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Association of cortical superficial siderosis with post-stroke epilepsy.

OBJECTIVE
To assess whether post-stroke epilepsy (PSE) is associated with neuroimaging findings of hemosiderin in a case-control study and whether the addition of hemosiderin markers improves the risk stratification models of PSE.


METHODS
We performed a post-hoc analysis of PROgnosis of POST-Stroke Epilepsy (PROPOSE) study enrolling PSE patients at our hospital from November 2014 to September 2019. PSE was diagnosed when one unprovoked seizure was experienced more than 7 days after the index stroke, as proposed by the International League Against Epilepsy. As controls, consecutive acute stroke patients with no history or absence of any late seizure or continuing antiseizure medications at least 3 months after stroke were retrospectively enrolled during the same study period. We examined cortical microbleeds and cortical superficial siderosis (cSS) using gradient-echo T2*-weighted images. A logistic regression model with ridge penalties was tuned using 10-fold cross-validation. We added the item of cSS to the existing models (SeLECT and CAVE) for predicting PSE and evaluated performance of new models.


RESULTS
The study included 180 patients with PSE (67 women; median age, 74 years) and 1183 controls (440 women; median age, 74 years). The cSS frequency was higher in PSE than control groups (48.9% vs 5.7%, p<0.0001). Compared with the existing models, the new models with cSS (SeLECT-S and CAVE-S) demonstrated significantly better predictive performance of PSE [net reclassification improvement, 0.63 (p=0.004) for SeLECT-S and 0.88 (p=0.001) for CAVE-S at the testing data].


INTERPRETATION
cSS was associated with PSE, stratifying stroke survivors at high risk of PSE. This article is protected by copyright. All rights reserved.