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

• Published in: Clinical neurology and neurosurgery Vol. 115; no. 5; pp. 591 - 596
• Main Authors: Maxwell, H, Hanby, M, Parkes, L.M, Gibson, L.M, Coutinho, C, Emsley, H.C.A
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.05.2013; Elsevier Limited
• Subjects: Age; Age of Onset; Aged; Case-Control Studies; Cerebral Small Vessel Diseases - complications; Cerebral Small Vessel Diseases - diagnostic imaging; Cerebrovascular disease; Cerebrovascular Disorders - diagnostic imaging; Cerebrovascular Disorders - epidemiology; Cerebrovascular Disorders - etiology; Epilepsy; Epilepsy - complications; Epilepsy - diagnostic imaging; Female; Gender; Humans; Image Processing, Computer-Assisted; Intracranial Hemorrhages - diagnostic imaging; Intracranial Hemorrhages - epidemiology; Intracranial Hemorrhages - etiology; Late-onset epilepsy; Leukoaraiosis - complications; Leukoaraiosis - diagnostic imaging; Magnetic Resonance Imaging; Male; Neuroimaging; Neurology; Neurosurgery; Odds Ratio; Patients; Prevalence; Radiological; Reproducibility of Results; Retrospective Studies; Seizures - complications; Seizures - diagnostic imaging; Studies; Tomography, X-Ray Computed; Radiological; Late-onset epilepsy; Cerebrovascular disease
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2012.07.009

Abstract Background Late-onset epilepsy (LOE), onset over 60, is often attributed to cerebrovascular disease (CVD), and is associated with increased stroke risk. We investigated the radiological prevalence of CVD in LOE. Methods We undertook a retrospective case-control study of patients with LOE and age and sex-matched controls, also matched for imaging modality. Radiological CVD was recorded, with radiological findings by an experienced consultant neuroradiologist usi a structured proforma. Results 105 cases and 105 controls were studied, comprising 61 (58.1%) males, mean (±SD) age (years) 72.7 ± 7.48 (cases), 72.4 ± 7.02 (controls). 9 cases had isolated seizures rather than LOE. Imaging modality (in cases and controls) was CT in 59 and MRI in 46. Radiological CVD was more prevalent amongst cases (65.7%) than controls (33.3%) ( p < 0.0001, Chi-square), odds ratio 3.83 (95% CI 2.16–6.79). Large vessel disease (LVD) (single or multiple cortical or subcortical infarcts > 1.5 cm) was present in 23 (21.9%) cases and 2 (1.9%) ( p < 0.001) controls, with small vessel disease (SVD) (periventricular or subcortical white matter lesions (WMLs), including leukoaraiosis (LA)) present in 52 (49.5%) cases (LA in 4) and 34 (32.3%) controls (LA in 0) ( p < 0.05). When WMLs were rated using a semiquantitative visual rating scale, a trend towards greater severity was observed amongst cases compared to controls. Conclusions Radiological CVD is significantly more prevalent in patients with LOE than controls, including signs of both LVD and SVD. SVD also appears to be of greater severity. Further studies are needed in this area.