Bosque Varela P, Machegger L, Steinbacher J, Oellerer A, Pfaff J, McCoy M, Trinka E, Kuchukhidze G
Department of Neurology, Christian Doppler University Hospital, Centre for Cognitive Neuroscience, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, Austria.
Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria.
Epilepsy Behav. 2024 Dec;161:110081. doi: 10.1016/j.yebeh.2024.110081. Epub 2024 Oct 28.
Status epilepticus (SE) is a severe neurological condition that might lead to long-term consequences such as neuronal death. This study investigated whether SE leads to brain volume loss by characterizing the dynamic of peri-ictal MRI abnormalities (PMA) through follow-up MRIs and assessing whether SE duration and specific outcome characteristics are associated with brain atrophy.
A prospective single-center cohort study enrolled 590 adult patients with definitive or possible SE. MRI in an acute setting was performed in 353/590 (60 %) patients. Follow-up MRIs at one week and one month were conducted to assess the reversibility of PMA. Measurements of diffuse brain volume were performed by employing a voxel-based morphometry with FreeSurfer, comparing an initial MRI with a follow-up test done four weeks after the initial one. The study analyzed the correlation between brain volume loss, SE duration, and clinical outcomes.
PMA were observed in 156/353 (44 %) patients in at least one MRI sequence. In 44/83 (53 %) patients, PMA were reversible in one week. PMA persisted in 39/83 (47 %) patients. A second follow-up MRI was performed four weeks after the initial MRI in 33/39 (85 %) patients. In 14/33 (42 %), the MRI showed signs of focal atrophy, mostly in hippocampus. Volumetric analysis performed in patients who underwent two follow-up MRIs, indicated that 85 % of patients (28/33) had a decreased diffuse brain volume, with a median volume reduction of 16 %. A moderate negative correlation was found between diffuse brain volume and SE duration (Spearman correlation: -0.57) as well as hospitalization length (Spearman correlation: -0.60). This indicates that longer SE duration and extended hospitalization were associated with a greater brain volume loss.
In this prospective study, a proportion of patients displayed cerebral volume loss following a SE. These patients had longer duration and worse outcome of SE. However, the findings should be interpreted with caution due to several limitations, including the lack of consideration for underlying etiologies that may contribute to volume loss.
癫痫持续状态（SE）是一种严重的神经系统疾病，可能导致诸如神经元死亡等长期后果。本研究通过随访磁共振成像（MRI）来描述发作期周围MRI异常（PMA）的动态变化，并评估SE持续时间和特定结局特征是否与脑萎缩相关，以此调查SE是否会导致脑容量减少。
一项前瞻性单中心队列研究纳入了590例确诊或可能患有SE的成年患者。353/590（60%）例患者在急性期进行了MRI检查。在一周和一个月时进行随访MRI，以评估PMA的可逆性。采用基于体素的形态测量法（使用FreeSurfer）测量全脑体积，将初始MRI与初始检查四周后的随访检查进行比较。该研究分析了脑容量减少、SE持续时间和临床结局之间 的相关性。
在至少一个MRI序列中，156/353（44%）例患者观察到PMA。在44/83（53%）例患者中，PMA在一周内可逆。39/83（47%）例患者的PMA持续存在。33/39（85%）例患者在初始MRI四周后进行了第二次随访MRI。在14/33（42%）例患者中，MRI显示局灶性萎缩迹象，主要位于海马体。对接受两次随访MRI检查的患者进行的体积分析表明，85%的患者（28/33）全脑体积减小，体积中位数减少16%。全脑体积与SE持续时间（Spearman相关性：-0.57）以及住院时间（Spearman相关性：-0.60）之间存在中度负相关。这表明SE持续时间越长和住院时间越长，脑容量损失越大。
在这项前瞻性研究中，一部分患者在SE后出现脑容量损失。这些患者的SE持续时间更长，结局更差。然而，由于存在一些局限性，包括未考虑可能导致体积损失的潜在病因，这些发现应谨慎解读。
