ALTERATIONS IN STRUCTURAL AND HAEMODYNAMIC CEREBROVASCULAR MEASURES IN LATE ONSET EPILEPSY

Epileptic seizure as a precipitating factor of vascular progressive supranuclear palsy: a case report

BACKGROUND

Vascular progressive supranuclear palsy (vPSP) is an uncommon akinetic-rigid syndrome characterized by asymmetric lower body involvement, predominant corticospinal and pseudobulbar signs, urinary incontinence, cognitive impairment, and increased frequency of stroke risk factors, together with neuroimaging evidence of vascular disease.

CASE REPORT

We report a case of a patient with a PSP-like phenotype and marked cognitive impairment who significantly worsened after a generalized epileptic seizure that occurred a few months after its clinical onset.

RESULTS

Signs of widespread ischemic subcortical vascular disease, together with atrophy of the midbrain tectum, corpus callosum, and cerebral cortex, were evident on brain magnetic resonance imaging.

CONCLUSIONS

vPSP is a condition that should be considered when a patient presents with a gradually progressive clinical picture suggestive of idiopathic PSP associated with neuroimaging evidence of cerebrovascular disease. The occurrence of epileptic seizures has not been reported before in vPSP but they might trigger the onset or precipitate the course of the PSP-like disorders.

Late-onset seizures and risk of subsequent stroke: a systematic review

Otherwise unexplained late-onset seizures, conventionally defined as epileptic seizures occurring in subjects older than 60years and in the absence of disorders known to increase the risk of developing epilepsy, have been assumed to be, in most cases, of cerebrovascular origin. We systematically searched the literature to identify the evidence supporting the association between otherwise unexplained late-onset seizures/epilepsy and the risk of subsequent stroke. Most data from the literature indicate that cerebrovascular disease often underlies otherwise unexplained late-onset seizures/epilepsy. Patients presenting with seizures occurring for the very first time in late life and without clinically overt cerebrovascular disease should be considered as at increased risk of stroke. Consequently, these patients should be screened for the presence of vascular risk factors and treated accordingly. Such measures may greatly contribute to prevent strokes in these patients.