Authors :
Presenting Author: Giorgi Kuchukhidze, MD, PhD – Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
Pilar Bosque-Varela, MD PhD – Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
Lukas Machegger, MD, PhD – Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
Nicolas Jannone-Pedro, MD – University and Polytechnic La Fe Hospital, Member of the European Reference Network EpiCARE, Valencia, Spain
Johannes Pfaff, MD – Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
Eugen Trinka, MD – Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
Kateriine Orav, MD – Reference Network EpiCARE, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria; North Estonia Medical Centre, Tallinn, Estonia
Rationale:
Status epilepticus (SE) is a common neurological emergency frequently associated with peri-ictal MRI abnormalities (PMA). PMA are seen in different MRI sequences including diffusion weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR). SE-associated diffusion restriction or/and FLAIR-hyperintensity. PMA affect brain areas such as cortex, hippocampus, and pulvinar of thalamus, corpus callosum, claustrum, etc. Our aim was to evaluate the association of the location of PMA with the occurrence of unprovoked seizures in patients with de novo SE.
Methods:
Adult patients diagnosed with SE were prospectively recruited at the Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria, between February 2019 and April 2024. One hundred and thirty-five patients with de novo SE and MRI performed within 48 hours of SE diagnosis were identified. MRI scans were assessed for the occurrence and location of SE-associated PMA on DWI and FLAIR sequences by two independent reviewers. The occurrence of unprovoked seizures after de novo SE was assessed through retrospective digital in- and outpatient hospital records review and telephone interviews. Follow-up data were acquired until April 8th, 2025. Patients were excluded due to no PMA on DWI/FLAIR sequences (n= 96) and occurrence of no seizures during a follow-up of less than six months (n=3).
Results:
Thirty-six patients with de novo SE and PMA on DWI/FLAIR sequences were included in the study. Twenty out of 36 (55%) of these patients developed unprovoked seizures during a median follow-up of 29 (IQR 13-45) months. PMA occurred in non-neocortical structures in 16/36 (44%) of patients, in neocortical structures in 14/36 (39%) of patients, and both neocortical and non-neocortical structures were involved in 6/36 (17%) of patients. The following subcortical structures were affected: hippocampus (13/22, 59% patients), pulvinar of thalamus (5/22, 23% patients), both pulvinar and hippocampus (3/22, 14% patients), and caudate nucleus (1/22, 4% patients). In the cortex PMA were most frequently located in the temporal lobe (12/20, 60% patients). The occurrence of seizures in patients stratified by location of PMA on DWI/FLAIR are shown in Figure 1. Around 60% of patients with PMA involving the hippocampus, frontal or temporal lobes developed unprovoked seizures during follow-up. Forty percent of patients with pulvinar involvement developed seizures. No patients with cortical PMA in the parietal or occipital lobes had seizures during the follow-up period.
Conclusions:
PMA location in hippocampus and fronto-temporal cortices represents a risk factor for developing seizures following the episode of de novo SE. These results have to be, however, confirmed on a larger series of patients with SE and PMA.
Funding:
This study was supported by FWF (Austrian Science Fund), project number KLI 969-B