Voxel-Based Lesion Symptom Mapping to Predict Poststroke Epilepsy After Mechanical Thrombectomy

Area of Science:

• Neurology
• Neuroimaging
• Stroke Medicine

Background:

• Poststroke epilepsy (PSE) is a significant long-term complication following stroke.
• Predictors of PSE in patients undergoing mechanical thrombectomy (MT) for large-vessel occlusion (LVO) stroke are not well-established.
• Voxel-based lesion symptom mapping (VLSM) shows promise for predicting PSE risk.

Purpose of the Study:

• To assess the risk of PSE after acute ischemic stroke treated with MT.
• To utilize voxel- and volumetric-based analyses, including VLSM, for PSE risk prediction.
• To identify specific topographical lesion patterns associated with PSE.

Main Methods:

• A bi-center study included 251 patients with acute ischemic stroke treated with MT (2011-2017) with available postinterventional MRI and follow-up data.
• Infarct volume and location were assessed using semiautomated lesion outlining and binarized masks.
• Voxel-based lesion symptom mapping was applied to identify lesion patterns linked to PSE.

Main Results:

• Of 251 patients analyzed, 26 (10.4%) developed PSE.
• Patients with PSE had a significantly larger mean infarct volume (119.2 cm³ vs. 43.9 cm³).
• VLSM identified the orbitofrontal region, operculum, and temporal pole as brain areas associated with PSE.

Conclusions:

• Infarct volume and specific lesion locations identified by VLSM are significant predictors of PSE after LVO stroke treated with MT.
• These findings can aid in risk stratification and follow-up care for patients at risk of PSE.
• Postinterventional brain MRI with VLSM is a valuable tool for understanding PSE development.