Jul 2026· Clinical EEG and Neuroscience· pp.
15500594261465502
· 0 citations· 19 references
Medicine
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.
Background: Migraine is a common neurological disorder characterized by recurrent headaches that significantly affect quality of life and daily functioning. Brain magnetic resonance imaging (MRI) often demonstrates white matter hyperintensities (WMHs), but their clinical significance remains uncertain. Therefore, this study was conducted to determine the frequency and radiological characteristics of WMHs on MRI in patients with migraine.
Methods: This descriptive cross-sectional study was conducted at Pak Emirates Military Hospital, Rawalpindi. A total of 400 patients aged 18–60 years with migraine diagnosed according to the International Classification of Headache Disorders, 3rd edition (ICHD-3), were included through non-probability consecutive sampling. Brain MRI was performed using T2-weighted and fluid-attenuated inversion recovery (FLAIR) sequences. Associations were evaluated using the Chi-square test, and multivariable binary logistic regression analysis was performed to identify independent predictors of WMHs. Data were analyzed using SPSS version 28.
Results: WMHs were significantly more frequent in patients aged >40 years (p<0.001), those with chronic migraine (p=0.01), and those with a migraine duration >5 years (p=0.003). Binary logistic regression demonstrated that age >40 years, chronic migraine, and migraine duration >5 years were independent predictors of WMHs, whereas gender, migraine aura, hypertension, and diabetes mellitus were not independently associated.
Conclusion: WMHs are common MRI findings in patients with migraine, particularly in older patients and those with chronic or long-standing disease. Most lesions are small, mild, and predominantly involve the frontal and deep white matter. These findings may improve the interpretation of MRI findings and contribute to a better understanding of migraine-related brain changes.
Aqeela, K. Nawaz, Sania Saeed et al.· International journal of pat...· 0 citations
Objectives Although MRI is the optimal imaging method for assessing white matter hyperintensity (WMH), it lacks sensitivity to the underlying pathophysiological changes of WMH. This study aims to investigate EEG changes associated with WMH and identify potential EEG biomarkers for WMH-related dementia. Methods This cross-sectional study enrolled 90 subjects: 30 patients with WMH with dementia (WMHD), 30 patients with WMH without dementia (WMH-ND), and 30 age-and sex-matched healthy controls. Brain MRI was used to segment and quantify deep, periventricular, and total WMH volumes (DWMH, PVWMH, TWMH). Resting-state EEG data were recorded for microstate analysis. Four microstate classes (A, B, C, D) were extracted, and their occurrence, mean duration, time coverage, and transition probabilities were calculated. Partial correlation analysis was used to evaluate the associations between microstate features and WMH volume as well as MMSE scores. Based on microstate features, classification prediction models were constructed using machine learning algorithm. Results In the WMHD group, the temporal parameters (occurrence, mean duration, time coverage) of microstate C were decreased (P < 0.05–0.001), while the mean duration of microstates A and B was prolonged (P < 0.05–0.001). The WMH-ND group also showed reduced microstate C temporal parameters (P < 0.001), but exhibited compensatory increases in mean duration and time coverage of microstate D (P < 0.001). Transition probabilities toward microstate C were reduced in both patient groups (P < 0.001), and all transition probabilities toward microstate D were lower in WMHD than in WMH-ND (P < 0.05–0.001). Temporal parameters of microstates A and B and transition probabilities toward them were positively correlated with WMH volume and negatively correlated with MMSE score. Conversely, those of microstate D showed the opposite correlations. For distinguishing WMHD from WMH-ND, support vector machine (SVM) and logistic regression (LR) performed best (accuracy: 76.67%, AUC: 0.84). Classification performance was highest for WMH-ND vs. HC (LR: 79.17%, AUC 0.86), and lowest for WMHD vs. HC (SVM: 68.33%, AUC 0.77). Conclusion Patients with WMH exhibit alterations in EEG microstate features that are significantly correlated with WMH burden and cognitive function. Classification models based on these microstate features show promise for practical application in WMH-related dementia.
Kaiyan Feng, Jiaxin Cai, Jian-Ming Lei et al.· Frontiers in Neuroscience· 0 citations
Introduction Migraine is ranked as the third most common and second most disabling neurological disorder worldwide. Neuroimaging studies demonstrate higher white matter lesion (WML) prevalence in migraineurs, with a meta-analysis reporting a 44% pooled prevalence. In the UAE, migraine affects 18.2% of healthcare professionals, but WML prevalence remains unstudied. This study investigates WML prevalence and clinical correlates in UAE migraine patients. Methods This retrospective study included 313 migraine patients aged 10–50 years who underwent brain MRI at HMS Mirdif Hospital (2022–2025). MRI scans (3T, T2/FLAIR) were assessed by three trained doctors supervised by a radiologist. Demographic, clinical, and MRI data were collected from electronic records. Non-parametric tests and binary logistic regression were used (p < 0.05). Results A total of 313 migraine patients (median age 32 years, 73.8% female) were included. White matter lesions were identified in 35.5% (n = 111), with a median of 4 lesions (IQR: 2–10). Lesions were predominantly frontal (86.5%), bilateral (70.3%), and cortical–subcortical (94.6%). Age was the only significant predictor of WML presence (OR = 1.038, p = 0.003), but did not correlate with lesion number among affected patients. Conclusion This study found white matter lesions in 35.5% of migraine patients, predominantly affecting frontal and cortical–subcortical regions. Age was the strongest predictor of lesion presence but did not correlate with lesion number. Why WMLs develop in some patients but not others remain unclear. The retrospective single-center design, potential selection bias, limited generalizability, and lack of an age- and sex-matched control group warrant cautious interpretation and underscore the need for prospective studies.
N. Akkawi, Elkhansa Hassabo Mohamed, Marwa Suliman et al.· Frontiers in Neurology· 0 citations
The association between b-WMHs and stroke remained significant after adjustment for age, sex, and supratentorial WMHs (s‑WMHs), but lost statistical significance when additional vascular risk factors were included.
Hüseyin Nezih Özdemir, E. Kumral, G. Baskan et al.· Turkish Journal of Cerebrova...· 0 citations
SCSs are present in approximately one quarter of presurgical epilepsy patients and show moderate concordance with CS and IED localization and their distinct localization profile and frequent containment within CS zones support their value as complementary information in epilepsy care.
L. Lankhuijzen, Monique Cloherty, J. Winston et al.· Frontiers in Neurology· 0 citations
The AEP 3-T MRI research protocol is feasible at multisite national scale, and sensitive for detection of subtle lesions when read by neuroradiologists with expertise in epilepsy.
David N. Vaughan, David F. Abbott, Amanda Anderson et al.· Epilepsia· 0 citations
