Progressive brain atrophy in super-refractory status epilepticus

Sara Hocker, Elanagan Nagarajan, Alejandro Rabinstein, Dennis Hanson, Jeffrey W. Britton

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Importance Prolonged seizures in super-refractory status epilepticus (SRSE) have been shown to cause neuronal death and reorganization, and visual inspection in individual case studies has demonstrated progressive cortical and subcortical atrophy. At present, magnetic resonance imaging (MRI) studies that evaluate brain atrophy in SRSE are lacking. OBJECTIVES To document and quantify the development of atrophy over time in SRSE. DESIGN, SETTING, AND PARTICIPANTS This retrospective medical record review included all patients with SRSE who were admitted to a tertiary referral campus of the Mayo Clinic Hospital with SRSE from January 1, 2001, to December 31, 2013. Patients with (1) an initial MRI scan performed within 2 weeks of SRSE onset, (2) a second MRI scan within 6 months of SRSE resolution, and (3) a minimum duration of 1 week between MRI scans were included. The ventricular brain ratio (VBR) was measured on T2-weighted fluid-attenuated inversion recovery (FLAIR) images at disease onset and during follow-up. Measurements were performed on axial FLAIR images with section thickness of less than 5 mm. The plane immediately superior to the caudate head was chosen for analysis. The hypothesis that atrophy develops during SRSE despite seizure control (electroencephalogram background suppression with anesthetic drugs) was tested. Data were analyzed from June 1 to December 31, 2015. MAIN OUTCOMES AND MEASURES Change in VBR (δVBR) as a percentage of the starting measure. RESULTS Nineteen patients met the inclusion criteria; these included 10 men (53%) and 9 women (47%) with a median age of 41 (interquartile range [IQR], 25-68) years. Anesthetic agents were required for a median of 13 (IQR, 5-37) days. Initial MRI was performed a median of 2 (IQR, 1-7.5) days from the onset of SRSE, and the second MRI was performed a median of 11 (IQR, 5-15.5) days from the resolution of SRSE, with a median of 40 (IQR, 15-65) days between MRI scans. Median δVBR was 23.3% (IQR, 10.5%-70.3%). A significant correlation between the duration of anesthetic agent use and δVBR was found (Spearman r = 0.54; P =.02). CONCLUSIONS AND RELEVANCE Atrophy developed in all patients with SRSE who underwent serial imaging, despite administration of agents for seizure control. The degree of atrophy appears to be related to the duration of SRSE.

Original languageEnglish (US)
Pages (from-to)1201-1207
Number of pages7
JournalJAMA Neurology
Volume73
Issue number10
DOIs
StatePublished - Oct 1 2016

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Status Epilepticus
Atrophy
Brain
Magnetic Resonance Imaging
Anesthetics
Seizures
Medical Records
Cause of Death
Electroencephalography
Referral and Consultation
Head
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Clinical Neurology

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Progressive brain atrophy in super-refractory status epilepticus. / Hocker, Sara; Nagarajan, Elanagan; Rabinstein, Alejandro; Hanson, Dennis; Britton, Jeffrey W.

In: JAMA Neurology, Vol. 73, No. 10, 01.10.2016, p. 1201-1207.

Research output: Contribution to journalArticle

Hocker, S, Nagarajan, E, Rabinstein, A, Hanson, D & Britton, JW 2016, 'Progressive brain atrophy in super-refractory status epilepticus', JAMA Neurology, vol. 73, no. 10, pp. 1201-1207. https://doi.org/10.1001/jamaneurol.2016.1572
Hocker, Sara ; Nagarajan, Elanagan ; Rabinstein, Alejandro ; Hanson, Dennis ; Britton, Jeffrey W. / Progressive brain atrophy in super-refractory status epilepticus. In: JAMA Neurology. 2016 ; Vol. 73, No. 10. pp. 1201-1207.
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