Prevalence and subtypes of radiological cerebrovascular disease in late-onset isolated seizures and epilepsy

Maxwell, Heather; Hanby, Martha F.; Parkes, Laura M.; Gibson, Lorna M; Coutinho, Christopher; Emsley, Hedley

doi:10.1016/j.clineuro.2012.07.009

Cited by 52 publications

(45 citation statements)

References 19 publications

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“…Finally, a combination of the two mechanisms described above cannot be ruled out. Of note, CSVD has been previously associated with late-life onset epilepsy in non-ICH patients (Maxwell et al, 2013;Gibson et al, 2014). Severe underlying CSVD, which is common among ICH patients, may therefore account for the relatively high incidence of pre-ICH epilepsy among our study population.…”

Section: Discussionmentioning

confidence: 86%

Delayed seizures after intracerebral haemorrhage

Biffi

Rattani

Anderson

et al. 2016

Brain

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Late seizures after intracerebral haemorrhage occur after the initial acute haemorrhagic insult subsides, and represent one of its most feared long-term sequelae. Both susceptibility to late seizures and their functional impact remain poorly characterized. We sought to: (i) compare patients with new-onset late seizures (i.e. delayed seizures), with those who experienced a recurrent late seizure following an immediately post-haemorrhagic seizure; and (ii) investigate the effect of late seizures on long-term functional performance after intracerebral haemorrhage. We performed prospective longitudinal follow-up of consecutive intracerebral haemorrhage survivors presenting to a single tertiary care centre. We tested for association with seizures the following neuroimaging and genetic markers of cerebral small vessel disease: APOE variants "2/"4, computer tomography-defined white matter disease, magnetic resonance imaging-defined white matter hyperintensities volume and cerebral microbleeds. Cognitive performance was measured using the Modified Telephone Interview for Cognitive Status, and functional performance using structured questionnaires obtained every 6 months. We performed time-to-event analysis using separate Cox models for risk to develop delayed and recurrent seizures, as well as for functional decline risk (mortality, incident dementia, and loss of functional independence) after intracerebral haemorrhage. A total of 872 survivors of intracerebral haemorrhage were enrolled and followed for a median of 3.9 years. Early seizure developed in 86 patients, 42 of whom went on to experience recurrent seizures. Admission Glasgow Coma Scale, increasing haematoma volume and cortical involvement were associated with recurrent seizure risk (all P 5 0.01). Recurrent seizures were not associated with long-term functional outcome (P = 0.67). Delayed seizures occurred in 37 patients, corresponding to an estimated incidence of 0.8% per year (95% confidence interval 0.5-1.2%). Factors associated with delayed seizures included cortical involvement on index haemorrhage (hazard ratio 1.63, P = 0.036), pre-haemorrhage dementia (hazard ratio 1.36, P = 0.044), history of multiple prior lobar haemorrhages (hazard ratio 2.50, P = 0.038), exclusively lobar microbleeds (hazard ratio 2.22, P = 0.008) and presence of 5 1 APOE "4 copies (hazard ratio 1.95, P = 0.020). Delayed seizures were associated with worse long-term functional outcome (hazard ratio 1.83, P = 0.005), but the association was removed by adjusting for neuroimaging and genetic markers of cerebral small vessel disease. Delayed seizures after intracerebral haemorrhage are associated with different risk factors, when compared to recurrent seizures. They are also associated with worse functional outcome, but this finding appears to be related to underlying small vessel disease. Further investigations into the connections between small vessel disease and delayed seizures are warranted.

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Section: Discussionmentioning

confidence: 86%

Delayed seizures after intracerebral haemorrhage

Biffi

Rattani

Anderson

et al. 2016

Brain

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“…(Bentes et al, 2001) These papers have some limitations: in the work by Bentes et al (2001), MRI was not performed; in the paper by Schreiner and co-workers (1995), sample size was limited to 18 cases. Another work (Maxwell et al, 2013) aimed at exploring the prevalence of radiological cerebrovascular disease in late-onset seizures and epilepsy: small vessel disease was found to be more frequent and more severe among subjects with seizures beginning after 60 years of age, with or without a clinical stroke, thus suggesting a possible epileptogenic role for small vessel disease. The presence of cortical microinfarcts cannot be excluded in patients with leukoaraiosis on the basis of 1.5 T MRI.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have elucidated epidemiologic and prognostic characteristics of post-stroke seizures and vascular epilepsy (Awada et al, 1999;Bladin et al, 2000;Lamy et al, 2013;Graham et al, 2013;Huang et al, 2014), but little attention has been dedicated to epilepsy associated with leukoaraiosis (Schreiner et al, 1995;Maxwell et al, 2013) in the absence of a manifest stroke. Data about the involvement of blood vessels in epileptogenesis come from experimental studies on animal models and surgically removed human brain tissue (Mott et al, 2009;Biagini et al, 2008;Gualtieri et al, 2012Gualtieri et al, , 2013.…”

Section: Introductionmentioning

confidence: 98%

Epilepsy associated with Leukoaraiosis mainly affects temporal lobe: a casual or causal relationship?

et al. 2015

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“…[8] geç başlangıçlı epileptik nöbet ve epilepsi prevalansını inmenin radyolojik alt tipleriyle karşılaştırmış-tır. Buna göre önce inmeler büyük damar hastalığı (kortikal ve subkortikal infarktlar) ve küçük damar tıkanıklığı (periventriküler ak madde veya subkortikal lezyonlar) olarak iki gruba ayrılmıştı.…”

Section: Discussionunclassified

Epilepsy in elderly patients

Halaç¹

2015

Epilepsi

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SummaryObjectives: The incidence of new-onset epilepsy is high among the elderly. This study presents the demographic characteristics, etiological factors, seizure types and response rates to treatment in a group of patients aged 65 years or over with delayed-onset epilepsy. Methods:The study comprised a retrospective evaluation of the records of 43 patients aged 65 or older with a diagnosis of delayed-onset epilepsy who were admitted to the epilepsy clinic in the Neurology Department of Bezmialem University Faculty of Medicine.Results: Patient mean age was 74.9 (66-92 years). Underlying disease was found to be cerebrovascular disease in 37.2%. Based on seizure type, 67.4% (n=29) patients had partial-onset and 32.6% (n=14) had generalized seizure. Treatment protocol in 93% (n=40) of the patients was monotherapy antiepileptic drugs, the most commonly used being levetiracetam (53.5%). Assessment of drug side effects showed no complaint in 86% (n=37) of the patients. During the three months prior to the study, 95.3% of the patients had been seizure free. Conclusion:The study found cerebrovascular disease to be the most common etiological factor in delayed-onset epilepsy. Partial-onset secondary generalized seizure was the most common seizure type. All patients responded well to monotherapy and have a good prognosis.Key words: Epilepsy; treatment; elderly patients. ÖzetAmaç: Yaşlılarda yeni başlangıçlı epilepsi insidansı oldukça yüksektir. Çalışmada, 65 yaş üstü geç başlangıçlı epilepsi tanısı alan hastaların demografik özellikleri, etiyolojik faktörleri, nöbet tipleri ve tedaviye yanıt oranları sunulmuştur ve literatür eşliğinde sonuçlar tartışılmıştır. Sonuç: Geç başlangıçlı epilepsi hastalarında en sık görülen etiyolojik neden serebrovasküler hastalık olup nöbet tipi çoğunlukla parsiyel başlangıçlı sekonder jeneralize tonik kloniktir, hastalar monoterapiye iyi yanıt verir ve prognoz iyi seyirlidir. Gereç ve

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Prevalence and subtypes of radiological cerebrovascular disease in late-onset isolated seizures and epilepsy

Cited by 52 publications

References 19 publications

Delayed seizures after intracerebral haemorrhage

Delayed seizures after intracerebral haemorrhage

Epilepsy associated with Leukoaraiosis mainly affects temporal lobe: a casual or causal relationship?

Epilepsy in elderly patients

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