Neurology · 2 h ago
MRI Abnormality Volume Linked to Mortality in Status Epilepticus
A multicenter cohort study of 260 adults with status epilepticus found diffusion-weighted MRI abnormalities in 35% of patients. Greater abnormality volume was associated with higher mortality, although the observational findings do not establish causality.
- PMA were detected in 35% of 260 patients.
- Longer status epilepticus was associated with greater PMA burden.
- Higher PMA volume was associated with increased mortality odds.
This multicenter cohort study included 260 adults with status epilepticus who underwent brain MRI within 48 hours of onset. The investigators combined retrospectively identified and prospectively recruited patients, used diffusion-weighted imaging to identify peri-ictal MRI abnormalities (PMA), and quantified their volume with an automated pipeline. Regression analyses assessed associations with seizure duration, etiology, and mortality.
PMA were present in 91 patients (35%). Status epilepticus lasting more than 60 minutes was associated with higher odds of PMA (adjusted odds ratio [OR] 3.90, 95% CI 1.79–8.82) and greater PMA volume. Among patients with epilepsy, acute triggering factors were associated with lower odds of PMA (OR 0.15, 95% CI 0.05–0.44). PMA presence was associated with higher odds of mortality (adjusted OR 3.85, 95% CI 1.55–10.24); each tenfold increase in PMA volume was associated with 43% higher odds (adjusted OR 1.43, 95% CI 1.14–1.80).
The results suggest that quantified PMA burden may provide prognostic information beyond its presence alone. However, this observational study cannot establish that PMA causes mortality, and MRI timing relative to seizure termination was not always known. The findings support further evaluation of PMA volume as an imaging biomarker, not a change in clinical management on their own.
In practice
In adults with status epilepticus who undergo MRI within 48 hours of onset, diffusion-weighted PMA presence and especially greater PMA volume were associated with higher mortality in this multicenter cohort. Quantitative PMA burden may therefore offer prognostic information beyond simply noting an abnormality. These findings are observational and do not show that PMA causes poor outcomes or establish how imaging should guide treatment; MRI timing relative to seizure termination was also not always known. The study alone does not justify changing management.
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Epilepsia: Quantification of peri‐ictal magnetic resonance imaging abnormalities ( PMA ) in status epilepticus: Clinical and prognostic significance of PMA volume ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.