What Is the Right Timepoint t2 in Status Epilepticus? – One Size Does Not Fit All
Abstract number :
2.306
Submission category :
5. Neuro Imaging / 5A. Structural Imaging
Year :
2024
Submission ID :
735
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Giorgi Kuchukhidze, MD, PhD – Department of Neurology, Christian Doppler University Hospital, Centre for Cognitive Neuroscience, Affiliated Member of the European Reference Network EpiCARE, Paracelsus Medical University, Salzburg, Austria
Pilar Bosque Varela, MD, PhD – Department of Neurology, Christian Doppler University Hospital, Centre for Cognitive Neuroscience, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, Austria
Lukas Machegger, MD, PhD – Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
Tanja Prüwasser, MSc – Department of Neurology, Christian Doppler University Hospital, Centre for Cognitive Neuroscience, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, Austria
Jürgen Steinbacher, PhD – Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
Andreas Öllerer, PhD – Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
Georg Zimmermann, PhD – Department of Neurology, Christian Doppler University Hospital, Centre for Cognitive Neuroscience, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, Austria
Johannes Pfaff, MD, Prof. – Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
Mark McCoy, MD, Prof. – Department of Neurology, Christian Doppler University Hospital, Centre for Cognitive Neuroscience, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, Austria
Bernardo Crespo Pimentel, MD – Department of Neurology, Christian Doppler University Hospital, Centre for Cognitive Neuroscience, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, Austria
Markus Leitinger, MD, Prof. – Department of Neurology, Christian Doppler University Hospital, Centre for Cognitive Neuroscience, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, Austria
Eugen Trinka, MD, Prof. – Department of Neurology, Christian Doppler University Hospital, Centre for Cognitive Neuroscience, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, Austria
Rationale: Status epilepticus (SE) is a common neurological emergency with high mortality and morbidity. Despite advances in SE treatment, around 50% of patients do not respond to the first line therapies, leading to brain injury or alteration of cerebral networks. This study aimed investigating timing of occurrence of peri-ictal MRI abnormalities (PMA) – a possible surrogate marker of cerebral injury (time to injury - t2).
Methods: We prospectively enrolled adult patients with SE and an MRI between Feb. 2019 and Dec. 2023. We investigated the occurrence of diffusion restriction or FLAIR- hyperintensity at different time points during and after SE focusing on SE duration its semiology, etiology and patients’ level of consciousness (LOC). A predictive probability model, employing logistic regression, integrated clinical factors (clinical duration, semiology, LOC, etiology) to predict development of PMA.
Results: We included 256 patients with SE; among them, 137/256 (53%) had PMA.
Logistic regression analysis, revealed that SE semiology, LOC and certain etiologies were associated with a higher likelihood of FLAIR-hyperintensity and diffusion restriction. Patients with non-convulsive SE (NCSE) had FLAIR-hyperintensity and diffusion restriction more frequently as compared to those with SE with prominent motor symptoms (SE-PM): (OR= 4.22, 95% CI: 2.11-8.80, p=0.001, adjusted) and (OR=5.63, 95% CI: 2.88-11.46, p< 0.001, adjusted), respectively.
Individuals in stupor or coma demonstrated higher incidence of FLAIR-hyperintensity and diffusion restriction as opposed to those who were alert or somnolent (OR=5.60, 95% CI: 2.85-11.35, p< 0.001) and (OR=5.34, 95% CI: 2.72-10.81, p=< 0.001, adjusted), respectively. Acute primary and secondary CNS pathologies, such as cerebrovascular disease, active CNS infections, head trauma, metabolic disturbances, systemic infections, were more commonly associated with FLAIR-hyperintensity compared to other etiologies (e.g. withdrawal of antiseizure medication, febrile illness, etc.) (OR=3.125, 95% CI: 1.61-6.25, p=0.015, adjusted).
Likelihood of developing FLAIR-hyperintensity and diffusion restriction increased over time under influence of SE semiology, etiology, and LOC. Chances of developing FLAIR-hyperintensity would be the highest in patients with NCSE and acute primary and secondary CNS pathologies even 10 minutes after the onset of SE in patients with stupor/coma (81%) but also in those who would be alert/somnolent (44%). In the same group of patients, chances of developing diffusion restriction at 10 minutes would be 85%, at 24h – 91.5% and at 48h – 95%. As opposed to this group, the possibility of developing FLAIR-hyperintensity or diffusion restriction in alert/somnolent patients with SE-PM at 24h after the onset of SE would be 5% and 4%, respectively and at 48h – 11% and 6%, respectively.
Conclusions: We propose a novel multimodal approach predicting possible cerebral injury based on MRI data, patients’ LOC, etiology and duration of SE. Our model offers insights into the risk of brain injury and may help tailoring treatment in SE.
Funding: FWF, Austrian Science Fund; Project Number KLI 969-B
Neuro Imaging