Enlarged Perivascular Spaces in Frontal and Temporal Cortical Regions Characterize Seizure Outcome After Traumatic Brain Injury

Post-traumatic epilepsy (PTE) is characterized by seizures that occur at least one week after traumatic brain injury (TBI). Although PTE remains one of the most life-altering outcomes of TBI, there are no preventative treatments. The Epilepsy Bioinformatics Study for Antiepileptogenic Therapy (EpiBioS4Rx) is an international project designed to identify multimodal biomarkers of PTE; early EpiBioS4Rx research suggests that features of perivascular spaces (PVS) are a potential biomarker. This study evaluates the association between volume fraction (VF), the volume of PVS relative to total brain volume, and seizure activity. Structural magnetic resonance (MR) imaging from a subset of 62 EpiBioS4Rx subjects was used to create Enhanced PVS Contrast (EPC) imaging to segment and quantify PVS metrics. A multiple logistic regression model that controlled for demographic and clinical factors revealed a significant difference between the late seizure-positive and seizure-negative groups in the paracentral lobule, precentral gyrus, and temporal pole of the right hemisphere. These findings are supported by prior literature that identify a relationship between PVS function in these regions and seizure activity after TBI.