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. 2022:35:103069.
doi: 10.1016/j.nicl.2022.103069. Epub 2022 Jun 1.

Strategic infarct location for post-stroke seizure

Chien-Chen Chou  1 , Yen-Cheng Shih  1 , Hsu-Huai Chiu  2 , Hsiang-Yu Yu  1 , I-Hui Lee  1 , Yung-Yang Lin  3 , Cheng-Chia Lee  4 , Syu-Jyun Peng  5
Affiliations

Strategic infarct location for post-stroke seizure

Chien-Chen Chou et al. Neuroimage Clin. 2022.

Abstract

Post-stroke seizure (PSS) can have a strong negative impact on functional recovery after stroke. Researchers have identified numerous risk factors of PSS; however, the relationship between infarction location and PSS remains unclear. We recruited patients who presented with an acute cerebral infarction between 2012 and 2017 and suffered from seizures within 1 year after stroke (PSS group). PSS group was subgrouped into early-PSS and late-PSS groups based on the interval between seizure and stroke. We also recruited an equal number of acute cerebral infarction patients without post-stroke seizures during the follow-up period (Non-PSS group). All brain MRIs from the two groups were processed, whereupon normalized infarct maps from the PSS and Non-PSS groups were compared via voxel- and volumetric-based analyses. A total of 132 subjects were enrolled in the study, including PSS (n = 66, consisting of 31 early-PSS and 35 late-PSS) and Non-PSS (n = 66) patients. No significant differences were observed between the two groups in terms of stroke lateralization or severity. Image analysis revealed that the volume of infarction was larger in the PSS group than in the Non-PSS group; however, the difference did not reach the level of significance. Unlike the Non-PSS group, the PSS group presented hot spots over the left central region, left superior parietal lobule, and right frontal operculum. We observed differences between the distribution of hot spots among patients with early-PSS and those with late-PSS. We found that some brain regions were significantly associated with the development of PSS after ischemic stroke, and these regions differed between cases of early and late PSS. It appears that the location of infarction could help clinicians assess the risk of PSS in specific post-stroke stages.

Keywords: Cerebral infarction; Epileptogenesis; Ischemic stroke; Post-stroke epilepsy; Risk factors.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Flowchart illustrating DWI and T1WI image processing employed to obtain normalized infarct maps and cortical infarct maps. The steps shown include co-registration, infarct labeling, GM segmentation, GM mask creation, and spatial normalization.
Fig. 2
Fig. 2
Total infarct maps in the (A) PSS and (B) Non-PSS groups. The significance threshold was set at 0.05 (via AlphaSim correction) for multiple comparisons. The left side of the MRI corresponds to the right hemisphere of the brain. The color bar indicated the T-score.
Fig. 3
Fig. 3
Differences in distribution of infarct between the Non-PSS group and the (A) PSS, (B) early-PSS, and (C) late-PSS groups. A two-sample t-test group comparison with infarct volume and lateralization of infarction as covariates was performed between the Non-PSS group and each other group. For this, a double statistical threshold (a height threshold of p < 0.05 and a minimum cluster size of 154 voxels, as determined using AlphaSim correction) was used. The color bar indicated the T-score.
See this image and copyright information in PMC

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Further reading

    1. Kammersgaard L.P., Olsen T.S. Poststroke epilepsy in the copenhagen stroke study: Incidence and predictors. J. Stroke Cerebrovasc Dis. 2005;14:210–214. - PubMed
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