Imaging of Status Epilepticus.

Area of Science:

• Neurology
• Radiology
• Neuroimaging

Background:

• Status epilepticus (SE) diagnosis and etiology are challenging, especially in new-onset cases.
• MRI is vital for identifying causes of SE and aiding diagnosis in non-convulsive SE (NCSE) with unclear EEG.
• MRI is recommended for de novo SE, first SE episodes in known epilepsy, and NCSE with equivocal EEG.

Purpose of the Study:

• To highlight the diagnostic and prognostic value of MRI in status epilepticus.
• To describe peri-ictal MRI alterations and their potential as biomarkers.
• To identify knowledge gaps and future research directions in SE neuroimaging.

Main Methods:

• Review of MRI's role in SE diagnosis and etiology identification.
• Description of peri-ictal MRI (PMA) alterations, including hyper-perfusion, diffusion restriction, and FLAIR-hyperintensity.
• Listing of essential MRI sequences for detecting PMA: DWI, FLAIR, T1-weighted (with/without contrast), and perfusion imaging (e.g., ASL).

Main Results:

• MRI is invaluable for identifying SE causes and diagnosing NCSE with ambiguous EEG.
• Peri-ictal MRI alterations (hyper-perfusion, diffusion restriction, FLAIR-hyperintensity) suggest a "status epilepticus network".
• Patients with PMA show a higher mortality rate, suggesting prognostic value.

Conclusions:

• MRI is a recommended diagnostic tool for specific SE presentations.
• Peri-ictal MRI alterations may serve as prognostic biomarkers for SE outcomes.
• Further quantitative MRI studies with standardized protocols are needed to address remaining questions in SE imaging.