Reduced total number of enlarged perivascular spaces in post-traumatic epilepsy patients with unilateral lesions – a feasibility study

Gernot Hlauschek; Morten I. Lossius; Daniel L. Schwartz; Lisa C. Silbert; Amelia J. Hicks; Jennie L. Ponsford; Lucy Vivash; Benjamin Sinclair; Patrick Kwan; Terrence J. O'Brien; Sandy R. Shultz; Meng Law; Gershon Spitz

doi:10.1016/j.seizure.2023.10.006

Reduced total number of enlarged perivascular spaces in post-traumatic epilepsy patients with unilateral lesions – a feasibility study

Gernot Hlauschek, Morten I. Lossius, Daniel L. Schwartz, Lisa C. Silbert, Amelia J. Hicks, Jennie L. Ponsford, Lucy Vivash, Benjamin Sinclair, Patrick Kwan, Terrence J. O'Brien, Sandy R. Shultz, Meng Law, Gershon Spitz

Neurology

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Background: We investigated the value of automated enlarged perivascular spaces (ePVS) quantification to distinguish chronic traumatic brain injury (TBI) patients with post-traumatic epilepsy (PTE⁺) from chronic TBI patients without PTE (PTE⁻) in a feasibility study. Methods: Patients with and without PTE were recruited and underwent an MRI post-TBI. Multimodal auto identification of ePVS algorithm was applied to T1-weighted MRIs to segment ePVS. The total number of ePVS was calculated and corrected for white matter volume, and an asymmetry index (AI) derived. Results: PTE was diagnosed in 7 out of the 99 participants (male=69) after a median time of less than one year since injury (range 10-22). Brain lesions were observed in all 7 PTE⁺ cases (unilateral=4, 57%; bilateral=3, 43%) as compared to 40 PTE⁻ cases (total 44%; unilateral=17, 42%; bilateral=23, 58%). There was a significant difference between PTE⁺ (M=1.21e⁻⁴, IQR [8.89e⁻⁵]) and PTE⁻ cases (M=2.79e⁻⁴, IQR [6.25e⁻⁵]) in total corrected numbers of ePVS in patients with unilateral lesions (p=0.024). No differences in AI, trauma severity and lesion volume were seen between groups. Conclusion: This study has shown that automated quantification of ePVS is feasible and provided initial evidence that individuals with PTE with unilateral lesions may have fewer ePVS compared to TBI patients without epilepsy. Further studies with larger sample sizes should be conducted to determine the value of ePVS quantification as a PTE-biomarker.

Original language	English (US)
Pages (from-to)	1-5
Number of pages	5
Journal	Seizure
Volume	113
DOIs	https://doi.org/10.1016/j.seizure.2023.10.006
State	Published - Dec 2023

Keywords

Glymphatic system
Imaging biomarker
Perivascular spaces
Post-traumatic epilepsy
Traumatic brain injury

ASJC Scopus subject areas

Neurology
Clinical Neurology

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10.1016/j.seizure.2023.10.006

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Hlauschek, G., Lossius, M. I., Schwartz, D. L., Silbert, L. C., Hicks, A. J., Ponsford, J. L., Vivash, L., Sinclair, B., Kwan, P., O'Brien, T. J., Shultz, S. R., Law, M., & Spitz, G. (2023). Reduced total number of enlarged perivascular spaces in post-traumatic epilepsy patients with unilateral lesions – a feasibility study. Seizure, 113, 1-5. https://doi.org/10.1016/j.seizure.2023.10.006

Hlauschek, G, Lossius, MI, Schwartz, DL, Silbert, LC, Hicks, AJ, Ponsford, JL, Vivash, L, Sinclair, B, Kwan, P, O'Brien, TJ, Shultz, SR, Law, M & Spitz, G 2023, 'Reduced total number of enlarged perivascular spaces in post-traumatic epilepsy patients with unilateral lesions – a feasibility study', Seizure, vol. 113, pp. 1-5. https://doi.org/10.1016/j.seizure.2023.10.006

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title = "Reduced total number of enlarged perivascular spaces in post-traumatic epilepsy patients with unilateral lesions – a feasibility study",

abstract = "Background: We investigated the value of automated enlarged perivascular spaces (ePVS) quantification to distinguish chronic traumatic brain injury (TBI) patients with post-traumatic epilepsy (PTE+) from chronic TBI patients without PTE (PTE−) in a feasibility study. Methods: Patients with and without PTE were recruited and underwent an MRI post-TBI. Multimodal auto identification of ePVS algorithm was applied to T1-weighted MRIs to segment ePVS. The total number of ePVS was calculated and corrected for white matter volume, and an asymmetry index (AI) derived. Results: PTE was diagnosed in 7 out of the 99 participants (male=69) after a median time of less than one year since injury (range 10-22). Brain lesions were observed in all 7 PTE+ cases (unilateral=4, 57%; bilateral=3, 43%) as compared to 40 PTE− cases (total 44%; unilateral=17, 42%; bilateral=23, 58%). There was a significant difference between PTE+ (M=1.21e−4, IQR [8.89e−5]) and PTE− cases (M=2.79e−4, IQR [6.25e−5]) in total corrected numbers of ePVS in patients with unilateral lesions (p=0.024). No differences in AI, trauma severity and lesion volume were seen between groups. Conclusion: This study has shown that automated quantification of ePVS is feasible and provided initial evidence that individuals with PTE with unilateral lesions may have fewer ePVS compared to TBI patients without epilepsy. Further studies with larger sample sizes should be conducted to determine the value of ePVS quantification as a PTE-biomarker.",

keywords = "Glymphatic system, Imaging biomarker, Perivascular spaces, Post-traumatic epilepsy, Traumatic brain injury",

author = "Gernot Hlauschek and Lossius, {Morten I.} and Schwartz, {Daniel L.} and Silbert, {Lisa C.} and Hicks, {Amelia J.} and Ponsford, {Jennie L.} and Lucy Vivash and Benjamin Sinclair and Patrick Kwan and O'Brien, {Terrence J.} and Shultz, {Sandy R.} and Meng Law and Gershon Spitz",

note = "Publisher Copyright: {\textcopyright} 2023 The Author(s)",

year = "2023",

month = dec,

doi = "10.1016/j.seizure.2023.10.006",

language = "English (US)",

volume = "113",

pages = "1--5",

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T1 - Reduced total number of enlarged perivascular spaces in post-traumatic epilepsy patients with unilateral lesions – a feasibility study

AU - Hlauschek, Gernot

AU - Lossius, Morten I.

AU - Schwartz, Daniel L.

AU - Silbert, Lisa C.

AU - Hicks, Amelia J.

AU - Ponsford, Jennie L.

AU - Vivash, Lucy

AU - Sinclair, Benjamin

AU - Kwan, Patrick

AU - O'Brien, Terrence J.

AU - Shultz, Sandy R.

AU - Law, Meng

AU - Spitz, Gershon

PY - 2023/12

Y1 - 2023/12

N2 - Background: We investigated the value of automated enlarged perivascular spaces (ePVS) quantification to distinguish chronic traumatic brain injury (TBI) patients with post-traumatic epilepsy (PTE+) from chronic TBI patients without PTE (PTE−) in a feasibility study. Methods: Patients with and without PTE were recruited and underwent an MRI post-TBI. Multimodal auto identification of ePVS algorithm was applied to T1-weighted MRIs to segment ePVS. The total number of ePVS was calculated and corrected for white matter volume, and an asymmetry index (AI) derived. Results: PTE was diagnosed in 7 out of the 99 participants (male=69) after a median time of less than one year since injury (range 10-22). Brain lesions were observed in all 7 PTE+ cases (unilateral=4, 57%; bilateral=3, 43%) as compared to 40 PTE− cases (total 44%; unilateral=17, 42%; bilateral=23, 58%). There was a significant difference between PTE+ (M=1.21e−4, IQR [8.89e−5]) and PTE− cases (M=2.79e−4, IQR [6.25e−5]) in total corrected numbers of ePVS in patients with unilateral lesions (p=0.024). No differences in AI, trauma severity and lesion volume were seen between groups. Conclusion: This study has shown that automated quantification of ePVS is feasible and provided initial evidence that individuals with PTE with unilateral lesions may have fewer ePVS compared to TBI patients without epilepsy. Further studies with larger sample sizes should be conducted to determine the value of ePVS quantification as a PTE-biomarker.

AB - Background: We investigated the value of automated enlarged perivascular spaces (ePVS) quantification to distinguish chronic traumatic brain injury (TBI) patients with post-traumatic epilepsy (PTE+) from chronic TBI patients without PTE (PTE−) in a feasibility study. Methods: Patients with and without PTE were recruited and underwent an MRI post-TBI. Multimodal auto identification of ePVS algorithm was applied to T1-weighted MRIs to segment ePVS. The total number of ePVS was calculated and corrected for white matter volume, and an asymmetry index (AI) derived. Results: PTE was diagnosed in 7 out of the 99 participants (male=69) after a median time of less than one year since injury (range 10-22). Brain lesions were observed in all 7 PTE+ cases (unilateral=4, 57%; bilateral=3, 43%) as compared to 40 PTE− cases (total 44%; unilateral=17, 42%; bilateral=23, 58%). There was a significant difference between PTE+ (M=1.21e−4, IQR [8.89e−5]) and PTE− cases (M=2.79e−4, IQR [6.25e−5]) in total corrected numbers of ePVS in patients with unilateral lesions (p=0.024). No differences in AI, trauma severity and lesion volume were seen between groups. Conclusion: This study has shown that automated quantification of ePVS is feasible and provided initial evidence that individuals with PTE with unilateral lesions may have fewer ePVS compared to TBI patients without epilepsy. Further studies with larger sample sizes should be conducted to determine the value of ePVS quantification as a PTE-biomarker.

KW - Glymphatic system

KW - Imaging biomarker

KW - Perivascular spaces

KW - Post-traumatic epilepsy

KW - Traumatic brain injury

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DO - 10.1016/j.seizure.2023.10.006

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AN - SCOPUS:85173846371

SN - 1059-1311

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JO - Seizure

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ER -

Reduced total number of enlarged perivascular spaces in post-traumatic epilepsy patients with unilateral lesions – a feasibility study

Abstract

Keywords

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