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Association of Acute Ischemic Stroke Volume With Post-Stroke Epilepsy Development
Vijaya Dasari1, Kunio Nakamura2, Bhaskar Thoomukuntla2
1Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Summary
Acute stroke volume independently predicts post-stroke epilepsy (PSE). This automated measure offers a scalable alternative to manual neuroimaging in the SeLECT score for predicting epilepsy after stroke.
Area of Science:
- Neurology
- Neuroimaging
- Epileptology
Background:
- Stroke is a primary cause of epilepsy, particularly in older individuals.
- The SeLECT score is the current standard for predicting post-stroke epilepsy (PSE).
- SeLECT's reliance on manual neuroimaging extraction (cortical and MCA involvement) limits its validation.
Purpose of the Study:
- To determine if acute stroke volume independently predicts PSE.
- To compare the predictive contribution of stroke volume against SeLECT's neuroimaging variables.
- To evaluate the potential of automated stroke volume quantification as a scalable PSE predictor.
Main Methods:
- Manual extraction of SeLECT variables.
- Automated quantification of diffusion-weighted imaging (DWI) stroke volume using a convolutional neural network.
- Development of Cox proportional hazards models to assess time to PSE, incorporating stroke volume and SeLECT neuroimaging predictors.
Main Results:
- Among 221 patients, 15.8% developed PSE.
- Stroke volume (per 10 mL) was an independent predictor, increasing PSE risk by 12% across models.
- Models incorporating automated stroke volume achieved comparable or improved discrimination (C-index up to 0.679) compared to SeLECT's neuroimaging components.
Conclusions:
- Acute stroke volume is a significant independent predictor of PSE.
- Automated stroke volume quantification provides a scalable and objective alternative to manual neuroimaging in PSE prediction.
- This finding supports the integration of automated stroke volume into future PSE prediction tools.
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