Association of ictal imaging changes in status epilepticus and neurological deterioration

Abstract

Objective In patients with status epilepticus (SE), the clinical significance of ictal changes on magnetic resonance imaging (MRI) is insufficiently understood. We here studied whether the presence of ictal MRI changes was associated with neurological deterioration at discharge. Methods The retrospective cohort comprised all identifiable patients treated at Odense University Hospital in the period 2008–2017. All amenable MRIs were systemically screened for ictal changes. Patient demographics, electroencephalography, seizure characteristics, treatment, and SE duration were assessed. Neurological status was estimated before and after SE. The predefined endpoint was the association of neurological deterioration and ictal MRI changes. Results Of 261 eligible patients, 101 received at least one MRI during SE or within 7 days after cessation; 43.6% (44/101) had SE due to non‐ or less brain‐damaging etiologies. Patients who received MRI had a longer duration of SE, less frequently had a history of epilepsy, and were more likely to have SE due to unknown causes. Basic characteristics (including electroencephalographic features defined by the Salzburg criteria) did not differ between patients with (n = 20) and without (n = 81) ictal MRI changes. Timing of MRI was important; postictal changes were rare within the first 24 h and hardly seen >5 days after cessation of SE. Ictal MRI changes were associated with a higher risk of neurological deterioration at discharge irrespective of etiology. Furthermore, they were associated with a longer duration of SE and higher long‐term mortality that reached statistical significance in patients with non‐ or less brain‐damaging etiologies. Significance In this retrospective cohort, ictal changes on MRI were associated with a higher risk of neurological deterioration at discharge and, possibly, with a longer duration of SE and poorer survival.

Magnetic Resonance Imaging in Status Epilepticus: Useful Scrying Board or Expensive Stopwatch?

“…Another recent study by Cornwall et al 6 confirms these findings. Following a similar retrospective design, the authors reviewed the acute MRI scans performed in 101 patients, among the 261 who were admitted for SE during a 10-year study period.…”

Postictal Encephalopathy After Status Epilepticus: Outcome and Risk Factors

“…This retrospective cohort study was based on an already existing cohort that was previously used to study the associations of magnetic resonance imaging (MRI), electroencephalography (EEG), and new neurological deficits with long-term outcome [ 9 , 16 , 17 ]. In brief, all adult patients (≥ 18 years old) with first-time, nonanoxic SE (as defined in [ 1 , 18 ]) who received a diagnosis and were treated at the University Hospital of Odense between January 2008 and December 2017 were retrospectively identified based on referrals for acute EEGs, from the International Classification of Diseases, Tenth Edition codes (DG40.3) at discharge and/or from clinical information by reviewing medical records.…”

Die Anwendung der Salzburg-Kriterien in der Diagnose des non-konvulsiven Status epilepticus

“…Seit der Etablierung im Jahr 2015 gab es, neben den bereits erwähnten Validierungsstudien und einigen kritischen Kommentaren, auf die im nächsten Abschnitt weiter eingegangen wird, nach einer Pubmed-Recherche (Suchterm „salzburg AND criteria“, durchgeführt am 24.02.2023) insgesamt 10 weitere Publikationen, die die Salzburg Kriterien verwendeten. Hiervon untersuchten drei Studien die Prävalenz bildgebender Auffälligkeiten im NCSE mittels cMRT 25 bzw. den differentialdiagnostischen Nutzen von MR basierter thalamokortikaler 26 27 oder mittels CT basierter Perfusionsbildgebung 28 .…”