Magnetic resonance imaging findings within 5 days of status epilepticus in childhood
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Published on: September 20, 2024
Rod C Scott1, D G Gadian, M D King
1Great Ormond Street Hospital for Children NHS Trust, Institute of Child Health, University College London, London, UK. rscott@ich.ucl.ac.uk
Insights
Prolonged febrile convulsions (PFC) in children can cause acute hippocampal abnormalities like edema, detected by MRI within days. These changes may link status epilepticus to later mesial temporal sclerosis.
Area of Science:
- Neurology
- Pediatric Neurology
- Neuroimaging
Background:
- The relationship between status epilepticus, acute brain injury, mesial temporal sclerosis (MTS), and temporal lobe epilepsy is not fully understood.
- Investigating early brain changes after status epilepticus is crucial for understanding its long-term consequences.
Purpose of the Study:
- To determine if generalized status epilepticus is associated with brain abnormalities, particularly in the mesial temporal lobe, within 5 days of the event.
- To explore if these early changes represent the initial stage in the development of MTS.
Main Methods:
- Utilized qualitative and quantitative MRI in 35 children post-status epilepticus, including 21 with prolonged febrile convulsions (PFC).
- Performed T2 relaxometry and hippocampal volumetry within 5 days of the acute episode.
- Compared findings with control subjects.
Main Results:
- Children with PFC showed enlarged hippocampi and elevated T2 relaxation times within the first 2 days, suggesting edema.
- These hippocampal abnormalities were not observed 3-5 days after the event in PFC patients.
- Afebrile status epilepticus cases exhibited varied MRI abnormalities, including elevated hippocampal T2 values, but no hippocampal enlargement.
Conclusions:
- Prolonged febrile convulsions are linked to acute hippocampal abnormalities, potentially indicating edema.
- Non-febrile status epilepticus does not appear to cause similar acute hippocampal enlargement.
- Further longitudinal studies are needed to track the evolution of these changes and their potential to cause MTS.
Abstract:
The nature of the relationships between status epilepticus, acute hippocampal injury, mesial temporal sclerosis (MTS) and temporal lobe epilepsy remains unclear. The aim of this study was to investigate whether generalized status epilepticus is associated with brain abnormalities, especially in the mesial temporal lobe, within 5 days of the acute event. Such changes may be the first part of a causative pathophysiological sequence relating status epilepticus and MTS. Thirty-five children with a history of status epilepticus, including 21 with a history of prolonged febrile convulsion (PFC), underwent qualitative and quantitative MRI investigations within 5 days of the acute episode. Quantitative assessments of the hippocampus included T(2) relaxometry and hippocampal volumetry. Hippocampal volumes were large in patients with PFC when compared with controls. In addition, T(2) relaxation time was elevated in patients with PFC compared with control subjects during the first 2 days of the acute event. No difference was observed in patients examined 3-5 days after the event. Patients with afebrile status epilepticus had a variety of imaging abnormalities including elevated hippocampal T(2) values, but no evidence of hippocampal enlargement. PFC is associated with hippocampal abnormalities, consistent with hippocampal oedema, whilst non-febrile status epilepticus is not. A systematic longitudinal study is required to characterize the evolution of these abnormalities and to determine whether any patient develops MTS.
