Role of MR imaging in the evaluation of etiology of status epilepticus

Abstract

Purpose MRI helps in detecting the etiology of epilepsy, which may assist in better management. However its role in emergency situations like status epilepticus (SE) is still not clear. We analyzed the MRI findings in various subtypes of SE and tried to find out if etiological diagnosis improves by doing MRI over and above that provided by clinical evaluation, CT scan and CSF and other laboratory data. Method This prospective study involved 34 patients (M:F:: 23:11, mean age: 25.8 ± 17.2 years; range = 1–60 years) of SE. Patients were chosen irrespective of type of SE, etiology of SE, duration of SE, or treatment received. MRI was performed using standard parameters and sequences. Details of clinical, laboratory, EEG, and CT/MRI scan data were recorded. Results While 23 patients had received some treatment prior to admission, the rest did not receive any treatment. Eight patients had past history of seizures and 3 of them had history of SE. EEG revealed background slowing (22) and epileptiform discharges (15). CT scan ( n = 32) observations were: normal (25), inconclusive (2), diagnostic (3). MRI improved the diagnosis in 32.4% (11/34) patients over and above that provided by clinical examination, EEG, other laboratory investigations and CT scan. Seizures could be controlled with recommended treatment in 29 patients, while in 5 (Generalized Convulsive SE: 3, Epilepsia Partialis Continua: 2), it remained uncontrolled. At discharge, all but eight scored ‘0’ on modified Rankin Scale. Conclusions MRI is an important diagnostic tool even in emergency situation like SE. Detection of proper etiology assists in appropriate treatment and hence improves the outcome of SE.