Cerebral small vessel disease burden in late-onset epilepsy of unknown aetiology: insights from a prospective multicenter cohort
Abstract
BACKGROUND: Late-onset epilepsy of unknown aetiology (LOEU) represents a prevalent and often disabling neurological disorder. Existing studies indicate that cerebral small vessel disease (cSVD) may play a significant role in the pathogenesis of epilepsy within this population; however, prospective investigations are currently lacking. We aimed to systematically describe the burden and qualitative aspects of cSVD in a LOEU population. METHODS: Patients with LOEU were prospectively included across three university hospitals (Nancy, Lille and Reims, France). Patients were systematically assessed for clinical, cardiovascular, neurophysiological (EEG, polygraphy/polysomnography), neuropsychological, and radiological features (brain MRI and FDG-PET). cSVD was assessed using MRI only. A composite score evaluating WMH, microbleeds, EPVS, and lacunar infarcts was used. Moderate-to-severe cSVD was defined as a score of 2 4. RESULTS: A total of 55 patients were enrolled, predominantly male (63.6%), with a median age of 71yo (IQR 12.7) and multiple cardiovascular risk factors. Moderate-to severe cSVD was infrequent in this cohort (23.6%). No significant association was observed between cSVD score and epilepsy characteristics. Objective cognitive impairment was prevalent but was not associated with a higher burden of cSVD. Multivariate logistic regression identified advanced age as the sole significant factor associated with moderate-to-severe cSVD. CONCLUSION: In this thoroughly characterized cohort, moderate-to-severe cSVD was infrequent, with age identified as the sole risk factor. These findings support the hypothesis that cSVD may serve as a biomarker of brain aging. Further research is required to substantiate these results.
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BibTeX
@article{hologne2026cerebral,
title = {{Cerebral small vessel disease burden in late-onset epilepsy of unknown aetiology: insights from a prospective multicenter cohort}},
author = {Emmanuelle Hologne and Floriane Machet and Salomé Puisieux and Dimitri Papathanassiou and Claire Launois and Ruben Wanono and Victoire Martin and Antoine Verger and Yaohua Chen and Louise Tyvaert and Solène Moulin},
journal = {Seizure - European Journal of Epilepsy},
year = {2026},
month = sep,
doi = {10.1016/j.seizure.2026.09.007},
url = {https://hal.science/hal-05753412v1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Cerebral small vessel disease burden in late-onset epilepsy of unknown aetiology: insights from a prospective multicenter cohort
AU - Emmanuelle Hologne
AU - Floriane Machet
AU - Salomé Puisieux
AU - Dimitri Papathanassiou
AU - Claire Launois
AU - Ruben Wanono
AU - Victoire Martin
AU - Antoine Verger
AU - Yaohua Chen
AU - Louise Tyvaert
AU - Solène Moulin
PY - 2026
DA - 2026/09/17
JO - Seizure - European Journal of Epilepsy
DO - 10.1016/j.seizure.2026.09.007
UR - https://hal.science/hal-05753412v1
AB - BACKGROUND: Late-onset epilepsy of unknown aetiology (LOEU) represents a prevalent and often disabling neurological disorder. Existing studies indicate that cerebral small vessel disease (cSVD) may play a significant role in the pathogenesis of epilepsy within this population; however, prospective investigations are currently lacking. We aimed to systematically describe the burden and qualitative aspects of cSVD in a LOEU population. METHODS: Patients with LOEU were prospectively included across three university hospitals (Nancy, Lille and Reims, France). Patients were systematically assessed for clinical, cardiovascular, neurophysiological (EEG, polygraphy/polysomnography), neuropsychological, and radiological features (brain MRI and FDG-PET). cSVD was assessed using MRI only. A composite score evaluating WMH, microbleeds, EPVS, and lacunar infarcts was used. Moderate-to-severe cSVD was defined as a score of 2 4. RESULTS: A total of 55 patients were enrolled, predominantly male (63.6%), with a median age of 71yo (IQR 12.7) and multiple cardiovascular risk factors. Moderate-to severe cSVD was infrequent in this cohort (23.6%). No significant association was observed between cSVD score and epilepsy characteristics. Objective cognitive impairment was prevalent but was not associated with a higher burden of cSVD. Multivariate logistic regression identified advanced age as the sole significant factor associated with moderate-to-severe cSVD. CONCLUSION: In this thoroughly characterized cohort, moderate-to-severe cSVD was infrequent, with age identified as the sole risk factor. These findings support the hypothesis that cSVD may serve as a biomarker of brain aging. Further research is required to substantiate these results.
SN - 1059-1311
ER -