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Hippocampal volume loss in patients with status epilepticus: A prospective MRI study

Abstract number : 2.452
Submission category : 5. Neuro Imaging / 5A. Structural Imaging
Year : 2022
Submission ID : 2232889
Source : www.aesnet.org
Presentation date : 12/4/2022 12:00:00 PM
Published date : Nov 22, 2022, 05:28 AM

Authors :
Lukas Machegger, MD, MBA, BSC – Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria; Pilar Bosque Varela, MD – Department of Neurology – Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria; Jürgen Steinbacher, PhD – Department of Neuroradiology – Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria; Andreas Oellerer, MSC – Department of Neuroradiology – Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria; Tanja Prüwasser, BSC – Department of Neurology, Department of Mathematics, Paris-Lodron University, Salzburg, Austria – 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 – Neuroscience Institute, Christian Doppler University Hospital, Salzburg, Austria; Research and Innovation Management, Paracelsus Medical University, Salzburg, Austria; Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria; Johannes Pfaff, Prof, MD, MHBA – Department of Neuroradiology – Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria; Mark McCoy, 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; Eugen Trinka, Prof, MD, 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; Neuroscience Institute, Christian Doppler University Hospital, Salzburg, Austria; Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria; Giorgi Kuchukhidze, 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; Neuroscience Institute, Christian Doppler University Hospital, Salzburg, Austria

This is a Late Breaking abstract

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 hippocampal volume loss and whether the duration of SE and the hospitalization length represent risk factors for developing hippocampal atrophy.

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 a hippocampus unilaterally 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, patients with an ictal-interictal pattern in EEG and those with bilateral hippocampal PMA were excluded from the analysis. Voxel-based morphometry with a FreeSurfer (v7.2.0) was performed. Time-dependent hippocampal volume loss rate was calculated by dividing the volume of the affected hippocampus by the volume of the contralateral healthy hippocampus for MRI-1 and MRI-3. Associations between the hippocampal volume loss and the duration of SE, the number of days spent in intensive care unit (ICU) and the total length of hospitalization were analyzed.

Results: Hundred and thirty-nine patients with a definite diagnosis of SE were prospectively recruited between February 20, 2019, and August 1, 2022. PMA were seen in 67/139 (48%) patients in MRI-1. Unilateral hippocampal PMA were seen in 10/67 (15%) patients in MRI-1. MRI-3 was performed in 8/10 patients (four females; median age 64 years, IQR 42-73). Median time lapse between MRI-1 and MRI-3 was 30.5 days (IQR: 25-52). Median duration of SE was 1.63 hours (IQR 0.42-2.86). The majority of patients displayed hippocampal volume loss - 7/8 (88%). The median ratio of hippocampal volume decrease between MRI-1 and MRI-3 was 14% (IQR 2%-34%). There were strong associations between the rate of volume change of hippocampus and the total length of hospitalization (Spearman correlation: -0.862) as well as the number of days spent in ICU (Spearman correlation: -0.723). Moderate association was seen between the duration of SE and hippocampal rate of volume change (Spearman correlation: -0.119).

Conclusions: The majority of patients with SE and hippocampal PMA showed decrease in the volume of hippocampus following SE. The longer the patients stayed at the hospital and particularly in ICU, the greater was the risk of developing hippocampal volume loss after SE.

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