Association between structural brain MRI abnormalities and epilepsy in older adults

Area of Science:

• Neurology
• Neuroimaging
• Epidemiology

Background:

• Late-onset epilepsy (LOE) affects older adults, and its underlying causes are not fully understood.
• Brain MRI is a key tool for investigating structural brain changes.

Purpose of the Study:

• To determine the association between brain MRI abnormalities and the incidence of epilepsy in older adults.
• To investigate if gray and white matter changes precede seizure onset in late-onset epilepsy.

Main Methods:

• Utilized brain MRI data from 1251 participants (ages 45-64) in the Atherosclerosis Risk in Communities study.
• Followed participants for incident late-onset epilepsy (LOE) after MRI acquisition, analyzing cortical thickness, subcortical volume, and white matter integrity.
• Employed Cox proportional hazards regression, adjusting for demographics and cardiovascular risk factors.

Main Results:

• 2.2% of participants developed LOE after MRI over a median of 6.4 years.
• Individuals with incident LOE showed greater cortical thinning and white matter abnormalities prior to seizure onset.
• Increased gray matter pathology (HR: 2.3) and white matter diffusivity abnormalities (HR: 3.0) were associated with incident LOE.

Conclusions:

• Significant gray and white matter pathology is evident in individuals who develop LOE.
• These neurodegenerative changes are present before the clinical manifestation of seizures.
• Findings highlight the role of neurodegeneration in the risk of late-onset epilepsy.