Risk Factors for White Matter Lesion Burden in Adults with Focal Epilepsy.
TL;DR
WMH are common in adults with focal epilepsy, and the frontal lobe is the most frequently affected region, and age, seizure duration, interictal epileptiform discharges, and seizure duration are independent risk factors for greater WMH burden.
Abstract
Objective
To identify factors associated with White matter hyperintensities burden in adults with focal epilepsy.
Methods
We conducted a retrospective review of 60 patients with focal epilepsy treated at the Second Affiliated Hospital of Xinjiang Medical University between October 2024 and October 2025. Patients were selected according to predefined inclusion and exclusion criteria. All patients underwent 17-h scalp video electroencephalography and 3 T brain magnetic resonance imaging (3D T1 and 3D FLAIR sequences, 1.0-mm slices). Clinical features were documented from caregiver-reported symptoms, video recordings, seizure frequency and duration during the preceding two months, and medical history. Seizure type and epilepsy classification were determined in a multidisciplinary conference in accordance with the 2017 International League Against Epilepsy guidelines. White matter hyperintensities (WMH) in the frontal, temporal, parietal, and occipital lobes and the periventricular region were scored using the modified Scheltens scale, and a total WMH score was calculated. Non-parametric tests were used to compare regional WMH scores. The total WMH score was categorized into four levels: 0 (score ≤1), 1 (score >1-5), 2 (score >5-10), and 3 (score ≥10). Univariate and multivariate ordinal logistic regression analyses were performed to identify risk factors associated with WMH burden.
Results
White matter hyperintensities were observed in 71.7% of patients. Lesions were predominantly located in the subcortical U-fibers and deep white matter, with fewer in the white matter adjacent to the cortex and in the corpus callosum. Frontal lobe WMH scores were significantly higher than temporal and occipital scores (P < 0.05). Most WMH were smaller than 3 mm in diameter(58%), whereas larger lesions were uncommon(42%). In multivariate analysis, age (OR = 1.60, 95% CI 1.01-1.10), seizure duration (OR = 1.06, 95% CI 1.13-2.24), and the presence of interictal epileptiform discharges (OR = 5.83, 95% CI 1.71-19.87) were independently associated with greater WMH burden. After adjustment for age, seizure duration, interictal epileptiform discharges, and a seizure frequency exceeding once per day were identified as independent risk factors for WMH burden.
Conclusion
WMH are common in adults with focal epilepsy, and the frontal lobe is the most frequently affected region. Age, interictal epileptiform discharges, and seizure duration are independent risk factors for greater WMH burden. WMH may serve as an imaging marker for clinical seizure severity.