title: Epilepsy associated with Leukoaraiosis mainly affects temporal lobe: a casual or causal relationship?
abstract: OBJECTIVE
  To compare anatomo-electro-clinical findings between patients with epilepsy associated with leukoaraiosis only (EAL) and patients with a well-defined vascular lesion, i.e. post-stroke epilepsy (PSE).
  
  
  METHODS
  Two hundred eighty-three subjects with epilepsy and cerebrovascular disease, consecutively seen in our epilepsy centres from January 2000 to March 2014, were retrospectively considered. Inclusion criteria were: history of one or more unprovoked seizures and MRI evidence of one or more vascular lesions. Exclusion criteria were: inadequate neuroimaging data, coexistence of nonvascular lesions, and psychogenic seizures. Subjects were divided in two groups: PSE and EAL, based onclinical and MRI findings. Epileptogenic focus was identified according to ictal semiology and EEG findings. In PSE group, coherence between the vascular lesion(s) and epileptogenic focus was scored as likely or unlikely.
  
  
  RESULTS
  One hundred seventeen subjects were included: 58 had PSE, 59 EAL. Coherence was identified as likely in 38 (95%) and unlikely in 2 (5%). At univariate analysis, abnormal EEG and frontal localization were associated with a lower EAL probability [odds ratio (OR) 0.36, 95% confidence interval (CI) 0.15-0.87, p=0.02 and OR 0.12, 95% CI 0.04-0.37, p<0.001, respectively], while temporal localization was associated with a higher EAL probability (OR 4.0, 95% CI 1.8-9.0, p<0.001). Multivariate confirmed these associations.
  
  
  CONCLUSIONS
  While in PSE epileptogenic focus is coherent with the vascular lesions, in EAL temporal lobe epilepsy predominates. In EAL, causal relationship between vascular lesions and epilepsy is not straightforward, and the role of adjunctive factors needs to be elucidated.
authors.affiliation: Magna Græcia University of Catanzaro, Regional Epilepsy Center, Via Melacrino, Reggio Calabria, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Gasparini
authors.affiliation: Magna Græcia University of Catanzaro, Regional Epilepsy Center, Via Melacrino, Reggio Calabria, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Ferlazzo
authors.affiliation: Laboratory of Neurological Disorders, "Mario Negri" Institute, Via G. La Masa 19, Milan, Italy.
authors.forename: Ettore
authors.initials: E
authors.lastname: Beghi
authors.affiliation: Department "GF.Ingrassia", Neurologic Clinic, University of Catania, Via S. Sofia 78, Catania, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Sofia
authors.affiliation: Neurologic Clinic, Magna Græcia University of Catanzaro, Viale Europa, Catanzaro, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Mumoli
authors.affiliation: Neurologic Clinic, Magna Græcia University of Catanzaro, Viale Europa, Catanzaro, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Labate
authors.affiliation: Magna Græcia University of Catanzaro, Regional Epilepsy Center, Via Melacrino, Reggio Calabria, Italy.
authors.forename: Vittoria
authors.initials: V
authors.lastname: Cianci
authors.affiliation: Department "GF.Ingrassia", Neurologic Clinic, University of Catania, Via S. Sofia 78, Catania, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Fatuzzo
authors.affiliation: Magna Græcia University of Catanzaro, Regional Epilepsy Center, Via Melacrino, Reggio Calabria, Italy.
authors.forename: Marina Angela
authors.initials: MA
authors.lastname: Bellavia
authors.affiliation: Stroke Unit Azienda Ospedaliera Bianchi Melacrino Morelli, Via Melacrino, Reggio Calabria, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Arcudi
authors.affiliation: Science of Health Department, School of Medicine, Magna Græcia University of Catanzaro, Viale Europa, Catanzaro, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Russo
authors.affiliation: Science of Health Department, School of Medicine, Magna Græcia University of Catanzaro, Viale Europa, Catanzaro, Italy.
authors.forename: Giovambattista
authors.initials: G
authors.lastname: De Sarro
authors.affiliation: Neurologic Clinic, Magna Græcia University of Catanzaro, Viale Europa, Catanzaro, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gambardella
authors.affiliation: Magna Græcia University of Catanzaro, Regional Epilepsy Center, Via Melacrino, Reggio Calabria, Italy. Electronic address: u.aguglia@tin.it.
authors.forename: Umberto
authors.initials: U
authors.lastname: Aguglia
mesh_terms: D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications* / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D049292:Leukoaraiosis / Q000150:complications* / Q000473:pathology / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D013702:Temporal Lobe / Q000473:pathology / Q000503:physiopathology*
keywords: Cerebrovascular disease; EEG; Leukoaraiosis; MRI; Seizures; Stroke