Magnetic resonance imaging findings in focal-onset status epilepticus

Area of Science:

• Neurology
• Radiology
• Neuroimaging

Background:

• Status epilepticus (SE) diagnosis frequently involves Magnetic Resonance Imaging (MRI).
• Characterizing MRI features in SE patients is crucial for understanding disease progression and outcomes.
• Assessing mid-term consequences of baseline MRI findings provides valuable prognostic information.

Purpose of the Study:

• To characterize the specific MRI features observed in patients experiencing status epilepticus (SE).
• To determine the association between MRI findings and clinical as well as electroencephalography (EEG) data in SE patients.
• To analyze the mid-term consequences of initial MRI features identified at the time of SE.

Main Methods:

• Prospective study of consecutive SE patients undergoing brain MRI within 240 hours of SE onset.
• Utilized a comprehensive MRI protocol including T1WI, T2W, FLAIR, and DWI sequences.
• Follow-up MRI scans were obtained after SE resolution in a subset of patients to assess changes.

Main Results:

• MRI abnormalities were detected in 51.7% of SE patients, commonly as T2W/FLAIR and DWI hyperintensities.
• Hippocampal and pulvinar involvement were frequent findings (58.0% and 25.8%, respectively).
• MRI abnormalities correlated with longer SE duration (p=0.013) and lateralized periodic discharges (LPDs) on EEG (p<0.001).
• Mesial temporal sclerosis (MTS) developed in 27.3% of follow-up MRIs, associated with baseline hippocampal edema and LPDs.
• Baseline T2W/FLAIR hyperintensities predicted poorer clinical outcomes (p=0.003).

Conclusions:

• Over half of SE patients exhibit MRI abnormalities.
• Prolonged SE duration and LPDs on EEG are linked to SE-related MRI findings and subsequent MTS development.
• MRI is a valuable tool for assessing SE severity and predicting outcomes.