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Abstracts

Duration of Status Epilepticus Determines Development of Peri-ictal MRI Abnormalities

Abstract number : 2.172
Submission category : 5. Neuro Imaging / 5A. Structural Imaging
Year : 2022
Submission ID : 2204605
Source : www.aesnet.org
Presentation date : 12/4/2022 12:00:00 PM
Published date : Nov 22, 2022, 05:25 AM

Authors :
Pilar Bosque Varela, MD – 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; Jürgen Steinbacher, Mr – Neuroradiology – Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria; Andreas Oellerer, Mr – Neuroradiology – Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria; Tanja Prüwasser, Ms – Neurology – Christian Doppler University Hospital, Centre for Cognitive Neuroscience, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, Austria. Department of Mathematics, 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, Salzburg, Austria. Research and Innovation Management, Paracelsus Medical University, Salzburg, Austria; Johannes Pfaff, Prof – Neuroradiology – Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria; Mark McCoy, MD – Neurology – Christian Doppler University Hospital, Centre for Cognitive Neuroscience, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, Austria; Eugen Trinka, Prof – Neurology – 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. Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria; Giorgi Kuchukhidze, PhD – Neurology – 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

Rationale: Peri-ictal MRI abnormalities (PMA) may occur in patients with status epilepticus (SE). However, it is not yet known which factors determine development of PMA in a given patient. Semiology and type of SE, its duration, etiology and EEG patterns have been implied as possible risks for developing PMA in patients with SE. In this prospective study, we aimed to determine whether the duration of SE and its semiology can predict the occurrence of PMA.

Methods: Patients with a definite electro-clinical diagnosis of SE who underwent MRI with a SE protocol within the first 48 hours due to clinical needs were prospectively recruited. Patients with global cerebral hypoxia due to cardiac arrest and patients with an ictal-interictal pattern in EEG were excluded. We performed a logistic regression for determining whether a duration of SE may influence occurrence of PMA. We divided the whole cohort into groups of patients based on semiology and duration of SE: (1) patients with convulsive status epilepticus (CSE); (2) patients with non-convulsive status epilepticus (NCSE); (3) patients with initial CSE which later developed into NCSE. We arbitrarily proposed a time cut-off of 30 minutes for CSE and of 60 minutes for NCSE in order to determine the risk of developing PMA for each group based on the length of SE.

Results: We prospectively recruited 256 patients with a possible electro-clinical diagnosis of SE between 20th of February 2019 and 06th of April 2022. After applying inclusion and exclusion criteria, we analyzed the data of 118 patients (53 females, median age 69 years; IQR 53-77). PMA were seen in 62/118 (53%) of patients. Median duration of SE was 2.5 hours (IQR 1-6) and median time lapse between the onset of SE and MRI was 8.8 hours (IQR 3-24). After excluding one outlier (patient with a very long duration of SE and normal MRI), duration of SE correlated positively with the chance of developing PMA (p=0.005; Holm adjustment: p=0.02). The following types of SE were observed: CSE – 68/118 (57%); NCSE – 41/118 (35%) and CSE evolving into NCSE – 9/118 (8%). The majority of patients with CSE-NCSE - 7/9 (78%) and more than half of patients with NCSE - 23/41 (56%) had PMA. In CSE, PMA was seen in 27/68 (40%) of patients. In a logistic regression analysis, if a duration of CSE was longer than 30 minutes, 52% of patients showed PMA. However, if the duration of CSE was shorter than 30 minutes, only 20% of patients would develop PMA (odds ratio 4.36; p=0.03, Holm adjustment: p=0.075). In 70% of patients with NCSE and CSE-NCSE, PMA were registered if SE lasted longer than 60 minutes. If NCSE and CSE-NCSE lasted shorter than 60 minutes, only 33% would develop PMA (odds ratio 4.66; p=0.09; Holm adjustment: p=0.098).

Conclusions: The longer the SE lasts, the higher the risk of developing PMA, irrespective of SE type. The time points when the chances of developing PMA increase, are 30 minutes for CSE and 60 minutes for NCSE and CSE-NCSE.

Funding: This study has been supported by FWF, Austrian Science Fund; Project number KLI 696.
Neuro Imaging