Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan.
Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Ann Neurol. 2023 Feb;93(2):357-370. doi: 10.1002/ana.26497. Epub 2022 Sep 20.
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.
We performed a post-hoc analysis of the PROgnosis of POST-Stroke Epilepsy study enrolling PSE patients at National Cerebral and Cardiovascular Center, Osaka, Japan, from November 2014 to September 2019. PSE was diagnosed when one unprovoked seizure was experienced >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.
The study included 180 patients with PSE (67 women; median age 74 years) and 1,183 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).
Cortical superficial siderosis was associated with PSE, stratifying stroke survivors at high risk of PSE. ANN NEUROL 2023;93:357-370.
在病例对照研究中评估卒中后癫痫（PSE）是否与含铁血黄素的神经影像学表现相关，以及添加含铁血黄素标志物是否能改善 PSE 的风险分层模型。
我们对日本大阪国立循环器病研究中心 2014 年 11 月至 2019 年 9 月期间的 PROgnosis of POST-Stroke Epilepsy 研究中的 PSE 患者进行了一项事后分析。根据国际抗癫痫联盟的建议，当指数卒中后 >7 天出现一次自发性癫痫发作时，诊断为 PSE。作为对照，在同一研究期间，回顾性纳入连续的急性卒中患者，这些患者无既往或无任何迟发性癫痫发作，且在卒中后至少 3 个月未继续使用抗癫痫药物。我们使用梯度回波 T2*-加权图像检查皮质微出血和皮质浅表铁沉积症（cSS）。使用 10 折交叉验证对带有岭惩罚的逻辑回归模型进行调整。我们将 cSS 项目添加到现有的预测 PSE 的模型（SeLECT 和 CAVE）中，并评估新模型的性能。
该研究纳入了 180 例 PSE 患者（67 例女性；中位年龄 74 岁）和 1183 例对照（440 例女性；中位年龄 74 岁）。PSE 组的 cSS 发生率高于对照组（48.9% vs 5.7%，p<0.0001）。与现有模型相比，具有 cSS 的新模型（SeLECT-S 和 CAVE-S）对 PSE 的预测性能有显著改善（在测试数据中，SeLECT-S 的净重新分类改善为 0.63 [p=0.004]，CAVE-S 的为 0.88 [p=0.001]）。
皮质浅表铁沉积症与 PSE 相关，可对 PSE 风险较高的卒中幸存者进行分层。ANN NEUROL 2023；93：357-370。
