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December 12, 2000

MRI, 1H-MRS, and functional MRI during and after prolonged nonconvulsive seizure activity

F. Lazeyras, PhD, O. Blanke, MD, I. Zimine, BSc, J. Delavelle, MD, S.H. Perrig, MD, and M. Seeck, MDAuthors Info & Affiliations

December 12, 2000 issue

55 (11) 1677-1682

https://doi.org/10.1212/WNL.55.11.1677

Abstract

Article abstract—

Background: Various structural and functional changes, such as focal edema, blood flow, and metabolism, occur in the cerebral cortex after focal status epilepticus. These changes can be assessed noninvasively by means of MRI techniques, such as fluid-attenuated inversion recovery (FLAIR), EEG-triggered functional MRI (EEG-fMRI), and proton MR spectroscopy (MRS).

Methods: The authors report on a 40-year-old patient with nonlesional partial epilepsy in the left posterior quadrant in whom these MRI techniques were applied in an active seizure focus and repeated during a follow-up of 1 year.

Results: FLAIR imaging taken at the time of status epilepticus showed a signal hyperintensity in the occipital region. ¹H-MRS of this cortical region showed elevated lactate, decreased N-acetylaspartate (NAA), and elevated choline (Cho). In the same region, EEG-fMRI revealed an area of signal enhancement. After seizure control, recovery of lactate and Cho was observed, whereas the NAA level remained reduced. The structural abnormality demonstrated on FLAIR disappeared within 3 months.

Conclusions: Repetitive MRI with sensitive sequences during clinically critical periods may disclose the structural correlate in a previously nonlesional epilepsy case. Corresponding to the clinical evolution, reversible and irreversible focally abnormal metabolism can be determined with ¹H-MRS, reflecting both increased neuronal activity and neuronal damage.

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Information & Authors

Information

Published In

Neurology^®

Volume 55 • Number 11 • December 12, 2000

Pages: 1677-1682

PubMed: 11113222

Copyright

© 2000.

Publication History

Received: May 4, 2000

Accepted: August 17, 2000

Published online: December 12, 2000

Published in print: December 12, 2000

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Authors

Affiliations & Disclosures

F. Lazeyras, PhD

From the Department of Radiology (Drs. Lazeyras and Delavelle, and I. Zimine), University Hospital of Geneva; and Laboratory of Presurgical Epilepsy Evaluation Vaud-Genève (Drs. Blanke, Perrig, and Seeck), University Hospitals of Lausanne and Geneva, Switzerland.

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O. Blanke, MD

From the Department of Radiology (Drs. Lazeyras and Delavelle, and I. Zimine), University Hospital of Geneva; and Laboratory of Presurgical Epilepsy Evaluation Vaud-Genève (Drs. Blanke, Perrig, and Seeck), University Hospitals of Lausanne and Geneva, Switzerland.

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I. Zimine, BSc

From the Department of Radiology (Drs. Lazeyras and Delavelle, and I. Zimine), University Hospital of Geneva; and Laboratory of Presurgical Epilepsy Evaluation Vaud-Genève (Drs. Blanke, Perrig, and Seeck), University Hospitals of Lausanne and Geneva, Switzerland.

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J. Delavelle, MD

From the Department of Radiology (Drs. Lazeyras and Delavelle, and I. Zimine), University Hospital of Geneva; and Laboratory of Presurgical Epilepsy Evaluation Vaud-Genève (Drs. Blanke, Perrig, and Seeck), University Hospitals of Lausanne and Geneva, Switzerland.

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S.H. Perrig, MD

From the Department of Radiology (Drs. Lazeyras and Delavelle, and I. Zimine), University Hospital of Geneva; and Laboratory of Presurgical Epilepsy Evaluation Vaud-Genève (Drs. Blanke, Perrig, and Seeck), University Hospitals of Lausanne and Geneva, Switzerland.

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M. Seeck, MD

From the Department of Radiology (Drs. Lazeyras and Delavelle, and I. Zimine), University Hospital of Geneva; and Laboratory of Presurgical Epilepsy Evaluation Vaud-Genève (Drs. Blanke, Perrig, and Seeck), University Hospitals of Lausanne and Geneva, Switzerland.

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Notes

Address correspondence and reprint requests to Dr. François Lazeyras, Department of Radiology, University Hospitals of Geneva, rue Micheli-du-Crest 24, 1211 Geneva, Switzerland; e-mail: [email protected]

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