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Updated: Jul 18, 2026
A Multimodal Imaging- and Stimulation-based Method of Evaluating Connectivity-related Brain Excitability in Patients with Epilepsy
Published on: November 13, 2016
Reversible periictal MRI abnormalities: clinical correlates and long-term outcome in 12 patients
S Raghavendra1, R Ashalatha, T Krishnamoorthy
1Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, Kerala, India.
Abstract:
Although a wide spectrum of reversible periictal magnetic resonance imaging (MRI) abnormalities (RPMA) are being increasingly identified, the clinicians are often in a dilemma about their localization significance. This prompted us to analyze the clinical, MRI, electroencephalographic (EEG) and follow-up data of 12 patients with RPMA seen in a tertiary referral epilepsy center. RPMA occurred after a single or a cluster of focal seizures with or without secondary generalization. The interictal and ictal EEG abnormalities were localized to the site of RPMA in nine patients. RPMA involved areas remote from the site of EEG abnormalities in four patients. We have developed a comprehensive classification to account for the wide spectrum of RPMA involving gray matter, white matter and leptomeninges with or without contrast enhancement or mass effect. Follow-up MRIs showed complete resolution of RPMA in all, except in four patients, who developed residual focal atrophy. During median follow-up period of 3 years, recurrence of RPMA was observed in two patients. Diffusion weighted MRI in two patients and histopathological finding in one patient favored causal role of hypoxia in the pathogenesis of RPMA. Our observations help to understand the electroclinical profile, radiological spectrum, localization significance and natural history of RPMA better.
Insights
Reversible periictal MRI abnormalities (RPMA) are often seen after seizures. This study clarifies their clinical significance, imaging features, and natural history in epilepsy patients.
Area of Science:
- Neurology
- Radiology
- Epileptology
Background:
- Reversible periictal magnetic resonance imaging abnormalities (RPMA) present a diagnostic challenge regarding their localization significance.
- Understanding the spectrum and clinical implications of RPMA is crucial for epilepsy management.
Purpose of the Study:
- To analyze the clinical, MRI, electroencephalographic (EEG), and follow-up data of patients with RPMA.
- To develop a classification system for the diverse presentations of RPMA.
- To elucidate the localization significance and natural history of RPMA.
Main Methods:
- Retrospective analysis of 12 patients with RPMA at a tertiary epilepsy center.
- Correlation of clinical presentation, ictal/interictal EEG findings, and serial MRI.
- Development of a comprehensive classification for RPMA involving gray matter, white matter, and leptomeninges.
Main Results:
- RPMA occurred post-seizure, with EEG abnormalities localizing to RPMA sites in most cases.
- A comprehensive classification for RPMA was established, encompassing various imaging features.
- Complete resolution of RPMA was observed in most patients, with some developing residual atrophy; recurrence was noted in two patients.
Conclusions:
- RPMA have a distinct electroclinical profile and radiological spectrum.
- The study enhances understanding of RPMA's localization significance and natural history.
- Hypoxia is suggested as a potential pathogenetic factor in RPMA.
