Chapter 16 - MRI for assessing the impact of febrile status epilepticus and predicting outcomes

Abstract

Over the past decade, MRI studies have revealed that febrile status epilepticus (FSE) can lead to acute hippocampal signal changes that likely signify swelling/edema. In some cases, these volume changes, apparent within days, are accompanied by a visibly increased hippocampal T2 signal. Follow-up MRIs months and years later reveal that the apparent injury may result in asymmetric hippocampal growth or even signals typical of hippocampal sclerosis. Not uncommonly, preexisting hippocampal or temporal lobe abnormalities accompany the acute hippocampal injury. The prognostic implications of the hippocampal changes that follow FSE, both acutely and long-term, are not fully understood. In animal models, signal changes predict epilepsy, yet it is unclear if such relation exists in children. Regarding cognitive outcomes, preliminary results suggest the hippocampal changes may be associated with decreased delayed recall or weakness in receptive language. In summary, although MRI changes follow FSE and may have important implications, current data do not allow us to predict the incidence or type of epilepsy that may result from the impact of FSE on hippocampal integrity.