Cognitive Impairment and Seizures in Patients with Lacunar Strokes

Abstract

Abstractlacunar strokes are mainly related to cerebral microangiopathy and to the presence of leukoaraiosis. cognitive impairment is frequently linked to the presence of lacunes and white matter changes. The cognitive impairment consists mainly of disturbances of executive functions sometimes leading to dementia. it is mainly due to interruption of the frontal-subcortical neuronal circuits. Seizures are also observed in patients with lacunes and white matter changes. although lacunes cannot be considered as the cause of the seizures, there is a relationship between the occurrence of cognitive impairment and seizures. Repeated seizures promote further cognitive decline. however, the development of dementia in patients with late-onset epilepsy is most probably not directly due to the lacunes but rather due to alzheimer's disease or to cortical cerebrovascular lesions. The development of lacunes should only be the aggravating factor for the cognitive decline as demonstrated in the Nun study. Seizures have also been described to occur in patients with lacunar strokes and white matter changes. 11 however, the relationship between seizures and lacunar infarcts is uncertain. Keywords 12 EpidemiologySilent thalamic and basal ganglia lacunes observed on computed tomography (cT) or MRi of the brain are independent predictors of cognitive decline in elderly individuals without concomitant dementing processes such as alzheimer's disease. 13 The presence of lacunes in the thalamus is associated with lower scores of Mini Mental State Examination (MMSE) and worse compound scores for speed and motor control and executive functions.14 The overall prevalence of cognitive impairment 3 months after any kind of stroke and at annual follow-up remains relatively unchanged at 22 %.The prevalence ratio of cognitive impairment increases with older age (2 % for each year of age), ethnicity (2.2-fold higher among black people) and socioeconomic status (42 % increased among manual workers).The effect of education on the cognitive reserve is most pronounced in patients with mild and moderate degrees of brain pathology, whereas there is no influence in patients with severe MRi changes. 15 a progressive trend of cognitive impairment is observed among patients with smallvessel occlusion and lacunar infarction, with an average annual percentage change of 10 and 2 % respectively, up to 5 years after stroke. Parkinsonism can also be found associated by the presence of more severe ischaemic lesions in the striatum, interrupting the basal ganglia-thalamic-cortical 'motor' circuits.

Epilepsy in cerebrovascular diseases: Review of experimental and clinical data with meta‐analysis of risk factors

“…The authors speculate that some subcortical white matter lesions may also affect U‐fibers, leading to a higher propensity for seizures. De Reuck and Van Maele investigated the amount of cognitive decline in 292 patients with leukoaraiosis, with and without seizures (n = 44 and 248, respectively), and found a higher proportion and severity of cognitive decline in patients with seizures. These authors speculated that an underlying neurodegenerative disease, rather than leukoaraiosis, might cause epilepsy in those patients.…”

Hypertension, seizures, and epilepsy: a review on pathophysiology and management

“…The first study [52] found that neither the presence of vascular risk factors including hypertension, nor the degree of white matter changes were associated with the development of epilepsy. The second study [53] on 292 subjects with lacunar strokes found that 44 patients with seizures had a lower main National Institute of Health Stroke Scale score (p = 0.00133) and a lower Mini Mental State Examination score (p < 0.001) as compared to 248 patients without seizures. These authors conclude that the seizures were more linked to the cognitive status than to SVD, postulating that an underlying neurodegenerative process may be responsible for seizures and cognitive impairment.…”

“…However, about half of the patients included in the study did not undergo brain MRI, thus limiting the generalizability of results. Two retrospective studies with overlapping population [52,53] examined the incidence and predictors of seizures and epilepsy in patients with lacunar stroke. The first study [52] found that neither the presence of vascular risk factors including hypertension, nor the degree of white matter changes were associated with the development of epilepsy.…”