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Dynamic Susceptibility Contrast Enhanced (DSC) MRI Perfusion and Plasma Cytokine Levels in Patients after
Tatjana Filipovic1, Katarina Surlan Popovic2, Alojz Ihan3
1Division of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Background:
Inflammatory events in brain parenchyma and glial tissue are involved in epileptogenesis. Blood concentration of cytokines is shown to be elevated after tonic-clonic seizures. As a result of inflammation, blood-brain barrier leakage occurs. This can be documented by imaging techniques, such is dynamic susceptibility contrast enhanced (DSC) MRI perfusion. Our aim was to check for postictal brain inflammation by studying DSC MRI perfusion and plasma level of cytokines. We looked for correlations between number and type of introducing seizures, postictal plasma level of cytokines and parameters of DSC MRI perfusion. Furthermore, we looked for correlation of those parameters and course of the disease over one year follow up.
Patients And Methods:
We prospectively enrolled 30 patients, 8-24 hours after single or repeated tonic-clonic seizures.
Results:
25 of them had normal perfusion parameters, while 5 had hyperperfusion. Patients with hyperperfusion were tested again, 3 months later. Two of 5 had hyperperfusion also on control measurements. Number of index seizures negatively correlated with concentration of proinflammatory cytokines IL-10, IFN-ϒ and TNF-α in a whole cohort. In patients with hyperperfusion, there were significantly lower concentrations of antiinflammatory cytokine IL-4 and higher concentrations of proinflammatory TNF-a.
Conclusions:
Long lasting blood- brain barrier disruption may be crucial for epileptogenesis in selected patients.
Insights
Brain inflammation and blood-brain barrier disruption may contribute to epilepsy after seizures. Dynamic susceptibility contrast enhanced MRI perfusion and cytokine levels reveal potential biomarkers for disease course.
Area of Science:
- Neuroscience
- Neurology
- Medical Imaging
Background:
- Inflammatory processes in the brain and glial tissue are implicated in epileptogenesis.
- Elevated blood cytokine levels and blood-brain barrier leakage are observed post-seizure.
- Dynamic susceptibility contrast enhanced (DSC) MRI perfusion can detect blood-brain barrier disruption.
Purpose of the Study:
- To investigate postictal brain inflammation using DSC MRI perfusion and plasma cytokine levels.
- To explore correlations between seizure characteristics, cytokine levels, and perfusion parameters.
- To assess the relationship between these parameters and the disease course over one year.
Main Methods:
- Prospective enrollment of 30 patients 8-24 hours after tonic-clonic seizures.
- Assessment of DSC MRI perfusion parameters and plasma cytokine concentrations (IL-10, IFN-ϒ, TNF-α, IL-4).
- Correlation analysis between seizure frequency/type, cytokine levels, perfusion metrics, and one-year disease follow-up.
Main Results:
- Five out of 30 patients exhibited hyperperfusion on DSC MRI; two maintained hyperperfusion at 3-month follow-up.
- A negative correlation was found between the number of index seizures and levels of IL-10, IFN-ϒ, and TNF-α.
- Patients with hyperperfusion showed lower IL-4 and higher TNF-α concentrations compared to normoperfused patients.
Conclusions:
- Persistent blood-brain barrier disruption may play a significant role in epileptogenesis for specific patient groups.
- DSC MRI perfusion and cytokine profiling offer potential insights into the mechanisms underlying postictal brain changes.
- These findings may inform prognostic assessments and therapeutic strategies for epilepsy.
