Cerebrovascular disease burden in late-onset non-lesional focal epilepsy

Abstract

Late-onset non-lesional focal epilepsy, defined as new-onset seizures in patients older than 60 years, is diagnosed increasingly more often in relation to aging of the population. It has been attributed mainly to occult cerebral small vessel disease (SVD), although high levels of evidence to support this notion are lacking. This study aimed to evaluate the burden of leukoaraiosis, a marker of cerebral SVD, and hippocampal atrophy in patients with late-onset epilepsy (LOE). Methods: Brain magnetic resonance imaging (MRI) studies were retrospectively analyzed by two blinded radiologists. The Fazekas and Scheltens scales were used to assess the degree of leukoaraiosis and hippocampal atrophy in 33 patients with non-lesional LOE, 41 patients with clinical signs of SVD (eg, recent history of transient ischemic attack [TIA] or lacunar stroke), and 26 healthy controls, all > 60 years of age. Results: Mean age in epilepsy patients was 70.9 ( ± 6.6) years; 57.6% were men. The history of vascular risk factors was similar in all groups. Median (interquartile range) Fazekas score was 1 (0-1) in the epilepsy group, 1 (0-2) in TIA/lacunar stroke patients, and 0 (0-1) in the healthy group. Degree of leukoaraiosis was milder in epilepsy patients compared to the TIA/lacunar stroke group (p = 0.004), and similar to that of healthy controls (p = 0.593). Hippocampal atrophy was significantly greater in patients with epilepsy (p < 0.005). Conclusion:These findings suggest that the etiology of LOE is not exclusively related to cerebrovascular disease. Hippocampal atrophy may contribute to the origin of the seizures.

Vascular risk factors as predictors of epilepsy in older age: The Framingham Heart Study

“…Conversely, in a study focusing on lacunar strokes, hypercholesterolemia was not protective for seizures 19 . In a retrospective study comparing nonlesional LOE cases to controls, diabetes was more prevalent among patients with epilepsy, but no differences were noted for hypertension or dyslipidemia 20 . Smoking has been studied in the Nurses' Health study II among 116 608 women between the ages of 25–42, and it was found to be associated with an increased risk of seizures independent of stroke 21 …”

“…19 In a retrospective study comparing nonlesional LOE cases to controls, diabetes was more prevalent among patients with epilepsy, but no differences were noted for hypertension or dyslipidemia. 20 Smoking has been studied in the Nurses' Health study II among 116 608 women between the ages of 25-42, and it was found to be associated with an increased risk of seizures independent of stroke. 21 Recent, population-based, epidemiological studies have addressed the role of specific VRFs in the development of LOE also with conflicting results.…”

Late-onset epilepsy predicts stroke: Systematic review and meta-analysis

“…Differences between findings might be partly due to the use of semi-quantitative WML measures (Fazekas and Scheltens scales), which may be insufficiently robust for reliable statistical analysis by comparison with quantitative measures. The role of WMLs is however still debated [26]. Some radiological studies suggest that LOE is associated with lower cortical volumes [19].…”

Late-Onset Focal Epilepsy: Electroclinical Features and Prognostic Role of Leukoaraiosis

“…So far, data on the association of this imaging marker with a late-onset epilepsy and interpretations of its meaning have been controversial ( 13 – 16 ).…”