Epileptic seizures in subcortical vascular encephalopathy

Area of Science:

• Neurology
• Vascular Neurology
• Epileptology

Background:

• Cerebrovascular disease is a leading cause of epilepsy in older adults.
• Research often focuses on cortical or hemorrhagic strokes, overlooking epilepsy linked to subcortical ischemia.
• The incidence of epilepsy due to subcortical ischemia, such as deep lacunar infarctions and white matter lesions, remains unclear.

Purpose of the Study:

• To investigate the relationship between subcortical vascular encephalopathy (SVE) and epileptic seizures.
• To identify specific subcortical vascular lesions associated with epilepsy in SVE patients.
• To compare EEG abnormalities in SVE patients with and without seizures.

Main Methods:

• Prospective study of 18 SVE patients with epileptic seizures (Group A) and 18 matched SVE patients without seizures (Group B).
• Comparison of subcortical lacunar infarctions, white matter changes, hydrocephalus, and cortical atrophy between groups.
• Analysis of electroencephalogram (EEG) findings, specifically temporal theta or delta foci.

Main Results:

• Subcortical lacunar infarctions were significantly more prevalent in Group A (15/18) than Group B (4/18) (p < 0.001).
• No significant differences were found in white matter changes, hydrocephalus, or cortical atrophy.
• Temporal EEG abnormalities (theta/delta focus) were more common in Group A (10/18) versus Group B (1/18) (p < 0.005).

Conclusions:

• The combination of SVE, multiple subcortical lacunas, and temporal EEG abnormalities suggests an elevated risk for epileptic seizures.
• These findings are crucial for managing SVE patients experiencing uncertain paroxysmal episodes like transient ischemic attacks or syncope.
• Early identification of these risk factors can guide appropriate treatment and monitoring for epilepsy in SVE.