This is the final report for a 2013 pilot grant for £29,080 awarded in 2013 to Dr Beate Diehl, Professor Louis Lemieux, and Professor Alex Leff at UCL. Stroke is the most common cause of epilepsy in people over the age of 60. Every year, around 150,000 people in the UK have a stroke, causing injury through changes to the brain’s blood supply. During the first phase of the stroke, irritation at the site of injury can cause a seizure. Seizures can also occur much later, and then carry a significant risk for a patient to develop epilepsy. It is not known why some stroke survivors develop epilepsy and others do not. In this pilot study researchers set out to determine who is at risk for post-stroke epilepsy, using advanced MR imaging.The researchers used computerised analysis methods on existing MRI scans from a group of over 700 participants who were part of a stroke research study. Out of the 450 participants who experienced seizures, 11% developed epilepsy. Using computerised analysis of the damage caused by the stroke and its extent and location, the researchers found that people with post-stroke epilepsy had a considerably larger volume of damage than those without. In fact the stroke was roughly double the size in people who developed post-stroke epilepsy. Therefore, a larger stroke is a risk factor for developing epilepsy. The research also investigated which areas of the brain affected by stroke are linked with post-stroke epilepsy. One area at the back of the temporal lobe was damaged in almost 2 in 3 patients with post-stroke epilepsy. Therefore, this area of the brain may be of interest, but further research is required to understand this further.Dr Diehl said: “I am very grateful that ERUK enabled us to investigate why some people with stroke develop epilepsy and others do not using a huge existing MRI database. Both the retrospective arm of this pilot project and the prospective arm using EEG-fMRI have been an important experience. Allowing me to embark in the exploratory phase of investigating imaging risk factors for developing epilepsy following a stroke has taught me a lot about feasibility of research projects in the clinical context.”