Imaging of status epilepticus: Making the invisible visible. A prospective study on 206 patients

Pilar Bosque Varela; Lukas Machegger; Andreas Oellerer; Jürgen Steinbacher; Mark McCoy; Johannes Pfaff; Eugen Trinka; Giorgi Kuchukhidze

doi:10.1016/j.yebeh.2023.109130

Imaging of status epilepticus: Making the invisible visible. A prospective study on 206 patients

Epilepsy Behav. 2023 Apr:141:109130. doi: 10.1016/j.yebeh.2023.109130. Epub 2023 Feb 18.

Authors

Pilar Bosque Varela¹, Lukas Machegger², Andreas Oellerer², Jürgen Steinbacher², Mark McCoy³, Johannes Pfaff², Eugen Trinka⁴, Giorgi Kuchukhidze⁵

Affiliations

¹ Department of Neurology, Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, and Centre for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Austria.
² Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University of Salzburg, Austria.
³ Department of Neurology, Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, and Centre for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Austria; Neuroscience Institute, Christian Doppler University Hospital, Salzburg, Austria.
⁴ Department of Neurology, Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, and Centre for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Austria; Neuroscience Institute, Christian Doppler University Hospital, Salzburg, Austria; Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria.
⁵ Department of Neurology, Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, and Centre for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Austria; Neuroscience Institute, Christian Doppler University Hospital, Salzburg, Austria. Electronic address: g.kuchukhidze@salk.at.

PMID: 36803874
DOI: 10.1016/j.yebeh.2023.109130

Abstract

Background: Peri-ictal MRI abnormalities (PMA) frequently affect the cerebral cortex, hippocampus, pulvinar of the thalamus, corpus callosum, and cerebellum. In this prospective study, we aimed to characterize the spectrum of PMA in a large cohort of patients with status epilepticus.

Methods: We prospectively recruited 206 patients with SE and an acute MRI. The MRI protocol included diffusion weighted imaging (DWI), fluid-attenuated inversion recovery (FLAIR), arterial spin labeling (ASL), and T1-weighted imaging pre-and post-contrast application. Peri-ictal MRI abnormalities were stratified as either neocortical or non-neocortical. Amygdala, hippocampus, cerebellum, and corpus callosum were regarded as non-neocortical structures.

Results: Peri-ictal MRI abnormalities were observed in 93/206 (45%) of patients in at least one MRI sequence. Diffusion restriction was observed in 56/206 (27%) of patients, which was mainly unilateral in 42/56 (75%) affecting neocortical structures in 25/56 (45%), non-neocortical structures in 20/56 (36%) and both areas in 11/56 (19%) of patients. Cortical DWI lesions were located mostly in frontal lobes 15/25 (60%); non-neocortical diffusion restriction affected either the pulvinar of the thalamus or hippocampus 29/31 (95%). Alterations in FLAIR were observed in 37/203 (18%) of patients. They were mainly unilateral 24/37 (65%); neocortical 18/37 (49%), non-neocortical 16/37 (43%), or affecting both neocortical and non-neocortical structures 3/37 (8%). In ASL, 51/140 (37%) of patients had ictal hyperperfusion. Hyperperfused areas were located mainly in the neocortex 45/51 (88%) and were unilateral 43/51 (84%). In 39/66 (59%) of patients, PMA were reversible in one week. In 27/66 (41%), the PMA persisted and a second follow-up MRI was performed three weeks later in 24/27 (89%) patients. In 19/24 (79%) PMA were resolved.

Conclusions: Almost half of the patients with SE had peri-ictal MRI abnormalities. The most prevalent PMA was ictal hyperperfusion followed by diffusion restriction and FLAIR abnormalities. Neocortex was most frequently affected especially the frontal lobes. The majority of PMAs were unilateral. This paper was presented at the 8th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures held in September 2022.

Keywords: Diffusion restriction; Hyperperfusion; MRI; Non-convulsive status epilepticus; Seizures.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Diffusion Magnetic Resonance Imaging / methods
Electroencephalography
Humans
Magnetic Resonance Imaging / methods
Neocortex* / pathology
Prospective Studies
Spin Labels
Status Epilepticus* / diagnostic imaging
Status Epilepticus* / pathology

Substances

Spin Labels