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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(12): 1084-1089
DOI: 10.1590/0004-282X-ANP-2021-0003
Articles

Relationship of white matter hyperintensities with clinical features of seizures in patients with epilepsy

A relação das hiperintensidades da substância branca com as características clínicas das crises em pacientes com epilepsia
Ferda Ilgen USLU 
1   Bezmialem Vakıf University, Medical Faculty, Department of Neurology, Fatih, İstanbul, Turkey.
,
Elif ÇETINTAŞ 
2   Bezmialem Vakıf University, Medical Faculty, Fatih, İstanbul, Turkey.
,
İsmail YURTSEVEN 
3   Bezmialem Vakıf University, Medical Faculty, Department of Radiology, Fatih, İstanbul, Turkey.
,
Alpay ALKAN 
3   Bezmialem Vakıf University, Medical Faculty, Department of Radiology, Fatih, İstanbul, Turkey.
,
Mehmet KOLUKISA 
1   Bezmialem Vakıf University, Medical Faculty, Department of Neurology, Fatih, İstanbul, Turkey.
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ABSTRACT

Background: Although epilepsy is primarily known as a cortical disorder, there is growing body of research demonstrating white matter alterations in patients with epilepsy. Objective: To investigate the prevalence of white matter hyperintensities (WMH) and its association with seizure characteristics in patients with epilepsy. Methods: The prevalence of WMH in 94 patients with epilepsy and 41 healthy controls were compared. Within the patient sample, the relationship between the presence of WMH and type of epilepsy, frequency of seizures, duration of disease and the number of antiepileptic medications were investigated. Results: The mean age and sex were not different between patients and healthy controls (p>0.2). WMH was present in 27.7% of patients and in 14.6% of healthy controls. Diagnosis of epilepsy was independently associated with the presence of WMH (ß=3.09, 95%CI 1.06-9.0, p=0.039). Patients with focal epilepsy had higher prevalence of WMH (35.5%) than patients with generalized epilepsy (14.7%). The presence of WMH was associated with older age but not with seizure characteristics. Conclusions: WMH is more common in patients with focal epilepsy than healthy controls. The presence of WMH is associated with older age, but not with seizure characteristics.

RESUMO

Antecedentes: Embora a epilepsia seja principalmente conhecida como um distúrbio cortical, há um crescente corpo de pesquisas que demonstra alterações na substância branca em pacientes com epilepsia. Objetivo: Investigar a prevalência de hiperintensidades da substância branca (WMH) e sua associação com características das crises em pacientes com epilepsia. Métodos: A prevalência de WMH em 94 pacientes com epilepsia e 41 controles saudáveis foi comparada. Na amostra de pacientes, foi investigada a relação entre a presença de WMH e o tipo de epilepsia, a frequência das crises, a duração da doença e o número de medicamentos antiepilépticos. Resultados: A média de idade e o sexo não diferiram entre pacientes e controles saudáveis (p>0,2). WMH estava presente em 27,7% dos pacientes, enquanto em 14,6% dos controles saudáveis. O diagnóstico de epilepsia foi independentemente associado à presença de WMH (ß=3,09, IC95% 1,06-9,0, p=0,039). Pacientes com epilepsia focal apresentaram maior prevalência de WMH (35,5%) do que pacientes com epilepsia generalizada (14,7%). A presença de WMH foi associada à idade avançada, mas não a características das crises. Conclusões: Pacientes com epilepsia focal têm WMH mais comum do que controles saudáveis. A presença de WMH está associada à idade avançada, mas não a características das crises epilépticas.

Keywords:

Epilepsy - White Matter - Epilepsies, Partial - Epilepsy, Generalized

Palavras-chave:

Epilepsia - Substância Branca - Epilepsias Parciais - Epilepsia Generalizada

Authors’ contributions:

FİU: designed, directed, and coordinated the study, analyzed data and wrote the paper; EÇ: acquisition of clinical and MRI data; İY: performed radiologic analyses; AA, MK: data interpretation, revising the article.




Publication History

Received: 12 January 2021

Accepted: 30 April 2021

Article published online:
07 June 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Ngugi AK, Bottomley C, Kleinschmidt I, Sander JW, Newton CR. Estimation of the burden of active and life-time epilepsy: a meta-analytic approach. Epilepsia. 2010 May;51(5):883-90. https://doi.org/10.1111/j.1528-1167.2009.02481.x
  • 2 Disease GBD, Injury I, Prevalence C. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016 Oct;388(10053):1545-602. https://doi.org/10.1016/S0140-6736(16)31678-6
  • 3 Scheffer IE, Berkovic S, Capovilla G, Connolly MB, French J, Guilhoto L, et al. ILAE classification of the epilepsies: position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017 Apr;58(4):512-21. https://doi.org/10.1111/epi.13709
  • 4 Crocker CE, Pohlmann-Eden B, Schmidt MH. Role of neuroimaging in first seizure diagnosis. Seizure. 2017 Jul;49:74-8. https://doi.org/10.1016/j.seizure.2016.05.015
  • 5 Hakami T, McIntosh A, Todaro M, Lui E, Yerra R, Tan KM, et al. MRI-identified pathology in adults with new-onset seizures. Neurology. 2013 Sep;81(10):920-7. https://doi.org/10.1212/WNL.0b013e3182a35193
  • 6 Olszewska DA, Costello DJ. Assessment of the usefulness of magnetic resonance brain imaging in patients presenting with acute seizures. Ir J Med Sci. 2014 Dec;183(4):621-4. https://doi.org/10.1007/s11845-013-1061-4
  • 7 Kramer MA, Cash SS. Epilepsy as a disorder of cortical network organization. Neuroscientist. 2012 Aug;18(4):360-72. https://doi.org/10.1177/1073858411422754
  • 8 Deleo F, Thom M, Concha L, Bernasconi A, Bernhardt BC, Bernasconi N. Histological and MRI markers of white matter damage in focal epilepsy. Epilepsy Res. 2018 Feb;140:29-38. https://doi.org/10.1016/j.eplepsyres.2017.11.010
  • 9 Hatton SN, Huynh KH, Bonilha L, Abela E, Alhusaini S, Altmann A, et al. White matter abnormalities across different epilepsy syndromes in adults: an ENIGMA-Epilepsy study. Brain. 2020 Aug;143(8):2454-73. https://doi.org/10.1093/brain/awaa200
  • 10 Buksakowska I, Szabó N, Martinkovič L, Faragó P, Király A, Vrána J, et al. Distinctive patterns of seizure-related white matter alterations in right and left temporal lobe epilepsy. Front Neurol. 2019;10:986. https://doi.org/10.3389/fneur.2019.00986
  • 11 Gong J, Chang X, Jiang S, Klugah-Brown B, Tan S, Yao D, et al. Microstructural alterations of white matter in juvenile myoclonic epilepsy. Epilepsy Res. 2017 Sep;135:1-8. https://doi.org/10.1016/j.eplepsyres.2017.04.002
  • 12 Focke NK, Yogarajah M, Bonelli SB, Bartlett PA, Symms MR, Duncan JS. Voxel-based diffusion tensor imaging in patients with mesial temporal lobe epilepsy and hippocampal sclerosis. Neuroimage. 2008 Apr;40(2):728-37. https://doi.org/10.1016/j.neuroimage.2007.12.031
  • 13 Lee CY, Tabesh A, Spampinato MV, Helpern JA, Jensen JH, Bonilha L. Diffusional kurtosis imaging reveals a distinctive pattern of microstructural alternations in idiopathic generalized epilepsy. Acta Neurol Scand. 2014 Sep;130(3):148-55. https://doi.org/10.1111/ane.12257
  • 14 Weidauer S, Nichtweiss M, Hattingen E. Differential diagnosis of white matter lesions: Nonvascular causes-Part II. Clin Neuroradiol. 2014 Jun;24(2):93-110. https://doi.org/10.1007/s00062-013-0267-1
  • 15 Porter A, Gladstone JP, Dodick DW. Migraine and white matter hyperintensities. Curr Pain Headache Rep. 2005 Aug;9(4):289-93. https://doi.org/10.1007/s11916-005-0039-y
  • 16 Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M, et al. A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke. 2001 Jun;32(6):1318-22. https://doi.org/10.1161/01.str.32.6.1318
  • 17 Wardlaw JM, Smith EE, Biessels GJ, Cordonnier C, Fazekas F, Frayne R, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol. 2013 Aug;12(8):822-38. https://doi.org/10.1016/S1474-4422(13)70124-8
  • 18 Hopkins RO, Beck CJ, Burnett DL, Weaver LK, Victoroff J, Bigler ED. Prevalence of white matter hyperintensities in a young healthy population. J Neuroimaging. 2006 Jul;16(3):243-51. https://doi.org/10.1111/j.1552-6569.2006.00047.x
  • 19 Mao YT, Goh E, Churilov L, McIntosh A, Ren YF, O’Brien TJ, et al. White matter hyperintensities on brain magnetic resonance imaging in people with epilepsy: a hospital-based study. CNS Neurosci Ther. 2016 Sep; 22(9): 758-63. https://doi.org/10.1111/cns.12571
  • 20 Labate A, Cherubini A, Tripepi G, Mumoli L, Ferlazzo E, Aguglia U, et al. White matter abnormalities differentiate severe from benign temporal lobe epilepsy. Epilepsia. 2015 Jul;56(7):1109-16. https://doi.org/10.1111/epi.13027
  • 21 Szaflarski JP, Lee S, Allendorfer JB, Gaston TE, Knowlton RC, Pati S, et al. White matter abnormalities in patients with treatment-resistant genetic generalized epilepsies. Med Sci Monit. 2016 Jun;22:1966-75. https://doi.org/10.12659/msm.897002
  • 22 Hatton SN, Huynh KH, Bonilha L, Abela E, Alhusaini S, Altmann A, et al. White matter abnormalities across different epilepsy syndromes in adults: an ENIGMA-Epilepsy study. Brain. 2020 Aug;143(8):2454-73. https://doi.org/10.1093/brain/awaa200
  • 23 Owen TW, de Tisi J, Vos SB, Winston GP, Duncan JS, Wang Y, et al. Multivariate white matter alterations are associated with epilepsy duration. Eur J Neurosci. 2021 Apr;53(8):2788-803. https://doi.org/10.1111/ejn.15055
  • 24 de Groot M, Verhaaren BF, de Boer R, Klein S, Hofman A, van der Lugt A, et al. Changes in normal-appearing white matter precede development of white matter lesions. Stroke. 2013 Apr;44(4):1037-42. https://doi.org/10.1161/STROKEAHA.112.680223
  • 25 Johnson EL, Krauss GL, Lee AK, Schneider AL, Kucharska-Newton AM, Huang J, et al. Association between white matter hyperintensities, cortical volumes, and late-onset epilepsy. Neurology. 2019 Feb;92(9):e988-e995. https://doi.org/10.1212/WNL.20210003202100037010
  • 26 Sarkis RA, Willment KC, Pennell PB, Marshall G. Late-onset unexplained epilepsy: What are we missing? Epilepsy Behav. 2019 Oct;99:106478. https://doi.org/10.1016/j.yebeh.2019.106478