*Result*: Enlarged perivascular spaces in the basal ganglia across epilepsy subtypes.
Title:
Enlarged perivascular spaces in the basal ganglia across epilepsy subtypes.
Authors:
Sinclair B; Department of Neuroscience, School of Translational Medicine, Alfred Hospital, Monash University, Melbourne, Australia., Yasuda CL; Department of Neurology and Neuroimaging Laboratory, University of Campinas, Campinas, Brazil., Nicolo JP; Department of Neuroscience, School of Translational Medicine, Alfred Hospital, Monash University, Melbourne, Australia., Hlauschek G; Department of Neuroscience, School of Translational Medicine, Alfred Hospital, Monash University, Melbourne, Australia.; Division of Clinical Neuroscience, National Center for Epilepsy, Oslo University Hospital, University of Oslo, Oslo, Norway.; Department of Neurology, Section of Clinical Neurophysiology, Oslo University Hospital, Oslo, Norway., Bezerra TMS; Department of Neurology and Neuroimaging Laboratory, University of Campinas, Campinas, Brazil., Chen Z; Department of Neuroscience, School of Translational Medicine, Alfred Hospital, Monash University, Melbourne, Australia., Vivash L; Department of Neuroscience, School of Translational Medicine, Alfred Hospital, Monash University, Melbourne, Australia., de Campos BM; Department of Neurology and Neuroimaging Laboratory, University of Campinas, Campinas, Brazil., João RB; Department of Neurology and Neuroimaging Laboratory, University of Campinas, Campinas, Brazil., Brioschi R; Department of Neurology and Neuroimaging Laboratory, University of Campinas, Campinas, Brazil., Scardua-Silva L; Department of Neurology and Neuroimaging Laboratory, University of Campinas, Campinas, Brazil., Nogueira MH; Department of Neurology and Neuroimaging Laboratory, University of Campinas, Campinas, Brazil., Alvim MKM; Department of Neurology and Neuroimaging Laboratory, University of Campinas, Campinas, Brazil., Kwan P; Department of Neuroscience, School of Translational Medicine, Alfred Hospital, Monash University, Melbourne, Australia., Cendes F; Department of Neurology and Neuroimaging Laboratory, University of Campinas, Campinas, Brazil., O'Brien TJ; Department of Neuroscience, School of Translational Medicine, Alfred Hospital, Monash University, Melbourne, Australia., Law M; Department of Neuroscience, School of Translational Medicine, Alfred Hospital, Monash University, Melbourne, Australia.
Source:
Epilepsia [Epilepsia] 2026 Feb; Vol. 67 (2), pp. 815-829. Date of Electronic Publication: 2025 Oct 29.
Publication Type:
Journal Article
Language:
English
Journal Info:
Publisher: Blackwell Science Country of Publication: United States NLM ID: 2983306R Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1528-1167 (Electronic) Linking ISSN: 00139580 NLM ISO Abbreviation: Epilepsia Subsets: MEDLINE
Imprint Name(s):
Publication: Malden, MA : Blackwell Science
Original Publication: Copenhagen : Munskgaard
Original Publication: Copenhagen : Munskgaard
MeSH Terms:
Glymphatic System*/diagnostic imaging , Glymphatic System*/pathology , Basal Ganglia*/diagnostic imaging , Basal Ganglia*/pathology , Epilepsy*/diagnostic imaging , Epilepsy*/pathology , Epilepsy*/classification, Epilepsy, Temporal Lobe/diagnostic imaging ; Epilepsy, Temporal Lobe/pathology ; White Matter/diagnostic imaging ; White Matter/pathology ; Epilepsy, Generalized/diagnostic imaging ; Epilepsy, Generalized/pathology ; Humans ; Male ; Female ; Adult ; Magnetic Resonance Imaging ; Middle Aged ; Young Adult ; Adolescent
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Leite JP, Peixoto‐Santos JE. Glia and extracellular matrix molecules: what are their importance for the electrographic and MRI changes in the epileptogenic zone? Epilepsy Behav. 2021;121:106542.
Mestre H, Mori Y, Nedergaard M. The Brain's Glymphatic system: current controversies. Trends Neurosci. 2020;43(7):458–466. https://doi.org/10.1016/j.tins.2020.04.003.
Wardlaw JM, Benveniste H, Nedergaard M, Zlokovic BV, Mestre H, Lee H, et al. Perivascular spaces in the brain: anatomy, physiology and pathology. Nat Rev Neurol. 2020;16(3):137–153. https://doi.org/10.1038/s41582‐020‐0312‐z.
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François L, Romagnolo A, Luinenburg MJ, Anink JJ, Godard P, Rajman M, et al. Identification of gene regulatory networks affected across drug‐resistant epilepsies. Nat Commun. 2024;15(1):2180. https://doi.org/10.1038/s41467‐024‐46592‐2.
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Lynch KM, Sepehrband F, Toga AW, Choupan J. Brain perivascular space imaging across the human lifespan. Neuroimage. 2023;271:120009.
Evans TE, Knol MJ, Schwingenschuh P, Wittfeld K, Hilal S, Ikram MA, et al. Determinants of perivascular spaces in the general population: a pooled cohort analysis of individual participant data. Neurology. 2023;100(2):e107–e122.
Lynch M, Pham W, Sinclair B, O'Brien TJ, Law M, Vivash L. Perivascular spaces as a potential biomarker of Alzheimer's disease. Front Neurosci. 2022;16:1021131.
Ramirez J, Berezuk C, McNeely AA, Gao F, McLaurin J, Black SE. Imaging the perivascular space as a potential biomarker of neurovascular and neurodegenerative diseases. Cell Mol Neurobiol. 2016;36:289–299.
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Contributed Indexing:
Keywords: MRI; epilepsy; glymphatic system; perivascular spaces
Entry Date(s):
Date Created: 20251029 Date Completed: 20260223 Latest Revision: 20260223
Update Code:
20260223
DOI:
10.1111/epi.18694
PMID:
41159639
Database:
MEDLINE
*Further Information*
*Objective: The glymphatic system is thought to be the brain's primary waste clearance system, responsible for eliminating soluble metabolites and proteins from the central nervous system. It consists of the cerebrospinal fluid, the interstitial fluid, and a conduit between the two, perivascular spaces (PVS). PVS and glymphatics may impact the pathophysiology of epilepsy and its associated neuropsychiatric comorbidities, potentially via reduced clearance of excitotoxic substances. This study investigates enlarged PVS burden in a large patient group with various types of epilepsy.
Methods: A total of 467 people with various types of epilepsy were recruited from the Hospital das Clínicas, University of Campinas, Brazil; 267 had temporal lobe epilepsy with hippocampal sclerosis (TLE-HS), 71 had TLE with no magnetic resonance imaging (MRI)-visible lesions, 65 had focal extratemporal epilepsy, and 64 had idiopathic generalized epilepsy. They were matched for age and sex with 473 healthy volunteers as controls. All participants were scanned with T1-weighted MRI, and a deep-learning algorithm, PINGU (Perivascular-Space Identification Nnunet for Generalized Usage), was applied to segment PVS. The volumes of PVS in the white matter (WM) and basal ganglia (BG) were calculated, and PVS volume fraction (PVS-VF) was used as a dependent variables in a general linear model, with the diagnostic group as the independent variable of interest.
Results: The epilepsy group, across all subtypes, had higher PVS-VF in the BG compared to controls (101%-140%, effect size = .95-1.37, p < 3.77 × 10<sup>-15</sup>). There was no difference in PVS-VF in the WM between the epilepsy groups and healthy controls, or between different epilepsy subtypes. Only the TLE-HS group had a PVS-VF asymmetry in the WM, with more PVS on the contralateral side, particularly in the temporal lobes. There was no association between PVS-VF and duration of illness.
Significance: There is an increase in PVS volume in the BG across broad subtypes of epilepsy, suggesting either a common mechanism of seizure generation or a common consequence of seizures.
(© 2025 International League Against Epilepsy.)*