Relationship of white matter hyperintensities with clinical features of seizures in patients with epilepsy

Abstract

Background: Although epilepsy is primarily known as a cortical disorder, there is growing body of research demonstrating white matter alterations in patients with epilepsy. Objective: To investigate the prevalence of white matter hyperintensities (WMH) and its association with seizure characteristics in patients with epilepsy. Methods: The prevalence of WMH in 94 patients with epilepsy and 41 healthy controls were compared. Within the patient sample, the relationship between the presence of WMH and type of epilepsy, frequency of seizures, duration of disease and the number of antiepileptic medications were investigated. Results: The mean age and sex were not different between patients and healthy controls (p>0.2). WMH was present in 27.7% of patients and in 14.6% of healthy controls. Diagnosis of epilepsy was independently associated with the presence of WMH (ß=3.09, 95%CI 1.06-9.0, p=0.039). Patients with focal epilepsy had higher prevalence of WMH (35.5%) than patients with generalized epilepsy (14.7%). The presence of WMH was associated with older age but not with seizure characteristics. Conclusions: WMH is more common in patients with focal epilepsy than healthy controls. The presence of WMH is associated with older age, but not with seizure characteristics.

Epileptogenicity of white matter lesions in cerebral small vessel disease: a systematic review and meta-analysis

“…The included studies were published between 2006 and 2022. Ten studies reported WML load of patients with first unprovoked seizure and/or epilepsy as compared to control groups (research question 1) [ 5 – 7 , 18 – 25 ]. Two studies compared risk of seizure recurrence in patients with and without WML (research question 2) [ 18 , 21 ].…”

“…Ten studies reported WML load of patients with first unprovoked seizure and/or epilepsy as compared to control groups (research question 1) [ 5 – 7 , 18 – 25 ]. Two studies compared risk of seizure recurrence in patients with and without WML (research question 2) [ 18 , 21 ]. We could not identify any study on treatment with ASM in patients with CSVD-related WML (research question 3).…”

“…Six studies reported presence of WML in 600 cases and 329 controls [ 5 , 6 , 18 , 20 , 23 , 25 ]. Of these studies, four covered only patients with epilepsy [ 5 , 18 , 23 , 25 ], one study included only patients with respective first seizures [ 6 ], and one study investigated patients with either a first seizure or epilepsy [ 20 ]. None of the four studies focusing on patients with epilepsy stated whether patients had new-onset epilepsy or already established epilepsy.…”

“…We identified two studies analyzing the association between risk of seizure recurrence and WML [ 18 , 21 ]. These studies included a total of 256 patients with epilepsy of whom 113 had and 143 did not have WML.…”

“…The main focus of the second study [ 18 ] was to compare lesion load between patients with epilepsy (age ≥ 18 years, exclusion of patients with cardiovascular risk factors) and a control group; therefore, this study is also part of the meta-analysis on presence of WML. In the epilepsy group, presence of WML was not associated with seizure frequency ( p = 0.444).…”