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Research Article
November 28, 2022
continuing medical education

Association of Peri-ictal MRI Abnormalities With Mortality, Antiseizure Medication Refractoriness, and Morbidity in Status Epilepticus

February 28, 2023 issue
100 (9) e943-e953
Letters to the Editor

Abstract

Background and Objectives

Status epilepticus (SE) is a life-threatening emergency requiring a prompt assessment of patient prognosis to guide management. MRI allows the identification of peri-ictal MRI abnormalities (PMAs) and provides insight into brain structural modifications induced by SE. However, little is known about the significance of PMA in SE prognosis. The aim of this study was to determine whether PMAs are associated with an increased mortality in SE and to establish the association between PMA and refractoriness to antiseizure medications, complications encountered, and induced morbidity.

Methods

We conducted a retrospective observational cohort study including all eligible consecutive patients over 15 years old and hospitalized with SE at Bordeaux University Hospital (France) between January 2015 and December 2019. The primary end point was in-hospital mortality. A dedicated neuroradiologic reassessment was performed, together with a comprehensive medical review assessing baseline characteristics, in-hospital death, SE characterization, drug refractoriness, and following outcome in survivors.

Results

Of 307 patients included, 79 (26%) showed PMA related to SE. Demographic, functional status at baseline and median delay between SE onset and MRI examination were similar in the PMA-positive and PMA-negative groups. In-hospital death occurred in 15% (45/307) patients and was significantly higher in the PMA-positive group (27%, 21/79 vs 11%, 24/228; p < 0.001). In multivariate analysis, the presence of PMA (odds ratio [OR] 2.86, 95% CI 1.02–8.18; p = 0.045), together with SE duration (OR 1.01, 95% CI 1.01–1.02; p = 0.007), older age at SE onset (OR 1.05, 95% CI 1.01–1.09; p = 0.013), preexisting ultimately fatal comorbidity (OR 4.01, 95% CI 1.56–10.6; p = 0.004), and acute lesional SE etiology (OR 3.74, 95% CI 1.45–10.2; p = 0.007) were independent predictors associated with in-hospital death. Patients with PMA had a higher risk of refractory SE (71 vs 33%, p < 0.001). Among survivors, delayed-onset epilepsy (40% vs 21%, p = 0.009) occurred more frequently in the PMA-positive group.

Discussion

PMA-positive cases had a higher mortality rate in the largest cohort so far to assess the prognosis value of PMA in SE. As a noninvasive and easily available tool, PMA represents a promising structural biomarker for developing a personalized approach to prognostication in patients with SE receiving MRI.

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References

1.
Leitinger M, Trinka E, Giovannini G, et al. Epidemiology of status epilepticus in adults: a population-based study on incidence, causes, and outcomes. Epilepsia. 2019;60(1):53-62.
2.
Legriel S, Azoulay E, Resche-Rigon M, et al. Functional outcome after convulsive status epilepticus. Crit Care Med. 2010;38(12):2295-2303.
3.
Sutter R, Kaplan PW, Rüegg S. Outcome predictors for status epilepticus—what really counts. Nat Rev Neurol. 2013;9(9):525-534.
4.
Alkhachroum A, Der-Nigoghossian CA, Rubinos C, Claassen J. Markers in status epilepticus prognosis. J Clin Neurophysiol. 2020;37(5):422-428.
5.
Leitinger M, Höller Y, Kalss G, et al. Epidemiology-based mortality score in status epilepticus (EMSE). Neurocrit Care. 2015;22(2):273-282.
6.
Rossetti AO, Logroscino G, Milligan TA, Michaelides C, Ruffieux C, Bromfield EB. Status Epilepticus Severity Score (STESS): a tool to orient early treatment strategy. J Neurol. 2008;255(10):1561-1566.
7.
Giovannini G, Monti G, Tondelli M, et al. Mortality, morbidity and refractoriness prediction in status epilepticus: comparison of STESS and EMSE scores. Seizure. 2017;46:31-37.
8.
Meletti S, Monti G, Mirandola L, Vaudano AE, Giovannini G. Neuroimaging of status epilepticus. Epilepsia. 2018;59(suppl 2):113-119.
9.
Valton L, Benaiteau M, Denuelle M, et al. Etiological assessment of status epilepticus. Rev Neurol. 2020;176(6):408-426.
10.
Rennebaum F, Kassubek J, Pinkhardt E, et al. Status epilepticus: clinical characteristics and EEG patterns associated with and without MRI diffusion restriction in 69 patients. Epilepsy Res. 2016;120:55-64.
11.
Requena M, Sarria-Estrada S, Santamarina E, et al. Peri-ictal magnetic resonance imaging in status epilepticus: temporal relationship and prognostic value in 60 patients. Seizure. 2019;71:289-294.
12.
Yu JT, Tan L. Diffusion-weighted magnetic resonance imaging demonstrates parenchymal pathophysiological changes in epilepsy. Brain Res Rev. 2008;59(1):34-41.
13.
Giovannini G, Kuchukhidze G, McCoy MR, Meletti S, Trinka E. Neuroimaging alterations related to status epilepticus in an adult population: definition of MRI findings and clinical-EEG correlation. Epilepsia. 2018;59(suppl 2):120-127.
14.
Canas N, Breia P, Soares P, et al. The electroclinical-imagiological spectrum and long-term outcome of transient periictal MRI abnormalities. Epilepsy Res. 2010;91(2-3):240-252.
15.
Jabeen SA, Cherukuri P, Mridula R, et al. A prospective study of diffusion weighted magnetic resonance imaging abnormalities in patients with cluster of seizures and status epilepticus. Clin Neurol Neurosurg. 2017;155:70-74.
16.
Zimmern V, Korff C. Status epilepticus in children. J Clin Neurophysiol. 2020;37(5):429-433.
17.
Trinka E, Cock H, Hesdorffer D, et al. A definition and classification of status epilepticus: report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia. 2015;56(10):1515-1523.
18.
Young GB, Gilbert JJ, Zochodne DW. The significance of myoclonic status epilepticus in postanoxic coma. Neurology. 1990;40(12):1843-1848.
19.
Cianfoni A, Caulo M, Cerase A, et al. Seizure-induced brain lesions: a wide spectrum of variably reversible MRI abnormalities. Eur J Radiol. 2013;82(11):1964-1972.
20.
Mendes A, Sampaio L. Brain magnetic resonance in status epilepticus: a focused review. Seizure. 2016;38:63-67.
21.
Williams JA, Bede P, Doherty CP. An exploration of the spectrum of peri-ictal MRI change; a comprehensive literature review. Seizure. 2017;50:19-32.
22.
Hirsch KG, Fischbein N, Mlynash M, et al. Prognostic value of diffusion-weighted MRI for post-cardiac arrest coma. Neurology. 2020;94(16):e1684-e1692.
23.
Hirsch KG, Mlynash M, Jansen S, et al. Prognostic value of a qualitative brain MRI scoring system after cardiac arrest. J Neuroimaging. 2015;25(3):430-437.
24.
Finn MA, Blumenthal DT, Salzman KL, Jensen RL. Transient postictal MRI changes in patients with brain tumors may mimic disease progression. Surg Neurol. 2007;67(3):246-250.
25.
Sutter R, Semmlack S, Opić P, et al. Untangling operational failures of the Status Epilepticus Severity Score (STESS). Neurology. 2019;92(17):e1948-e1956.
26.
Sutter R, Tschudin-Sutter S, Grize L, et al. Associations between infections and clinical outcome parameters in status epilepticus: a retrospective 5-year cohort study. Epilepsia. 2012;53(9):1489-1497.
27.
Jaitly R, Sgro JA, Towne AR, Ko D, DeLorenzo RJ. Prognostic value of EEG monitoring after status epilepticus: a prospective adult study. J Clin Neurophysiol. 1997;14(4):326-334.
28.
Gutiérrez-Viedma Á, Parejo-Carbonell B, Romeral-Jiménez M, et al. Therapy delay in status epilepticus extends its duration and worsens its prognosis. Acta Neurol Scand. 2021;143(3):281-289.
29.
Semmlack S, Yeginsoy D, Spiegel R, et al. Emergency response to out-of-hospital status epilepticus: a 10-year observational cohort study. Neurology. 2017;89(4):376-384.
30.
Mezouar N, Demeret S, Rotge JY, Dupont S, Navarro V. Psychogenic non-epileptic seizure-status in patients admitted to the intensive care unit. Eur J Neurol. 2021;28(8):2775-2779.

Information & Authors

Information

Published In

Neurology®
Volume 100Number 9February 28, 2023
Pages: e943-e953
PubMed: 36443013

Publication History

Received: January 26, 2022
Accepted: October 6, 2022
Published online: November 28, 2022
Published in print: February 28, 2023

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Disclosure

The authors report no relevant disclosures. Go to Neurology.org/N for full disclosures.

Study Funding

No targeted funding reported.

Authors

Affiliations & Disclosures

From the Department of Clinical Neurosciences (T.B., B.T., A.D., V.M., M.D.M., C.M., J.A.), Department of Neuroimaging (M.O.), and Department of Medical Information (K.T.), Centre Hospitalier Universitaire de Bordeaux; and CNRS (J.A.), IMN, UMR 5293, Univ. Bordeaux, France.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Morgan Ollivier, MD
From the Department of Clinical Neurosciences (T.B., B.T., A.D., V.M., M.D.M., C.M., J.A.), Department of Neuroimaging (M.O.), and Department of Medical Information (K.T.), Centre Hospitalier Universitaire de Bordeaux; and CNRS (J.A.), IMN, UMR 5293, Univ. Bordeaux, France.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Kilian Trin, MD
From the Department of Clinical Neurosciences (T.B., B.T., A.D., V.M., M.D.M., C.M., J.A.), Department of Neuroimaging (M.O.), and Department of Medical Information (K.T.), Centre Hospitalier Universitaire de Bordeaux; and CNRS (J.A.), IMN, UMR 5293, Univ. Bordeaux, France.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Benjamin Thomas, MD
From the Department of Clinical Neurosciences (T.B., B.T., A.D., V.M., M.D.M., C.M., J.A.), Department of Neuroimaging (M.O.), and Department of Medical Information (K.T.), Centre Hospitalier Universitaire de Bordeaux; and CNRS (J.A.), IMN, UMR 5293, Univ. Bordeaux, France.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Antoine Daubigney, MD
From the Department of Clinical Neurosciences (T.B., B.T., A.D., V.M., M.D.M., C.M., J.A.), Department of Neuroimaging (M.O.), and Department of Medical Information (K.T.), Centre Hospitalier Universitaire de Bordeaux; and CNRS (J.A.), IMN, UMR 5293, Univ. Bordeaux, France.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Veronique Michel, MD
From the Department of Clinical Neurosciences (T.B., B.T., A.D., V.M., M.D.M., C.M., J.A.), Department of Neuroimaging (M.O.), and Department of Medical Information (K.T.), Centre Hospitalier Universitaire de Bordeaux; and CNRS (J.A.), IMN, UMR 5293, Univ. Bordeaux, France.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Marie De Montaudouin, MD
From the Department of Clinical Neurosciences (T.B., B.T., A.D., V.M., M.D.M., C.M., J.A.), Department of Neuroimaging (M.O.), and Department of Medical Information (K.T.), Centre Hospitalier Universitaire de Bordeaux; and CNRS (J.A.), IMN, UMR 5293, Univ. Bordeaux, France.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Cécile Marchal, MD
From the Department of Clinical Neurosciences (T.B., B.T., A.D., V.M., M.D.M., C.M., J.A.), Department of Neuroimaging (M.O.), and Department of Medical Information (K.T.), Centre Hospitalier Universitaire de Bordeaux; and CNRS (J.A.), IMN, UMR 5293, Univ. Bordeaux, France.
Disclosure
Scientific Advisory Boards:
1.
(1) : member of advisory board for EISAI laboratory
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
(1) speaker honoraria for UCB laboratory
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
From the Department of Clinical Neurosciences (T.B., B.T., A.D., V.M., M.D.M., C.M., J.A.), Department of Neuroimaging (M.O.), and Department of Medical Information (K.T.), Centre Hospitalier Universitaire de Bordeaux; and CNRS (J.A.), IMN, UMR 5293, Univ. Bordeaux, France.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence Dr. Bonduelle [email protected]
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Barbara Jobst, MD, PhD, FAAN.

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Cited By
  1. Response: “What is the risk of unprovoked seizures after acute symptomatic status epilepticus?”, Epilepsia, 64, 12, (3410-3411), (2023).https://doi.org/10.1111/epi.17790
    Crossref
  2. Prediction of long‐term unprovoked seizures after status epilepticus, Epilepsia, 64, 9, (2399-2408), (2023).https://doi.org/10.1111/epi.17697
    Crossref
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