Authors :
Presenting Author: Takafumi Kubota, MD – Tohoku University Graduate School of Medicine
Mizuki Otomo, MD – Neurology – National Hospital Organization Sendai Medical Center; Noriko Kurihara, MD – Radiology – National Hospital Organization Sendai Medical Center; Genya Watanabe, MD – Neurology – National Hospital Organization Sendai Medical Center; Kenichi Tsukita, MD – National Hospital Organization Sendai Medical Center; Yasushi Suzuki, MD – National Hospital Organization Sendai Medical Center
Rationale: Reversible splenial lesion syndrome is a rare neurological disorder with a good prognosis seen in East Asia. However, the risk of de novo epilepsy following reversible splenial lesion syndrome has not been investigated. Therefore, we aimed to clarify the association between reversible splenial lesion syndrome and de novo epilepsy.
Methods: This is a single-center cohort study conducted at the Sendai Medical Center in Japan. Inclusion criteria are (1) patients with
reversible splenial lesions on diffusion-weighted imaging of magnetic resonance imaging (MRI) and without previous epilepsy between February 2008 and May 2023 and (2) those patients followed for at least one month. The outcome is de novo epilepsy after reversible splenial lesion syndrome without other etiologies of epilepsy. We described the characteristics of this cohort and divided it into two groups: Group A with de novo epilepsy and Group B without de novo epilepsy. We statistically compared the variables during the acute phase between the two groups. Statistical analysis was performed using a t-test, Man-Whitney U test, or Fisher’s exact test.
Results: Twenty-two patients (Males 11/22; 50%) met our criteria. The mean age and mean follow-up duration were 37 ± 20 years and 1765.9 ± 1763.5 days, retrospectively. The etiologies of reversible splenial lesions included infection (10/22; 45.5%), cerebrovascular disorder (3/22; 13.6%), and others (8/22; 36.4%). Acute symptoms included fever (14/22; 63.6%), altered mental status (19/22; 86.4%), seizure (8/22; 36.4%), and status epilepticus (2/22; 9.1%). MRI showed splenial lesions (mean vertical length 7.0 ± 1.7mm and mean horizontal length 14.2 ± 7.6 mm) and extra splenium lesions of corpus callosum (1/22; 4.5%). Electroencephalography showed generalized slow waves (3/5; 60.0%), and focal slow waves (1/5; 20.0%), but did not show any epileptiform discharges (0/5; 0%). They were treated by antibiotics (11/22; 50.0%), acyclovir (7/22; 31.8%), anti-seizure medications (5/22; 22.7%), and steroids (4/22; 18.2%). Although all patients were alive, 27.3% (6/22) of them had neurological complications and 9.1% (2/22) developed de novo epilepsy. In comparison with Group A and Group B, status epilepticus (2 vs 0;
p = 0.001), long horizontal splenial lesions (24.7 mm vs 13.2mm;
p= 0.04), use of anti-seizure medication (3 vs 2;
p = 0.04) were significantly more common in patients with de novo epilepsy than in those without it.
Conclusions: Status epilepticus and long horizontal splenial lesions during the acute phase of reversible splenium lesions might be associated with the increased risk of the development of epilepsy.
Funding: No funding.