Brain Volume Loss After Status Epilepticus: A Prospective Longitudinal MRI Study
Abstract number :
2.177
Submission category :
5. Neuro Imaging / 5A. Structural Imaging
Year :
2022
Submission ID :
2204893
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:27 AM
Authors :
Giorgi Kuchukhidze, MD, PhD – Christian Doppler University Hospital, Centre for Cognitive Neuroscience, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, Austria. Neuroscience Institute, Christian Doppler University Hospital, Salzburg, Austria; Pilar Bosque Varela, MD – 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 – Neuroradiology – Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria; Andreas Oellerer, MSc – Neuroradiology – Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria; Jürgen Steinbacher, PhD – Neuroradiology – Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria; Tanja Prüwasser, MSc – Neurology – Christian Doppler University Hospital, Centre for Cognitive Neuroscience, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, Austria. Paris-Lodron University, Salzburg, Austria.; Georg Zimmermann, PhD – Department of Mathematics, Paris-Lodron University, Salzburg, Austria. Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University. Research and Innovation Management, Paracelsus Medical University, Salzburg Austria; Johannes Pfaff, Prof. , MD – Neuroradiology – Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria; Mark McCoy, MD – Neurology and Neuroradiology – Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria; Eugen Trinka, Prof. , MD – Neurology – Christian Doppler University Hospital, Centre for Cognitive Neuroscience, Member of the European Reference Network EpiCARE, Paracelsus Medical University, Salzburg, Austria. Neuroscience Institute, Christian Doppler University Hospital, Salzburg, Austria. Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria.
Rationale: Status epilepticus (SE) may have long-term consequences such as neuronal injury, neuronal death and alterations of neuronal networks. Based on animals models it is presumed that irreversible changes may occur in brain if tonic-clonic SE lasts longer than 30 minutes and focal SE with impaired consciousness – for longer than 60 minutes. The time point, when irreversible changes in brain occur, is not known for other forms of SE, including non-convulsive SE (NCSE). In this study, we aimed to determine whether SE is associated with a cerebral volume loss and whether the duration of SE and the hospitalization length represent risk factors for developing long-term consequences.
Methods: Patients with a definite electro-clinical diagnosis of SE were prospectively recruited. All patients underwent an acute MRI (MRI-1) within the first 48 hours after the onset of SE. Those patients who displayed peri-ictal MRI abnormalities (PMA) in an MRI-1, underwent two follow-up MRIs: I) one week after the initial MRI (MRI-2) and II) one to three months following the MRI-1 (MRI-3). Patients with a global cerebral hypoxia due to cardiac arrest and patients with an ictal-interictal pattern in EEG were excluded from the analysis. Voxel-based morphometry with a FreeSurfer (v7.2.0) was performed. The ventricle-brain ratio (VBR) was calculated by dividing the volume of ventricles by the volume of the whole brain. We compared VBR of two MRIs: MRI-1 and MRI-3. We correlated the degree of brain volume loss with the duration of SE, days spent in ICU and the total number of days spent at hospital.
Results: Hundred and thirty-nine patients with a definite diagnosis of SE were prospectively recruited between February 20, 2019, and May 9, 2022. PMA were seen in 67/139 (48%) patients in MRI-1. MRI-2 was performed in 45/67 (67%) patients and MRI-3 – in 18/45 (40%) patients. The median age of these 18 patients was 62 years, IQR 52-72; 11 females. Median time lapse between MRI-1 and MRI 3 was 29 days (IQR 26-41). Median duration of SE was 2.5 hours (IQR 1-4). The most frequent etiologies of SE were chronic cerebrovascular disease (35%), cryptogenic (25%), metabolic disease (5%), intracranial tumors (5%), etc. Brain volume loss was seen in 16/18 (89%) patients. The median VBR was -0,09 (IQR -0.17 and -0.03). A weak association between the duration of SE and loss of brain volume was seen (Spearman correlation -0.305). There was also a weak association between the number of days at hospital and brain volume loss (Spearman correlation: -0.39) However, a strong association between the days spent in intensive care unit and brain volume loss was observed (Spearman correlation: -0.739).
Conclusions: In the majority of patients of this cohort, brain volume loss after SE was observed. The duration of SE and the hospitalization time were weakly associated with the risk of brain volume loss. However, the longer the patients required treatment in the intensive care unit the higher were the chances of developing brain volume loss.
Funding: This study has been supported by FWF, Austrian Science Fund; Project number KLI 696.
Neuro Imaging