Progressive Brain Atrophy in Super-refractory Status Epilepticus

Area of Science:

• Neuroscience
• Radiology
• Neurology

Background:

• Prolonged seizures in super-refractory status epilepticus (SRSE) can lead to neuronal damage and brain atrophy.
• Previous studies have suggested atrophy through visual inspection, but quantitative MRI data are lacking.

Purpose of the Study:

• To document and quantify the progression of brain atrophy over time in patients with SRSE.
• To investigate the relationship between SRSE duration and the development of atrophy.

Main Methods:

• Retrospective review of 19 SRSE patients at Mayo Clinic Hospital (2001-2013).
• Inclusion criteria: initial MRI within 2 weeks of SRSE onset, follow-up MRI within 6 months of resolution, and at least 1 week between scans.
• Ventricular brain ratio (VBR) was measured using FLAIR MRI sequences at disease onset and follow-up.

Main Results:

• All 19 patients showed increased VBR, indicating atrophy, with a median change of 23.3%.
• A significant correlation was found between the duration of anesthetic agent use and the degree of VBR change (Spearman r=0.54; P=.02).
• Median duration of anesthetic use was 13 days, and median time between MRIs was 40 days.

Conclusions:

• Brain atrophy occurs in all SRSE patients, irrespective of seizure control achieved with anesthetic agents.
• The extent of brain atrophy is associated with the duration of SRSE and anesthetic treatment.
• Serial MRI is crucial for monitoring and quantifying neurodegenerative changes in SRSE.