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Published on: June 23, 2023
Peri-ictal signal changes in seven patients with status epilepticus: interesting MRI observations
Manoj K Goyal1, Sanjib Sinha, Shivshankar Ravishankar
1Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Karnataka, India.
Introduction:
Transient peri-ictal changes on imaging had been described following status epilepticus (SE), but its cause is not very well understood. We analyzed the magnetic resonance imaging (MRI) findings in SE patients in order to elucidate such changes including peri-ictal signal.
Materials And Methods:
This prospective study involved 34 patients (M/F 23:11, mean age 25.8 +/- 17.2 years) who experienced SE. MRI was performed during or within 96 h of cessation of seizures. Twenty-five patients had generalized convulsive status epilectus (GCSE; ten secondary GCSE and 15 primary GCSE). Seven patients had epilepsia partialis continua and two patients non-convulsive SE. Eight patients had a history of seizures and three patients previous SE. The mean duration of SE prior to MRI was 89.2 +/- 105.3 h (range 2-360 h). MRI provided diagnosis in 17 patients, and in 13 patients, no structural cause was identified.
Results:
Peri-ictal focal signal changes with restricted diffusion on apparent diffusion coefficient maps were present in seven (20.6%) patients with SE (generalized convulsive, three; partial, three; non-convulsive, one). The changes were observed when MRI was performed during SE in 3/10 (30%) patients, or within 24 h in 1/7 (14.3%), 48 h in 1/5 (20%), 72 h in 1/6 (16.7%), or 96 h in 1/6 (16.7%) patients after cessation of seizures. Repeat MRI revealed disappearance of signal changes in two patients.
Conclusions:
Peri-ictal MR changes with restricted diffusion appear to be an effect rather than the cause of SE.
