title: Late-onset epilepsy and occult cerebrovascular disease.
abstract: The interface between cerebrovascular disease (CVD) and epilepsy is complex and multifaceted. Late-onset epilepsy (LOE) is increasingly common and is often attributed to CVD, and is indeed associated with an increased risk of stroke. This relationship is easily recognizable where there is a history of stroke, particularly involving the cerebral cortex. However, the relationship with otherwise occult, subcortical CVD is currently less well established yet causality is often invoked. In this review, we consider the diagnosis of LOE in clinical practice--including its behaviour as a potential mimic of acute ischemic stroke and transient ischemic attack; evidence for an association between occult CVD and LOE; and potential mechanisms of epileptogenesis in occult CVD, including potential interrelationships between disordered cerebral metabolism and perfusion, disrupted neurovascular unit integrity, blood-brain barrier dysfunction, and inflammation. We also discuss recently recognized issues concerning antiepileptic drug treatment and vascular risk and consider a variety of less common CVD entities associated with seizures.
authors: Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.
authors: Lorna M
authors: LM
authors: Gibson
authors: University of Leicester, UK.
authors: Martha F
authors: MF
authors: Hanby
authors: 1] Department of Neurology, Royal Preston Hospital, Preston, UK [2] University of Manchester, Manchester, UK.
authors: Sarah M
authors: SM
authors: Al-Bachari
authors: Biomedical Imaging Institute, University of Manchester, Manchester, UK.
authors: Laura M
authors: LM
authors: Parkes
authors: Faculty of Life Sciences, University of Manchester, Manchester, UK.
authors: Stuart M
authors: SM
authors: Allan
authors: 1] Department of Neurology, Royal Preston Hospital, Preston, UK [2] School of Medicine, University of Manchester, Manchester, UK.
authors: Hedley C A
authors: HC
authors: Emsley
mesh_terms: D017668:Age of Onset; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000187:drug effects / Q000378:metabolism / Q000473:pathology; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D004827:Epilepsy / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D015995:Prevalence; D012307:Risk Factors; D014057:Tomography, X-Ray Computed