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Journal of Neurology

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Open Access 21-06-2023 | Epilepsy | Original Communication

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

Authors: Jakob I. Doerrfuss, Jonas M. Hebel, Martin Holtkamp

Published in: Journal of Neurology | Issue 10/2023

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.

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Title: Epileptogenicity of white matter lesions in cerebral small vessel disease: a systematic review and meta-analysis
Authors: Jakob I. Doerrfuss
Jonas M. Hebel
Martin Holtkamp
Publication date: 21-06-2023
Publisher: Springer Berlin Heidelberg
Keywords: Epilepsy
Cerebral Small Vessel Disease
Stroke
Published in: Journal of Neurology / Issue 10/2023
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-023-11828-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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