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Epileptic seizures in subcortical vascular encephalopathy
A Schreiner1, B Pohlmann-Eden, A Schwartz
1Department of Neurology, Mannheim Medical School, University of Heidelberg, Germany.
Insights
Subcortical vascular encephalopathy (SVE) with multiple lacunar infarctions and temporal EEG abnormalities significantly increases epilepsy risk in the elderly. This finding aids in diagnosing uncertain episodes in SVE patients.
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.
Abstract:
Cerebrovascular disease is one of the most common causes of epilepsy in the elderly. Most of the studies published relate to cortical infarction, subarachnoid, and intracranial hemorrhage, whereas the incidence of epilepsy from subcortical ischemia, i.e. deep lacunar infarctions and diffuse white matter lesions, is obscure. Therefore, we prospectively examined 18 patients with the precisely defined diagnosis of subcortical vascular encephalopathy (SVE), who were admitted to our hospital due to epileptic seizures (group A), and compared them to a similarly selected group matched for age, sex, risk factors, and neurological deficits with an equivalent severity of SVE but without seizures (group B). Subcortical lacunar infarctions were significantly more frequent in group A than group B (15/18 versus 4/18, p < 0.001), whereas neither the extension, degree, distribution of periventricular white matter changes, nor the presence of internal hydrocephalus, focal or diffuse cortical atrophy showed any statistical significance. However, a temporal constant theta or delta EEG focus was present in 10/18 patients in group A but only in 1/18 patients from group B (p < 0.005). 10/18 patients developed epilepsy with further seizures during follow-up. The association of SVE, multiple subcortical lacunas, and temporal EEG abnormalities are suggestive for an increased risk for epileptic seizures, which is particularly important for the treatment of patients with SVE if uncertain paroxysmal episodes occur, e.g. transient ischemic attacks, seizures, or cardiac syncope.