We evaluated the grey matter atrophy (GMA) of twenty-six patients with post-stroke epilepsy (PSE) comparing to thirty free-seizures controls using Voxel-Based Morphometry (VBM).

Although seizures after stroke are very common (around 10%), the etiopathology of PSE is still unclear. PSE accounts for approximately 50% of new-onset seizures after 65 years and associates with a negative impact on quality of life, anxiety level, and recovery.

Patients (n=26; 61±16 years) and controls (n=30; 60±11 years) were balanced for age (p= 0.5) and sex (p=0.4). High resolution T1-weighted MRI scans (3T) were segmented into grey and white matter maps with VBM (SPM12/CAT12_http://www.fil.ion.ucl.ac.uk) running on Matlab2014. Preprocessing included realignment, spatial normalization, tissue segmentation. After flipping GM maps from individuals with left-sided lesions (left to right) to increase the statistic power, we investigated GMA with T-tests (performed with SPM12) between patients and controls. Clinical information was analyzed with SPSS23.

Late-onset PSE (seizures started after one week of stroke) occurred in 65% (n=17), with an average time between stroke and the first seizure of 1.4 years. Most of patients presented large vessels occlusions with cortico-subcortical lesions 84% (n=22), the remaining 16% (n=4) showed lacunar lesions (small vessels disease).

GMA was mainly identified in ipsilateral limbic regions (parahippocampal gyrus, thalamus, and hippocampus) and frontal lobe; and contralateral cerebellum, p<0.05 (Bonferroni adjusted).