Late-Onset Epilepsy and Occult Cerebrovascular Disease

Gibson, Lorna M; Hanby, Martha F.; Al–Bachari, Sarah; Parkes, Laura M.; Allan, Stuart M.; Emsley, Hedley

doi:10.1038/jcbfm.2014.25

Cited by 53 publications

(45 citation statements)

References 52 publications

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“…A predominance of vascular lesions was also found. Epilepsy with focal seizures was most prevalent (83.8%), representing a slightly higher value than those found in previous studies (60% cases with focal seizures) [11][12] .…”

Section: Discussioncontrasting

confidence: 59%

Caracterização da epilepsia com início após os 60 anos de idade

Bruscky

Leite

Correia

et al. 2016

Rev. bras. geriatr. gerontol.

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Introduction: Despite its high incidence, the characteristics of epilepsy in elderly patients have not yet been widely studied. The clinical presentation of the disease is mostly atypical and findings from complementary examinations provide little help with diagnosis. Few reports have characterized this group of individuals. Objective: To describe the characteristics of patients with epilepsy with onset after 60 years of age. Method: A descriptive study of a case series was designed. For this purpose, 50 patients diagnosed with epilepsy with onset after 60 years of age, treated at the outpatient epilepsy clinic of the Hospital da Restauração (Recife-PE), were consecutively assessed. Results: The 50 patients included in the study had an average age of 75.3 (±13) years, 30 (60.0%) were female and 20 (40.0%) were male. The average age at the first seizure episode was 72.5 (±11.5) years. Focal epilepsy seizures were the most predominant (83.8%). The occurrence of status epilepticus was low in this group (4.0%). Symptomatic epilepsy was the most frequent type, and most of the causes were of vascular etiology (43.0%). Carbamazepine was most commonly used for treatment, and the patients responded well to low-dose monotherapy. Electroencephalograms displayed normal results in many cases (50.0%), and neuroimaging showed nonspecific findings for most individuals (83.0%). Conclusion: Epilepsy in elderly patients is predominantly focal and symptomatic, with a low occurrence of status epilepticus and good therapeutic response. The encephalogram and neuroimaging results are frequently nonspecific.

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Section: Discussioncontrasting

confidence: 59%

Caracterização da epilepsia com início após os 60 anos de idade

Bruscky

Leite

Correia

et al. 2016

Rev. bras. geriatr. gerontol.

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“…Finally, a combination of the two mechanisms described above cannot be ruled out. Of note, CSVD has been previously associated with late-life onset epilepsy in non-ICH patients (Maxwell et al, 2013;Gibson et al, 2014). Severe underlying CSVD, which is common among ICH patients, may therefore account for the relatively high incidence of pre-ICH epilepsy among our study population.…”

Section: Discussionmentioning

confidence: 77%

“…The biological implications of these associations, however, may be different in each case. Direct cortical involvement has been associated with epileptogenesis in both ischaemic and haemorrhagic stroke (Gibson et al, 2014;Haapaniemi et al, 2014). However, in the setting of post-ICH delayed seizures, cortical involvement stems from the lobar location of the haematoma.…”

Section: Discussionmentioning

confidence: 99%

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Delayed seizures after intracerebral haemorrhage

Biffi

Rattani

Anderson

et al. 2016

Brain

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Late seizures after intracerebral haemorrhage occur after the initial acute haemorrhagic insult subsides, and represent one of its most feared long-term sequelae. Both susceptibility to late seizures and their functional impact remain poorly characterized. We sought to: (i) compare patients with new-onset late seizures (i.e. delayed seizures), with those who experienced a recurrent late seizure following an immediately post-haemorrhagic seizure; and (ii) investigate the effect of late seizures on long-term functional performance after intracerebral haemorrhage. We performed prospective longitudinal follow-up of consecutive intracerebral haemorrhage survivors presenting to a single tertiary care centre. We tested for association with seizures the following neuroimaging and genetic markers of cerebral small vessel disease: APOE variants "2/"4, computer tomography-defined white matter disease, magnetic resonance imaging-defined white matter hyperintensities volume and cerebral microbleeds. Cognitive performance was measured using the Modified Telephone Interview for Cognitive Status, and functional performance using structured questionnaires obtained every 6 months. We performed time-to-event analysis using separate Cox models for risk to develop delayed and recurrent seizures, as well as for functional decline risk (mortality, incident dementia, and loss of functional independence) after intracerebral haemorrhage. A total of 872 survivors of intracerebral haemorrhage were enrolled and followed for a median of 3.9 years. Early seizure developed in 86 patients, 42 of whom went on to experience recurrent seizures. Admission Glasgow Coma Scale, increasing haematoma volume and cortical involvement were associated with recurrent seizure risk (all P 5 0.01). Recurrent seizures were not associated with long-term functional outcome (P = 0.67). Delayed seizures occurred in 37 patients, corresponding to an estimated incidence of 0.8% per year (95% confidence interval 0.5-1.2%). Factors associated with delayed seizures included cortical involvement on index haemorrhage (hazard ratio 1.63, P = 0.036), pre-haemorrhage dementia (hazard ratio 1.36, P = 0.044), history of multiple prior lobar haemorrhages (hazard ratio 2.50, P = 0.038), exclusively lobar microbleeds (hazard ratio 2.22, P = 0.008) and presence of 5 1 APOE "4 copies (hazard ratio 1.95, P = 0.020). Delayed seizures were associated with worse long-term functional outcome (hazard ratio 1.83, P = 0.005), but the association was removed by adjusting for neuroimaging and genetic markers of cerebral small vessel disease. Delayed seizures after intracerebral haemorrhage are associated with different risk factors, when compared to recurrent seizures. They are also associated with worse functional outcome, but this finding appears to be related to underlying small vessel disease. Further investigations into the connections between small vessel disease and delayed seizures are warranted.

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“…An ischemic stroke was due to the scarcity of cerebral blood supply. The blood supply of brain was compromised but not completely interrupted in the early phase of ischemic stroke [1,2]. Neurons could continue to progress towards infarction and subsequently injure the adjacent viable tissue without sufficient blood.…”

Section: Introductionmentioning

confidence: 99%