epilepsy or seizures than control populations (odds ratio, 2.03 [95% CI, 1.83–2.25]; I²=0%). Conclusion: Epilepsy and seizures appear to occur in a nontrivial proportion of individuals with FTD and may be more frequent than in control populations. Substantial heterogeneity and limited comparative data underscore the need for prospective studies with standardized seizure ascertainment in FTD syndromes.