Cognitive Impairment and Seizures in Patients with Lacunar Strokes

Abstract

Background: Lacunar infarcts and white matter changes have been linked to cognitive impairment. Patients with lacunar strokes can also develop seizures, although the relationship between the two remains unclear. The present study investigates whether seizures in patients with lacunar infarcts are related to the strokes or to an underlying neurodegenerative disorder leading to cognitive impairment. Methods: The demographic features, vascular risk factors and scores on the National Institutes of Health Stroke Scale (NIHSS) on admission for the stroke and on the modified Rankin scale on discharge, as well as on the Mini-Mental State Examination (MMSE), were determined in patients with a lacunar stroke. They were compared between 44 patients with and 248 without subsequent seizures. Results: Patients with seizures had a lower main NIHSS score (p = 0.00133) and a more severe MMSE score (p < 0.001). They remained significantly more dependent (p = 0.019) after hospital discharge. Smoking, as a vascular risk factor, appeared to occur less frequently in seizure patients (p = 0.039). On logistic regression analysis, only NIHSS and MMSE scores remained independent variables. Conclusions: Seizure occurrence in patients with a lacunar infarct is not related to the severity of the stroke but rather to the degree of cognitive impairment. The present study suggests that the seizures are not due to lacunar infarcts but are more probably the expression of an underlying neurodegenerative process that is also responsible for the mental deterioration.

Seizures in patients with symptomatic cervical artery occlusion by dissection and by atherosclerosis

“…Although the presence of lacunas is linked to arterial hypertension, their high incidence in patients with ATO cannot explain the trend to a higher incidence of seizures. Lacunar infarcts have not been found to be responsible for the occurrence of stroke-related seizures [31,32].…”

Seizures after percutaneous endoscopic lumbar discectomy

“…[ 14 ] However, seizures are more likely the expression of an underlying neurodegenerative process and cause more severe cognitive impairment than lacunar infarcts. [ 16 , 17 ]…”

Cerebrovascular disease burden in late-onset non-lesional focal epilepsy

“…It could be that LOE patients have a higher underlying predisposition to experience seizures. Neurodegenerative changes in the medial temporal lobe structures could be one such predisposing factor [17].…”

“…The lack of consistent pathophysiological explanations for LOE has raised several additional hypotheses to explain the epileptogenic process. Some authors believe that occult cortical microinfarcts may be present in these patients [14][15][16] T stroke may be involved in development of the seizures [12,13,17,18].…”