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Journal of Neurology

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01-05-2019 | Magnetic Resonance Imaging | Original Communication

Juxtacortical lesions are associated with seizures in cerebral small vessel disease

Authors: Sebastian Stösser, Stefanie Böckler, Albert C. Ludolph, Jan Kassubek, Hermann Neugebauer

Published in: Journal of Neurology | Issue 5/2019

Abstract

Background and objective

Small vessel cerebrovascular disease (SVCD) can manifest with epileptic seizures and transient ischemic attacks (TIA). This study was designed to test if the extent and spatial distribution of SVCD differs in patients with focal impaired awareness seizures (FIAS) from patients with TIA.

Methods

This is a retrospective single-center case–control study of elderly patients at a high cardiovascular risk. 118 patients with FIAS (cases) were compared to a matched control group of 118 patients with TIA. The extent and spatial distribution of white matter hyperintensities (WMH) characteristic for SVCD and medial temporal lobe atrophy were analyzed on magnetic resonance imaging (MRI) obtained at admission. The Fazekas, Wahlund, and Scheltens scales were used for grading. Juxtacortical small lesions were analyzed separately.

Results

FIAS patients were observed to have more extensive WMH (p < 0.001) and more pronounced medial temporal lobe atrophy (p < 0.001) than TIA patients. WMH in FIAS patients were predominantly localized in supratentorial white matter compared to TIA patients (p < 0.001). Juxtacortical hyperintensities were far more common in FIAS patients than in TIA patients (80.5% vs. 22.0%; p < 0.001). Multivariate analysis revealed juxtacortical small lesions as strong independent predictor (OR, 95% CI 12.8, 6.7–24.3) and medial temporal lobe atrophy as further independent predictor of FIAS (3.1, 1.3–7.1).

Conclusions

Juxtacortical small lesions and to a smaller extent medial temporal lobe atrophy are associated with epileptic seizures in elderly patients at a high cardiovascular risk. This observation may provide a structural explanation for epilepsy in SVCD. Juxtacortical small lesions in SVCD should be considered a structural cause for epilepsy and promote anticonvulsive therapy after a first seizure.

Okroglic S, Widmann CN, Urbach H et al (2013) Clinical symptoms and risk factors in cerebral microangiopathy patients. PloS One 8:e53455. https://doi.org/10.1371/journal.pone.0053455 CrossRefPubMedPubMedCentral

van der Flier WM, van Straaten ECW, Barkhof F et al (2005) Small vessel disease and general cognitive function in nondisabled elderly: the LADIS study. Stroke 36:2116–2120. https://doi.org/10.1161/01.STR.0000179092.59909.42 CrossRefPubMed

Wardlaw JM, Smith EE, Biessels GJ et al (2013) Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol 12:822–838. https://doi.org/10.1016/S1474-4422(13)70124-8 CrossRefPubMedPubMedCentral

Maxwell H, Hanby M, Parkes LM et al (2013) Prevalence and subtypes of radiological cerebrovascular disease in late-onset isolated seizures and epilepsy. Clin Neurol Neurosurg 115:591–596. https://doi.org/10.1016/j.clineuro.2012.07.009 CrossRefPubMed

van Veluw SJ, Zwanenburg JJM, Engelen-Lee J et al (2013) In vivo detection of cerebral cortical microinfarcts with high-resolution 7T MRI. J Cereb Blood Flow Metab Off J Int Soc Cereb Blood Flow Metab 33:322–329. https://doi.org/10.1038/jcbfm.2012.196 CrossRef

Shan Y, Tan S, Wang Y et al (2017) Risk factors and clinical manifestations of juxtacortical small lesions: a neuroimaging study. Front Neurol 8:497. https://doi.org/10.3389/fneur.2017.00497 CrossRefPubMedPubMedCentral

Fisher RS, Cross JH, French JA et al (2017) Operational classification of seizure types by the international league against epilepsy: position paper of the ILAE commission for classification and terminology. Epilepsia 58:522–530. https://doi.org/10.1111/epi.13670 CrossRefPubMed

Albers GW, Caplan LR, Easton JD et al (2002) Transient ischemic attack—proposal for a new definition. N Engl J Med 347:1713–1716. https://doi.org/10.1056/NEJMsb020987 CrossRefPubMed

Inzitari D, Pracucci G, Poggesi A et al (2009) Changes in white matter as determinant of global functional decline in older independent outpatients: three year follow-up of LADIS (leukoaraiosis and disability) study cohort. BMJ 339:b2477CrossRefPubMedPubMedCentral

10.

Wahlund LO, Barkhof F, Fazekas F et al (2001) A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke 32:1318–1322CrossRefPubMed

11.

Fazekas F, Chawluk JB, Alavi A et al (1987) MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. AJR Am J Roentgenol 149:351–356. https://doi.org/10.2214/ajr.149.2.351 CrossRefPubMed

12.

Scheltens P, Launer LJ, Barkhof F et al (1995) Visual assessment of medial temporal lobe atrophy on magnetic resonance imaging: interobserver reliability. J Neurol 242:557–560CrossRefPubMed

13.

Vinters HV, Ellis WG, Zarow C et al (2000) Neuropathologic substrates of ischemic vascular dementia. J Neuropathol Exp Neurol 59:931–945CrossRefPubMed

14.

Moody DM, Bell MA, Challa VR (1990) Features of the cerebral vascular pattern that predict vulnerability to perfusion or oxygenation deficiency: an anatomic study. AJNR Am J Neuroradiol 11:431–439PubMedPubMedCentral

15.

Moody DM, Brown WR, Challa VR et al (1997) Cerebral microvascular alterations in aging, leukoaraiosis, and Alzheimer’s disease. Ann N Y Acad Sci 826:103–116CrossRefPubMed

16.

Westover MB, Bianchi MT, Yang C et al (2013) Estimating cerebral microinfarct burden from autopsy samples. Neurology 80:1365–1369. https://doi.org/10.1212/WNL.0b013e31828c2f52 CrossRefPubMedPubMedCentral

17.

Auriel E, Westover MB, Bianchi MT et al (2015) Estimating Total Cerebral Microinfarct Burden From Diffusion-Weighted Imaging. Stroke 46:2129–2135. https://doi.org/10.1161/STROKEAHA.115.009208 CrossRefPubMedPubMedCentral

18.

Summers PM, Hartmann DA, Hui ES et al (2017) Functional deficits induced by cortical microinfarcts. J Cereb Blood Flow Metab Off J Int Soc Cereb Blood Flow Metab 37:3599–3614. https://doi.org/10.1177/0271678X16685573 CrossRef

19.

Shih AY, Blinder P, Tsai PS et al (2013) The smallest stroke: occlusion of one penetrating vessel leads to infarction and a cognitive deficit. Nat Neurosci 16:55–63. https://doi.org/10.1038/nn.3278 CrossRefPubMed

20.

Clarkson AN, Clarkson J, Jackson DM, Sammut IA (2007) Mitochondrial involvement in transhemispheric diaschisis following hypoxia-ischemia: clomethiazole-mediated amelioration. Neuroscience 144:547–561. https://doi.org/10.1016/j.neuroscience.2006.09.040 CrossRefPubMed

21.

Anenberg E, Arstikaitis P, Niitsu Y et al (2014) Ministrokes in channelrhodopsin-2 transgenic mice reveal widespread deficits in motor output despite maintenance of cortical neuronal excitability. J Neurosci Off J Soc Neurosci 34:1094–1104. https://doi.org/10.1523/JNEUROSCI.1442-13.2014 CrossRef

22.

Arba F, Quinn T, Hankey GJ et al (2017) Cerebral small vessel disease, medial temporal lobe atrophy and cognitive status in patients with ischaemic stroke and transient ischaemic attack. Eur J Neurol 24:276–282. https://doi.org/10.1111/ene.13191 CrossRefPubMed

23.

Cheng C-H, Liu C-J, Ou S-M et al (2015) Incidence and risk of seizures in Alzheimer’s disease: a nationwide population-based cohort study. Epilepsy Res 115:63–66. https://doi.org/10.1016/j.eplepsyres.2015.05.009 CrossRefPubMed

24.

Sohn HS, Kim SK, Lee S-Y (2016) Inflammatory markers associated with seizures. Epileptic Disord Int Epilepsy J Videotape 18:51–57. https://doi.org/10.1684/epd.2016.0794 CrossRef

25.

Muraga K, Suda S, Nagayama H et al (2016) Limb-shaking TIA: cortical myoclonus associated with ICA stenosis. Neurology 86:307–309. https://doi.org/10.1212/WNL.0000000000002293 CrossRefPubMed

26.

Devuyst G, Bogousslavsky J, Meuli R et al (2002) Stroke or transient ischemic attacks with basilar artery stenosis or occlusion: clinical patterns and outcome. Arch Neurol 59:567–573CrossRefPubMed

27.

Werhahn KJ (2010) Weakness and focal sensory deficits in the postictal state. Epilepsy Behav EB 19:138–139. https://doi.org/10.1016/j.yebeh.2010.06.029 CrossRef

28.

Noachtar S, Lüders HO (1999) Focal akinetic seizures as documented by electroencephalography and video recordings. Neurology 53:427–429CrossRefPubMed

Title: Juxtacortical lesions are associated with seizures in cerebral small vessel disease
Authors: Sebastian Stösser
Stefanie Böckler
Albert C. Ludolph
Jan Kassubek
Hermann Neugebauer
Publication date: 01-05-2019
Publisher: Springer Berlin Heidelberg
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Cerebral Small Vessel Disease
Epileptic Seizure
Published in: Journal of Neurology / Issue 5/2019
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-019-09253-9

At a glance: The STEP trials

Springer Medicine

Juxtacortical lesions are associated with seizures in cerebral small vessel disease

Abstract

Background and objective

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background and objective

Methods

Results

Conclusions

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