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

Abstract

Background The epileptogenic properties of white matter lesions (WML) in cerebral small vessel disease (CSVD) are not yet understood. The aim of our systematic review and meta-analysis was to estimate the association between the extent of WML in CSVD and epilepsy, analyze whether these WML are associated with an increased risk of seizure recurrence, and evaluate if treatment with anti-seizure medication (ASM) is justified in first-seizure patients with WML and no cortical lesions. Methods Following a pre-registered study protocol (PROSPERO-ID CRD42023390665), we systematically searched Pubmed and Embase for relevant literature comparing WML load between patients with epilepsy and controls as well as studies on seizure recurrence risk and ASM therapy in the presence vs. absence of WML. We calculated pooled estimates using a random effects model. Results Eleven studies comprising 2983 patients were included in our study. Presence of WML (OR 2.14, 95% CI 1.38–3.33) and presence of relevant WML as assessed by visual rating scales (OR 3.96, 95% CI 2.55–6.16) but not WML volume (OR 1.30, 95% CI 0.91–1.85) were significantly associated with seizures. These results stayed robust in sensitivity analyses restricted to studies on patients with late-onset seizures/epilepsy. Only two studies assessed the association between WML and risk of seizure recurrence with conflicting results. Currently, there are no studies on the efficacy of ASM therapy in the presence of WML in CSVD. Conclusions This meta-analysis suggests an association between presence of WML in CSVD and seizures. More research is needed addressing the association between WML and risk of seizure recurrence and ASM therapy focusing on a population of patients with a first unprovoked seizure.

Prospective neuroimaging and neuropsychological evaluation in adults with newly diagnosed focal epilepsy

“…A leading cause of focal white matter lesions is small vessel ischemia, which is has been associated with focal onset seizures in some studies. 36,37 The higher incidence of white matter changes in patients could not be attributed to an aging cohort given that our controls were slightly older than our patients. We are unsure as to the reason for the discrepancy in the reported proportion of patients with white matter abnormalities between our study and the aforementioned previous study, 19 but this could be due to methodological factors such as our use of identical MRI sequences, a single highend 3 T scanner and a single epilepsy-experienced neuroradiologist for evaluation all patients and controls.…”

Seizing the Connection: Exploring the Interplay Between Epilepsy and Glycemic Control in Diabetes Management

“…On the other hand, several antidiabetic drugs may change AED concentrations, resulting in less-than-ideal seizure control [7,8]. Epilepsy-related cognitive deficits and behavioral problems can make managing diabetes challenging.…”

“…Blood glucose levels increase as a result [2,3]. Following a seizure, glucose usage may remain high, resulting in hypoglycemia (low blood sugar) [7]. It can be challenging to control this postictal state if the person is ignorant of the occurrence.…”

“…The interplay between treating a particular condition and its potential ramifications on another condition is significant. As an illustration, it is worth noting that the utilization of antiepileptic drugs (AEDs) and antidiabetic medications may engender an intricate interplay, thereby exerting an influence on the regulation of glycemic levels as well as the management of seizures [6,7]. Healthcare providers must exercise prudence and deliberation in their approach when formulating treatment plans for individuals who have both epilepsy and diabetes.…”