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A Multimodal Imaging- and Stimulation-based Method of Evaluating Connectivity-related Brain Excitability in Patients with Epilepsy
Published on: November 13, 2016
Investigating Peri-Ictal MRI Abnormalities: A Prospective Neuroimaging Study on Status Epilepticus, Seizure Clusters,
Angelo Pascarella1,2,3, Lucia Manzo4, Oreste Marsico1
1Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, 88100 Catanzaro, Italy.
Abstract:
Background/Objectives: Brain magnetic resonance imaging (MRI) often reveals acute peri-ictal abnormalities (PMAs) during or shortly after status epilepticus (SE) but also following single seizures (SiS) or clusters of seizures (CS). However, the incidence, characteristics, and progression remain not clearly known. This study aimed to investigate incidence, clinical correlations, and evolution of PMAs in SE, CS, and SiS patients. Methods: This prospective observational study enrolled patients with SE, CS, and SiS who underwent MRI within 120 h of the ictal event. Demographic, clinical, EEG, and MRI data were collected. Patients with PMAs (PMAs+) underwent serial follow-up MRI. Incidence, association with clinical characteristics, and progression of PMAs were analyzed across the three groups. Results: Among 76 patients (30 SE, 22 CS, 24 SiS), PMAs were observed in 31 (41%), with a significant difference between groups (p = 0.011), as PMAs were less frequent in SiS (17%) compared to SE (57%) and CS (45%) patients. Acute symptomatic SE/seizures were significantly more common in PMAs+ compared to PMAs- in the overall cohort (52% vs. 29%; p = 0.045) and in the SiS group (100% vs. 25%; p = 0.031). History of epilepsy was less frequent in PMAs+ in the whole cohort (13% vs. 40%; p = 0.011) and in SE in particular (12% vs. 46%, p = 0.049). No association between PMAs and seizure type, SE duration, etiology, time to MRI, and EEG findings (p > 0.005) was found. The temporal cortex and hippocampus were most frequently affected by PMAs. Follow-up MRI performed in 16 patients showed resolution of PMAs in 75% (5/7 SE, 3/6 CS, 3/3 SiS) within a median time of 24 days (IQR: 8-39). Conclusions: PMAs were more common in SE and CS than in SiS. Acute underlying pathology was frequently associated with PMAs. While duration of ictal activity is an important factor, it was not the sole determinant. Most PMAs resolved, particularly in SiS. Further studies are needed to clarify the pathophysiological mechanism and clinical implications of PMAs.
Insights
Acute brain abnormalities (PMAs) after seizures are more common in status epilepticus (SE) and seizure clusters (CS) than single seizures (SiS). Most PMAs resolve over time, especially in SiS, and are often linked to acute underlying pathologies.
Area of Science:
- Neurology
- Radiology
- Epileptology
Background:
- Acute brain magnetic resonance imaging (MRI) abnormalities, termed peri-ictal abnormalities (PMAs), are observed after seizures but their incidence, characteristics, and progression are not well understood.
- PMAs can occur after status epilepticus (SE), clusters of seizures (CS), or single seizures (SiS).
Purpose of the Study:
- To investigate the incidence, clinical correlations, and evolution of PMAs in patients experiencing SE, CS, and SiS.
- To compare PMA frequency and characteristics across different seizure types.
Main Methods:
- A prospective observational study enrolled 76 patients (30 SE, 22 CS, 24 SiS) who underwent MRI within 120 hours of an ictal event.
- Demographic, clinical, EEG, and MRI data were collected, with serial follow-up MRIs for patients with PMAs.
- Statistical analyses were performed to assess incidence, associations with clinical factors, and PMA progression.
Main Results:
- PMAs were detected in 41% of patients, with significantly higher incidence in SE (57%) and CS (45%) compared to SiS (17%).
- PMAs were associated with acute symptomatic seizures and less frequently with a history of epilepsy.
- The temporal cortex and hippocampus were the most commonly affected areas, and 75% of PMAs resolved on follow-up MRI within a median of 24 days.
Conclusions:
- PMAs are more prevalent in SE and CS than SiS, often linked to acute pathologies.
- While seizure duration is a factor, it's not the sole determinant of PMA occurrence.
- The majority of PMAs demonstrate resolution, particularly in the context of SiS, suggesting a generally favorable prognosis for these imaging findings.
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