Authors :
Presenting Author: Julia Pottkämper, MSc – University of Twente, Enschede, The Netherlands
Joey Verdijk, MD – Rijnstate Hospital Arnhem, The Netherlands; Eva Aalbregt, MSc – Department of Radiology and Nuclear Medicine – Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Sven Stuiver, MSc – Rijnstate Hospital Arnhem, The Netherlands; Laurens van de Mortel, MSc – Department of Psychiatry – Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; David Norris, prof.dr. – Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Michel van Putten, prof.dr.ir. – Clinical Neurophysiology – University of Twente, Enschede, The Netherlands; Jeannette Hofmeijer, prof.dr. – Clinical Neurophysiology – University of Twente, Enschede, The Netherlands; Guido van Wingen, prof.dr. – Department of Psychiatry – Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Jeroen van Waarde, MD – Rijnstate Hospital Arnhem, The Netherlands
Rationale:
Postictal symptoms may result from cerebral hypoperfusion as a consequence of seizure-induced vasoconstriction (Farrell et al., 2016, eLife; doi: 10.7554/eLife.19352). Longer seizures led to more severe postictal hypoperfusion in rats and epilepsy patients. Here, we studied cerebral perfusion after generalized seizures elicited by electroconvulsive therapy (ECT) and its relation to seizure duration. Methods:
Arterial spin labeling magnetic resonance imaging (ASL-MRI) scans of 24 ECT patients were acquired before the ECT-course (baseline) and approximately one hour after an ECT-induced seizure (postictal) to quantify global and regional gray matter cerebral blood flow (CBF). Twenty-seven healthy controls were scanned twice with an interval of six weeks to control for test-retest variability. Per participant, postictal perfusion maps were compared to baseline maps. We performed hypothesis-driven Bayesian analyses to explore global and regional perfusion changes. Associations between postictal CBF changes and seizure duration were investigated in all patient models. Results:
On group level, no global CBF changes were found when comparing patients and healthy controls. When investigating CBF changes over time in patients, seizure duration was negatively associated with change in global (-0.43 [-0.74 - -0.13]CI95) and regional postictal perfusion in the cingulate gyrus (-0.50 [-0.83 - -0.16]CI95), the inferior frontal gyrus (-0.49 [-0.86 - -0.12]CI95), and insula (-0.40 [-0.66 - -0.13]CI95). Seizure duration ranged from 25 s to 114 s.
The longest seizure (114 s) was associated with decreases of 28 ml/100g/min in global postictal perfusion and decreases in regional postictal perfusion in the inferior frontal gyrus (38.2 ml/100g/min), cingulate gyrus (37 ml/100g/min), and insula (28.7 ml/100g/min).
The shortest seizure (25 s) showed relatively small perfusion increases in global postictal perfusion (15.4 ml/100g/min) and regional postictal perfusion in the inferior frontal gyrus (16 ml/100g/min), cingulate gyrus (19.6 ml/100g/min), and insula (11.4 ml/100g/min). The amygdala, caudate, and putamen showed a trend towards a negative association with seizure duration.Conclusions:
We show a clear relation between seizure duration and postictal perfusion changes with a global and regional decrease with longer seizures and increase with shorter seizures at approximately one hour post seizure. This implies that postictal cerebral perfusion probably depends on seizure duration. Our results support the postictal hypoperfusion hypothesis.Funding:
This work has been funded by the Dutch National Epilepsy Fund (WAR 19-02).