Branch atheromatous disease has a stronger association with late-onset epileptic seizures than lacunar infarction in Japanese patients.

Objective: To evaluate the relationship between late-onset epileptic seizures and non-cortical infarction (namely, lacunar infarction and branch atheromatous disease [BAD]) in Japanese patients. Methods: We reviewed the medical records and brain magnetic resonance imaging findings of all patients with ischemic stroke admitted to the Departments of Neurology, Neurosurgery, and Stroke Unit at Kurashiki Central Hospital from 1 January 2011 to 31 December 2012. Patients with lacunar infarction and BAD were enrolled; those with cortical and brain stem ischemic lesions were excluded. We analyzed the clinical features of patients who developed late-onset epileptic seizures after cerebral infarction. Results: Eighty-five patients with lacunar infarction and 99 patients with BAD were enrolled. Four patients with BAD subsequently developed epileptic seizures (2.2% of total patients, 4.0% of patients with BAD), whereas no patients with lacunar infarction developed epileptic seizures. All patients with epileptic seizures had infarction involving the basal ganglia or thalamus. Three of them had multiple cerebral microbleeds, and two had dementia. Conclusions: Patients with BAD, but not with lacunar infarction, might have a higher risk of developing epileptic seizures than the general population. Non-cortical infarctions with involvement of the basal ganglia or thalamus may increase the risk of subsequent late-onset epileptic seizures.