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Postictal MRI abnormalities and seizure-induced brain injury: notions to be challenged
1Department of Pediatrics, Hospital Universitário-Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Department of Neurology, Hospital Infantil Joana de Gusmão, Florianópolis, SC, Brazil.
Objective:
This was a bibliographic search to address the quality of evidence in clinical reports supporting the assertion that brain MRI signal abnormalities are a direct consequence of seizures.
Methods:
The search on PubMed was performed by applying the following inclusion criteria: a) original case reports, b) in humans, c) as single case reports or series of patients, d) of visually detected acute MRI signal abnormalities, e) attributable directly to seizures, and f) published in English. Bibliographic references of initially selected publications were reviewed for additional articles. Full texts of selected publications were read for information regarding clinical, EEG, and MRI features. Moreover, claimed evidence supporting seizure-induced excitotoxicity was assessed.
Results:
The search resulted in 91 publications corresponding to 413 cases. There was a wide range of clinical features and EEG and MRI abnormalities. Premorbid or comorbid conditions were present in many cases, and some of them are potential causes of MRI changes. Claimed evidence for MRI signal abnormalities as a direct consequence of ictal activity was mostly based on the similarity with previous reports, animal models, reversibility, congruent EEG, MRI changes not respecting vascular territories, and ruling out other etiologies.
Conclusions:
Evidence supporting the notion of seizure-induced excitotoxicity is questionable in the studied reports of postictal MRI abnormalities.
Insights
Evidence linking brain MRI signal abnormalities directly to seizures is questionable. A review of 91 publications found that claimed evidence for seizure-induced excitotoxicity in postictal MRI findings is not robust.
Area of Science:
- Neuroimaging
- Neurology
- Epileptology
Background:
- Brain magnetic resonance imaging (MRI) can detect signal abnormalities.
- Seizures are known to cause various neurological effects.
- The direct causal link between seizures and specific MRI findings requires rigorous evidence.
Purpose of the Study:
- To evaluate the quality of evidence supporting the assertion that brain MRI signal abnormalities are a direct consequence of seizures.
- To assess the evidence for seizure-induced excitotoxicity in reported cases.
Main Methods:
- Bibliographic search of PubMed using specific inclusion criteria for case reports.
- Review of references and full texts for clinical, electroencephalogram (EEG), and MRI data.
- Assessment of evidence supporting seizure-induced excitotoxicity.
Main Results:
- 91 publications (413 cases) were identified, showing diverse clinical, EEG, and MRI features.
- Many cases had comorbid conditions that could explain MRI changes.
- Evidence for direct seizure causation was often based on similarity to prior reports, animal models, or exclusion of other causes.
Conclusions:
- The evidence supporting seizure-induced excitotoxicity as the cause of postictal MRI abnormalities is questionable.
- Further research is needed to establish a definitive causal link.
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