EPILEPTIC SEIZURES IN SUBCORTICAL VASCULAR ENCEPHALOPATHY

Cerebrovascular disease is one of the most common causes of epilepsy i n the elderly. Most of the studies published relate to cortical infarc tion, subarachnoid, and intracranial hemorrhage, whereas the incidence of epilepsy from subcortical ischemia, i.e. deep lacunar infarctions and diffuse white matter lesions, is obscure. Therefore, we prospectiv ely examined 18 patients with the precisely defined diagnosis of subco rtical vascular encephalopathy (SVE), who were admitted to our hospita l due to epileptic seizures (group A), and compared them to a similarl y selected group matched for age, sex, risk factors, and neurological deficits with an equivalent severity of SVE but without seizures (grou p B). Subcortical lacunar infarctions were significantly more frequent in group A than group B (15/18 versus 4/18, p < 0.001), whereas neith er the extension, degree, distribution of periventricular white matter changes, nor the presence of internal hydrocephalus, focal or diffuse cortical atrophy showed any statistical significance. However, a temp oral constant theta or delta EEG focus was present in 10/18 patients i n group A but only in 1/18 patients from group B (p < 0.005). 10/18 pa tients developed epilepsy with further seizures during follow-up. The association of SVE, multiple subcortical lacunas, and temporal EEG abn ormalities are suggestive for an increased risk for epileptic seizures , which is particularly important for the treatment of patients with S VE if uncertain paroxysmal episodes occur, e.g. transient ischemic att acks, seizures, or cardiac syncope.