Question: My brother has severe epilepsy and he has been treated for this for many years. But now his doctor has told us that he has “white matter degeneration.” What exactly does this mean?
Dr. Hibberd’s answer:
Hopefully his epilepsy is being kept under control with one of the many effective and well tolerated medication regimens available today. The brain has grey matter and white matter visualized best by MRI. The gray matter contains pathways, and coordinates basic brain functions, while the white matter is peripheral, and often processes higher-order brain functions.
Small amounts of white matter can be excised or damaged, and the brain is usually able to re-allocate much of its function to other areas, just like a computer hard drive re-allocates data to good sectors on a computer hard drive.
White matter atrophy or degeneration is often described when there is a shrinking of the volume of the white matter seen with CT and MRI imaging. This happens in a progressive way in all of our brains as we age normally. We have not found a way to delay or prevent it and there has been no consistent relation to seizure control.
Your brother likely has either a decreased threshold for brain cell activation or has damage from a past injury. In either case, he must maintain control of his seizures through regular medication. There are many famous and prominent people with epilepsy who function normally, often without the knowledge of anyone but close friends and family. The presence of white matter degeneration should have absolutely no practical impact on his health and does not relate to seizure management or longevity in any way.