Cognitive impairment and seizures in patients with lacunar strokes

Lacunar infarcts and white matter changes have been linked to cognitive impairment. Patients with lacunar strokes can also develop seizures, although the relationship between the two remains unclear. The present study investigates whether seizures in patients with lacunar infarcts are related to the strokes or to an underlying neurodegenerative disorder leading to cognitive impairment.

The demographic features, vascular risk factors and scores on the National Institutes of Health Stroke Scale (NIHSS) on admission for the stroke and on the modified Rankin scale on discharge, as well as on the Mini-Mental State Examination (MMSE), were determined in patients with a lacunar stroke. They were compared between 44 patients with and 248 without subsequent seizures.

Patients with seizures had a lower main NIHSS score (p = 0.00133) and a more severe MMSE score (p < 0.001). They remained significantly more dependent (p = 0.019) after hospital discharge. Smoking, as a vascular risk factor, appeared to occur less frequently in seizure patients (p = 0.039). On logistic regression analysis, only NIHSS and MMSE scores remained independent variables.

Seizure occurrence in patients with a lacunar infarct is not related to the severity of the stroke but rather to the degree of cognitive impairment. The present study suggests that the seizures are not due to lacunar infarcts but are more probably the expression of an underlying neurodegenerative process that is also responsible for the mental deterioration.