Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Department of Neurology, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Ann Clin Transl Neurol. 2024 Feb;11(2):342-354. doi: 10.1002/acn3.51955. Epub 2023 Dec 28.
To determine the association between brain MRI abnormalities and incident epilepsy in older adults.
Men and women (ages 45-64 years) from the Atherosclerosis Risk in Communities study were followed up from 1987 to 2018 with brain MRI performed between 2011 and 2013. We identified cases of incident late-onset epilepsy (LOE) with onset of seizures occurring after the acquisition of brain MRI. We evaluated the relative pattern of cortical thickness, subcortical volume, and white matter integrity among participants with incident LOE after MRI in comparison with participants without seizures. We examined the association between MRI abnormalities and incident LOE using Cox proportional hazards regression. Models were adjusted for demographics, hypertension, diabetes, smoking, stroke, and dementia status.
Among 1251 participants with brain MRI data, 27 (2.2%) developed LOE after MRI over a median of 6.4 years (25-75 percentile 5.8-6.9) of follow-up. Participants with incident LOE after MRI had higher levels of cortical thinning and white matter microstructural abnormalities before seizure onset compared to those without seizures. In longitudinal analyses, greater number of abnormalities was associated with incident LOE after controlling for demographic factors, risk factors for cardiovascular disease, stroke, and dementia (gray matter: hazard ratio [HR]: 2.3, 95% confidence interval [CI]: 1.0-4.9; white matter diffusivity: HR: 3.0, 95% CI: 1.2-7.3).
This study demonstrates considerable gray and white matter pathology among individuals with LOE, which is present prior to the onset of seizures and provides important insights into the role of neurodegeneration, both of gray and white matter, and the risk of LOE.
确定大脑 MRI 异常与老年人癫痫发作的关系。
动脉粥样硬化风险社区研究中的男性和女性（年龄 45-64 岁）从 1987 年随访至 2018 年，在 2011 年至 2013 年之间进行了脑部 MRI 检查。我们确定了在 MRI 检查后出现迟发性癫痫发作（LOE）的病例。我们评估了 MRI 检查后出现 LOE 的参与者与未发生癫痫发作的参与者之间皮质厚度、皮质下体积和白质完整性的相对模式。我们使用 Cox 比例风险回归分析评估 MRI 异常与 LOE 之间的关联。模型调整了人口统计学因素、高血压、糖尿病、吸烟、中风和痴呆状态。
在 1251 名有脑部 MRI 数据的参与者中，有 27 名（2.2%）在 MRI 检查后出现 LOE，MRI 检查后中位随访时间为 6.4 年（25-75%分位数 5.8-6.9）。与无癫痫发作的参与者相比，MRI 检查后出现 LOE 的参与者在癫痫发作前有更高水平的皮质变薄和白质微观结构异常。在纵向分析中，在校正了人口统计学因素、心血管疾病危险因素、中风和痴呆后，异常数量越多与 LOE 后发生的 LOE 相关（灰质：风险比 [HR]：2.3，95%置信区间 [CI]：1.0-4.9；白质弥散率：HR：3.0，95% CI：1.2-7.3）。
本研究表明，LOE 患者存在大量的灰质和白质病理学，这些病理学在癫痫发作前就存在，为神经退行性变，包括灰质和白质，以及 LOE 的风险提供了重要的见解。
