Abstracts

Rationale: In patients with frequent uncontrolled seizures, acute MRI findings can become a diagnostic quandary: are changes in the MRI the cause of epileptic seizures or the sequelae to the seizures? Transient MRI abnormalities in patients with Epilepsia Partialis Continua (EPC) have been reported in the literature.Methods: Here we report on 3 patients with multiple seizures over several days that developed acute changes in brain MRI. We analyzed Diffusion Weighted (DW) and Fluid Attenuated Inversion Recovery (FLAIR) MRI sequences in these patients during the acute phase and followed the clinical course and MRIs of these patients.Results: In all the patients, both FLAIR and DW MRI showed signal changes. The mesial temporal lobe was involved unilaterally in the first two patients, and the left posterior parietal lobe was involved in the third. Seizures were controlled with classic antiepileptics (phenytoin or valproate) with add-on therapy (topiramate or levetiracetam) in two cases. Seizure control was achieved within 3 days. At follow-up, all patients were free of seizures. Repeat MRIs done at one month and one week showed complete resolution of the FLAIR and DW changes. Conclusions: Transient changes in brain MRI can occur secondary to prolonged or multiple seizures. Understanding this concept can prevent further unnecessary work-up for diagnosis of etiology of seizures. Previous studies reporting transient FLAIR and T2 abnormalities in status epilepticus attribute these to focal cerebral edema. While increased DW signal suggests cytotoxic edema, its complete resolution more strongly indicates a reversible process such as vasogenic edema. These cases add to the existing literature reporting transient MRI abnormalities in patients with EPC. A good outcome in terms of full resolution of brain lesions and full clinical recovery can be expected.