The impact of white matter lesions on seizure recurrence after first epileptic seizures in the elderly: a prospective study.

Q2 Medicine
Jenny Weil, Louise Linka, Mariana Gurschi, Seyyid Abdulkerim Kidik, Alena Fuchs, Rebecca Schoenfeldt, Felix Zahnert, Leona Möller, Katja Menzler, André Kemmling, Susanne Knake, Lena Habermehl
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引用次数: 0

Abstract

Background: Despite considerable previous research, to what degree white matter lesions (WML) may be epileptogenic remains unclear. Therefore, the decision of initiating treatment with antiseizure medication (ASM) can be challenging in patients with only WML on neuroimaging. In this prospective study we assessed whether the prevalence, localization or severity of WML impact the risk of seizure recurrence in patients aged 60 years or older after first-time seizures.

Methods: Data was analyzed from 168 patients, aged ≥ 60 years-old who had experienced a previous unprovoked seizure and had either a potentially epileptogenic lesion or WML on neuroimaging. The frequency of seizure recurrence was documented after 6, 12, and 24 months. Pearson´s chi-square test of independence (categorical variables) and the independent Student´s t-test (continuous variables) were used to analyze intergroup differences. Binary logistic regressions were calculated to examine the influence of WML locations as a predictor of seizure recurrence. Kaplan-Meier survival analyses and log-rank statistics were performed to determine the cumulative recurrence rates between the groups.

Results: Fifteen patients had only potentially epileptogenic lesions on neuroimaging (EPI) and 93 showed WML only (OWML). Sixty patients showed both of them on neuroimaging (EWML). Frontal and parieto-occipital were the predominant WML locations. Neither severity nor location of WML had a significant impact on recurrence rates. The two-year cumulative probability of becoming seizure-free was significantly lower in the EPI group compared to the EWML (χ2 [1] = 4.425, p = 0.035) and the OWML group (χ2 [1] = 13.094, p < 0.001). A significant association between interictal epileptiform discharges in EEG and seizure recurrence was found in OWML patients (p = 0.004).

Conclusion: We could not find any association between prevalence, severity or location of WML and seizure recurrence after first seizures in the elderly. Therefore, treatment with ASM should be started with caution in those patients. Our results show a trend of WML not having epileptogenic potential, but further studies are needed to get better evidence.

Trial registration: ClinicalTrials.gov Protocol Registration and Results, NCT06836687, AZ 199/17, release: 03/19/2024 retrospectively registered. https://register.

Clinicaltrials: gov/prs/beta/studies/S000EBC700000025/recordSummary.

老年人首次癫痫发作后白质病变对癫痫复发的影响:一项前瞻性研究。
背景:尽管之前有大量的研究,但白质病变(WML)在多大程度上可能是癫痫性的仍不清楚。因此,在神经影像学上只有WML的患者中,决定开始使用抗癫痫药物(ASM)治疗是具有挑战性的。在这项前瞻性研究中,我们评估了WML的患病率、定位或严重程度是否会影响60岁及以上患者首次癫痫发作后癫痫复发的风险。方法:对168例患者的数据进行分析,这些患者年龄≥60岁,既往有过非诱发性癫痫发作,神经影像学上有潜在的癫痫性病变或WML。在6个月、12个月和24个月后记录癫痫发作的复发频率。采用Pearson独立卡方检验(分类变量)和独立Student t检验(连续变量)分析组间差异。计算二元逻辑回归来检验WML位置作为癫痫复发预测因子的影响。采用Kaplan-Meier生存分析和log-rank统计来确定两组间的累积复发率。结果:15例患者在神经影像学(EPI)上仅表现为潜在癫痫性病变,93例仅表现为WML。60例患者在神经影像学(EWML)上同时出现两种症状。额部和顶枕部是WML的主要部位。WML的严重程度和部位对复发率均无显著影响。EPI组2年累计无癫痫发作概率显著低于EWML组(χ2 [1] = 4.425, p = 0.035)和OWML组(χ2 [1] = 13.094, p)。结论:老年人WML的患病率、严重程度、发病部位与首次发作后癫痫复发无相关性。因此,在这些患者开始ASM治疗时应谨慎。我们的结果显示WML有不具有致痫潜能的趋势,但需要进一步的研究来获得更好的证据。试验注册:ClinicalTrials.gov方案注册和结果,NCT06836687, AZ 199/17,发布:03/19/2024回顾性注册。https://register.Clinicaltrials: gov / prs /测试/研究/ S000EBC700000025 / recordSummary。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.40
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0.00%
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审稿时长
14 weeks
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