Epilepsy Unit, hôpital Gui-de-Chauliac, 80, avenue Fliche, 34295 Montpellier cedex 05, France; Research Unit (URCMA: unité de recherche sur les comportements et mouvements anormaux), INSERM, U661, 34000 Montpellier, France.
Centre Saint-Paul-H, Gastaut, Marseille, France.
Rev Neurol (Paris). 2021 Apr;177(4):359-369. doi: 10.1016/j.neurol.2020.09.005. Epub 2021 Jan 22.
Magnetic resonance imaging (MRI) can now be used to diagnose or to provide confirmation of focal nonconvulsive status epilepticus (NCSE). Approximately half of patients with status epilepticus (SE) have signal changes. MRI can also aid in the differential diagnosis with generalized NCSE when there is a clinical or EEG doubt, e.g. with metabolic/toxic encephalopathies or Creutzfeldt-Jakob disease. With the development of stroke centers, MRI is available 24h/24 in most hospitals. MRI has a higher spatial resolution than electroencephalography (EEG). MRI with hyperintense lesions on FLAIR and DWI provides information related to brain activity over a longer period of time than a standard EEG where only controversial patterns like lateralized periodic discharges (LPDs) may be recorded. MRI may help identify the ictal nature of LPDs. The interpretation of EEG tracings is not easy, with numerous pitfalls and artifacts. Continuous video-EEGs require a specialized neurophysiology unit. The learning curve for MRI is better than for EEG. It is now easy to transfer MRI to a platform with expertise. MRI is more accessible than single photon emission computed tomography (SPECT) or positron emission tomography (PET). For the future, it is more interesting to develop a strategy with MRI than SPECT or PET for the diagnosis of NCSE. With the development of artificial intelligence, MRI has the potential to transform the diagnosis of SE. Additional MRI criteria beyond the classical clinical/EEG criteria of NCSE (rhythmic versus periodic, spatiotemporal evolution of the pattern…) should now be systematically added. However, it is more complicated to move patients to MRI than to perform an EEG in the intensive care unit, and at this time, we do not know how long the signal changes persist after the end of the SE. Studies with MRI at fixed intervals and after SE cessation are necessary.
磁共振成像（MRI）现在可用于诊断或确认局灶性非惊厥性癫痫持续状态（NCSE）。大约一半的癫痫持续状态（SE）患者有信号改变。当临床或脑电图存在疑问时，如代谢/中毒性脑病或克雅氏病，MRI 还可辅助进行鉴别诊断，与广义 NCSE 相区别。随着卒中中心的发展，MRI 在大多数医院 24 小时/天可用。MRI 的空间分辨率高于脑电图（EEG）。MRI 显示 FLAIR 和 DWI 上的高信号病变，提供了比标准 EEG 更长时间的脑活动相关信息，标准 EEG 仅可记录有争议的模式，如偏侧周期性放电（LPD）。MRI 可帮助确定 LPD 的发作性质。脑电图描记的解释并不容易，存在许多陷阱和伪影。连续视频脑电图需要专门的神经生理学单位。MRI 的学习曲线优于 EEG。现在，将 MRI 转移到具有专业知识的平台上变得更加容易。MRI 比单光子发射计算机断层扫描（SPECT）或正电子发射断层扫描（PET）更易获得。对于未来，与 SPECT 或 PET 相比，使用 MRI 制定 NCSE 诊断策略更有意义。随着人工智能的发展，MRI 有可能改变 SE 的诊断。现在应该系统地添加除 NCSE 的经典临床/脑电图标准（节律性与周期性、模式的时空演变……）之外的 MRI 标准。然而，与在重症监护病房进行 EEG 相比，将患者转移到 MRI 更复杂，并且目前我们不知道 SE 结束后信号改变会持续多久。有必要进行 MRI 间隔固定和 SE 停止后的研究。
