Superficial White Matter Microstructure Alterations in the Right Temporal Lobe Associated with Post-Traumatic Epilepsy

Post-traumatic epilepsy (PTE), a delayed consequence of traumatic brain injury (TBI), typically arises more than a week post-injury. While pathological changes in white matter (WM) post-TBI have been highlighted using diffusion tensor imaging (DTI), alterations in superficial white matter (SWM)-key in cortico-cortical connectivity-are less understood in PTE. We analyzed DTI metrics (AD, MD, RD, and FA) across 68 SWM regions in 27 TBI patients with PTE and 41 without, as part of the EpiBioS4Rx study. Employing Elastic Net Regression (ENR), we achieved an average area under the curve (AUC) of 0.86 in classifying PTE from TBI patients and identified critical SWM regions linked to PTE, including the right temporal pole, parahippocampal gyrus, and superior temporal gyrus. These SWM alterations correlated with functional outcomes, marking an important advancement in understanding microstructural SWM abnor- malities in PTE within a multisite research framework.