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Diffusion-weighted and perfusion MRI demonstrates parenchymal changes in complex partial status epilepticus
Kristina Szabo1, Annkathrin Poepel, Bernd Pohlmann-Eden
1Department of Neurology, Universitätsklinikum Mannheim, University of Heidelberg, Mannheim, Germany.
Abstract:
Diffusion-weighted MRI (DWI) and perfusion MRI (PI) have been mainly applied in acute stroke, but may provide information in the peri-ictal phase in epilepsy patients. Both transient reductions of brain water diffusion, namely a low apparent diffusion coefficient (ADC), and signs of hyperperfusion have been reported in experimental and human epilepsy case studies. We studied 10 patients with complex partial status epilepticus (CPSE) with serial MRI including DWI and PI. All patients showed regional hyperintensity on DWI, and a reduction of the ADC in (i) the hippocampal formation and the pulvinar region of the thalamus (six out of 10 patients), (ii) the pulvinar and cortical regions (two out of 10), (iii) the hippocampal formation only (one out of 10), and (iv) the hippocampal formation, the pulvinar and the cortex (one out of 10). In all patients a close spatial correlation of focal hyperperfusion with areas of ADC/DWI change was present. In two patients hyperperfusion was confirmed in additional SPECT (single photon emission computed tomography) studies. All patients received follow-up MRI examinations showing partial or complete resolution of diffusion and perfusion abnormalities depending on the length of the follow-up interval. The clinical course, EEG and SPECT results all indicate that MRI detected changes related to prolonged epileptic activity. Combined PI and DWI can visualize haemodynamic and tissue changes after CPSE in the hippocampus, thalamus and affected cortical regions.
Insights
Diffusion-weighted MRI (DWI) and perfusion imaging (PI) reveal brain changes during complex partial status epilepticus (CPSE). These advanced MRI techniques visualize temporary tissue and blood flow alterations in epilepsy patients.
Area of Science:
- Neuroimaging
- Epileptology
- Radiology
Background:
- Diffusion-weighted MRI (DWI) and perfusion imaging (PI) are primarily used for acute stroke but show potential in epilepsy's peri-ictal phase.
- Previous studies suggest transient reductions in apparent diffusion coefficient (ADC) and hyperperfusion occur in experimental and human epilepsy.
Purpose of the Study:
- To investigate the utility of serial DWI and PI in patients experiencing complex partial status epilepticus (CPSE).
- To correlate MRI findings with clinical course, EEG, and SPECT data.
Main Methods:
- Serial MRI, including DWI and PI, was performed on 10 patients with CPSE.
- Apparent diffusion coefficient (ADC) values and perfusion changes were analyzed in specific brain regions.
- SPECT studies were used for confirmation in select cases.
Main Results:
- All patients exhibited regional hyperintensity on DWI with reduced ADC in the hippocampus, thalamus (pulvinar), and/or cortex.
- A strong spatial correlation was observed between focal hyperperfusion and areas of ADC/DWI abnormality.
- Follow-up MRIs demonstrated resolution of diffusion and perfusion abnormalities.
Conclusions:
- Combined PI and DWI effectively visualize hemodynamic and tissue changes in the hippocampus, thalamus, and cortex following CPSE.
- MRI findings correlate with prolonged epileptic activity, as supported by clinical, EEG, and SPECT data.
- DWI and PI offer valuable insights into the peri-ictal phase of epilepsy.
