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Seizures in the context of occult cerebrovascular disease

Hedley C A Emsley1, Laura M Parkes2

  • 1Department of Neurology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Fulwood, Preston PR2 9HT, UK; Lancaster Medical School, Lancaster University, Bailrigg, Lancaster LA1 4YW, UK; Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Stopford Building, Oxford Road, Manchester M13 9BG, UK.

Epilepsy & Behavior : E&B
|August 3, 2019
PubMed

Insights

Occult cerebrovascular disease (CVD) is a key cause of late-onset seizures (LOS) and epilepsy (LOE). LOS/LOE significantly increases stroke risk, highlighting the bidirectional link between seizures and CVD.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Epileptology

Background:

  • A significant bidirectional relationship exists between seizures and cerebrovascular disease (CVD).
  • Occult CVD is a primary cause of late-onset seizures (LOS) and late-onset epilepsy (LOE), particularly from the fourth decade of life.
  • LOS/LOE is linked to a threefold increased risk of subsequent clinical stroke.

Purpose of the Study:

  • To review the bidirectional relationship between seizures and CVD.
  • To highlight the role of occult CVD in LOS/LOE.
  • To emphasize the increased stroke risk associated with LOS/LOE and discuss related factors like hypertension and cerebral small vessel disease (SVD).

Main Methods:

  • Literature review and synthesis of existing evidence.
  • Analysis of epidemiological data and natural history studies.
  • Exploration of potential epileptogenic mechanisms in CVD.

Main Results:

  • Occult CVD is a significant cause of LOS/LOE.
  • LOS/LOE elevates the risk of subsequent stroke.
  • Hypertension and SVD are implicated in epileptogenesis.
  • Potential increased risk of intracerebral hemorrhage (ICH) post-LOS/LOE requires further investigation.
  • Bidirectional links between LOS/LOE, cognitive impairment, and dementia are suggested, involving vascular and neurodegenerative interactions.

Conclusions:

  • The interplay between CVD and epilepsy, especially late-onset forms, is critical.
  • Further research is needed to understand mechanisms, refine epidemiological data, and improve clinical management of patients with LOS/LOE and CVD.
  • Addressing vascular factors is crucial for managing LOS/LOE and preventing stroke and cognitive decline.

Keywords:
Cerebrovascular diseaseEpileptogenesisLate-onset epilepsyLate-onset seizuresSmall vessel disease

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