A prospective study of diffusion weighted magnetic resonance imaging abnormalities in patients with cluster of seizures and status epilepticus

- We conducted a prospective study over 2 years period.
- Thirty patients with status epilepticus and cluster of seizures are included.
- Diffusion weighted imaging was done in 24 h after the end of last seizure.
- The incidence of periictal diffusion weighted imaging abnormalities is 66%.
- The duration of seizures/status strongly correlated with the imaging abnormality.

ObjectiveTo study the frequency, imaging characteristics, and clinical predictors for development of periictal diffusion weighted MRI abnormalities.MethodsWe prospectively analyzed electro clinical and imaging characteristic of adult patients with cluster of seizures or status epilepticus between November 2013 and November 2015, in whom the diffusion weighted imaging was done within 24 h after the end of last seizure (clinical or electrographic).ResultsThere were thirty patients who fulfilled the inclusion and exclusion criteria. Twenty patients (66%) had periictal MRI abnormalities. Nine patients (34%) did not have any MRI abnormality. All the patients with PMA had abnormalities on diffusion weighted imaging (DWI). Hippocampal abnormalities were seen in nine (53%), perisylvian in two (11.7%), thalamic in five (30%), splenium involvement in two (11.7%) and cortical involvement (temporo-occipital, parieto-occipital, temporo-parietal, fronto-parietal and fronto-temporal) in sixteen (94.1%) patients. Complete reversal of DWI changes was noted in sixteen (80%) patients and four (20%) patients showed partial resolution of MRI abnormalities. Mean duration of seizures was significantly higher among patients with PMA (59.11 + 20.97 h) compared to those without MRI changes (27.33 + 9.33 h) (p < 0.001).ConclusionsDiffusion abnormalities on MRI are common in patients with cluster of seizures and status epilepticus and were highly concordant with clinical semiology and EEG activity. Patients with longer duration of seizures/status were more likely to have PMA.