Lancaster Medical School, Lancaster University, Lancaster, UK; Department of Neurology, Royal Preston Hospital, Preston, UK.
Lancaster Medical School, Lancaster University, Lancaster, UK; Department of Psychiatry, University of Toronto, Toronto, Canada.
Epilepsy Behav. 2021 Feb;115:107634. doi: 10.1016/j.yebeh.2020.107634. Epub 2020 Dec 15.
Late-onset epilepsy (LOE) is closely associated with cerebrovascular disease, acting as both a marker of cerebrovascular disease (CVD) and occurring as a direct consequence. Despite this, our understanding of LOE as a cerebrovascular phenomenon is in its infancy. LOE also appears to be a harbinger of dementia.
A systematic review was performed to identify publications relating to LOE and identified observational studies, clinical studies, and radiological studies.
A meta-analysis of observational studies demonstrated that patients presenting with LOE experience an increased risk of subsequent stroke (weighted OR 3.88 (95% CI 2.76-5.46)). The additional studies demonstrated clinical and radiological evidence to support the premise that LOE is likely to reflect underlying cerebrovascular disease.
Cerebrovascular disease risk factors convey increased risk of LOE and LOE can precede stroke and dementia, acting as an early marker for cerebrovascular risk. This may represent a potential point for intervention. There are a number of suggested mechanisms relating LOE to stroke; however, there is limited understanding of the natural history of LOE. Current data support the need for prospective research in order to understand the natural history of LOE and modify disease, in order to reduce the apparent sequelae of stroke and dementia.
迟发性癫痫（LOE）与脑血管疾病密切相关，既是脑血管疾病（CVD）的标志物，也是其直接后果。尽管如此，我们对 LOE 作为一种脑血管现象的理解还处于起步阶段。LOE 似乎也是痴呆的先兆。
进行了系统评价，以确定与 LOE 相关的出版物，并确定了观察性研究、临床研究和影像学研究。
对观察性研究的荟萃分析表明，出现 LOE 的患者随后发生中风的风险增加（加权 OR 3.88（95% CI 2.76-5.46））。其他研究提供了临床和影像学证据，支持 LOE 可能反映潜在脑血管疾病的前提。
脑血管病危险因素增加 LOE 的风险，LOE 可先于中风和痴呆发生，作为脑血管风险的早期标志物。这可能代表了一个潜在的干预点。有许多与 LOE 相关的中风机制，但对 LOE 的自然史了解有限。目前的数据支持需要进行前瞻性研究，以了解 LOE 的自然史并改变疾病，以减少中风和痴呆的明显后遗症。
