Authors :
Presenting Author: Kaiyuan Shen, MD – Zhongshan Hospital Fudan University
Jing Wang, PhD – Zhongshan Hospital Fudan University
Wei Sun, MD – Zhongshan Hospital Fudan University
Jing Ding, MD，PhD – Zhongshan Hospital Fudan University
Rationale:
Ischemic stroke constitutes approximately 70% of all post-stroke epilepsy (PSE) cases, yet the underlying mechanisms remain unclear. Early-onset seizure (occurring within 7 days post-stroke) is an established risk factor for the development of PSE. Growing evidence suggests that blood-brain barrier (BBB) disruption may play a vital role of PSE pathogenesis. This study specifically examines the association between BBB dysfunction and early-onset seizures in acute ischemic stroke patients, with the aim of exploring potential mechanisms underlying PSE.
Methods:
We conducted a cross-sectional study using data from the PROMISE cohort to investigate blood-brain barrier (BBB) dysfunction in three patient groups: with early-onset seizures after ischemic stroke (ES), without early-onset seizures after ischemic stroke (NES), and controls without cerebrovascular events (NC). Early-onset seizures were identified through clinical manifestations combined with electroencephalogram assessment, and were defined according to International League Against Epilepsy (ILAE) criteria as epileptic seizures occurring within 7 days after stroke onset. BBB permeability was quantitatively assessed using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), with post-processing calculations of the volume transfer coefficient Ktrans. The relation between BBB permeability and National Institute of Health stroke scale (NIHSS) scores and ages were analyzed.Results:
We totally enrolled 58 participants in this study (NES: 44, ES: 5, NC: 9), with all acute ischemic stroke patients demonstrating cortical infarction. Stroke patients had an average age of 67.58 years (75% male), while the NC group averaged 62.22 years (67% male). Peak BBB disruption occurred 5-9 days post-stroke (Ktrans: 0.08 min⁻¹ ± 0.01 min⁻¹). We therefore focused on BBB dysfunction during this critical window in participants of the ES and NES groups. Significant BBB dysfunction was observed in both ES (Ktrans: 0.10 min⁻¹ ± 0.03 min⁻¹) and NES groups (Ktrans: 0.08 min⁻¹ ± 0.01 min⁻¹). Quantitative assessment indicated BBB permeability in ES patients tended to be elevated compared to NES patients. Notably, Ktrans showed no significant correlation with NIHSS scores (r=0.13, p=0.46) or age (r=0.07, p=0.67).Conclusions:
Severe blood-brain barrier (BBB) dysfunction was observed in patients with early-onset seizures after acute ischemic stroke. The study found no association between stroke severity and early-onset seizures, suggesting that BBB disruption may independently contribute to seizure pathogenesis. These findings provide novel insights into the mechanisms of PSE and potential biomarkers for early intervention.Funding:
The study was supported by the National Key R&D Program of China (2022YFC2503802).