PMID- 28092848 OWN - NLM STAT- MEDLINE DCOM- 20180103 LR - 20220331 IS - 1872-6844 (Electronic) IS - 0920-1211 (Linking) VI - 129 DP - 2017 Jan TI - The initial use of arterial spin labeling perfusion and diffusion-weighted magnetic resonance images in the diagnosis of nonconvulsive partial status epileptics. PG - 162-173 LID - S0920-1211(16)30391-6 [pii] LID - 10.1016/j.eplepsyres.2016.12.008 [doi] AB - BACKGROUND: In the diagnosis of nonconvulsive status epilepticus (NCSE), capture of ongoing ictal electroencephalographic (EEG) findings is the gold standard; however, this is practically difficult without continuous EEG monitoring facilities. Magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI) and perfusion MRI with arterial spin labeling (ASL), have been applied mainly in emergency situations. Recent reports have described that ictal MRI findings, including ictal hyperperfusion on ASL and cortical hyperintensity of cytotoxic edema on DWI, can be obtained from epileptically activated cortex. We demonstrate the characteristics and clinical value of ictal MRI findings. METHODS: Fifteen patients diagnosed as having NCSE (eight had complex partial status epilepticus (SE) and seven subtle SE) who underwent an initial MRI and subsequent EEG confrmation, participated in this study. Follow-up MRI and repeated routine EEG were performed. RESULTS: In 11 patients (73%), ictal MRI findings were obtained on both DWI and ASL, while in four (27%) patients, ictal hyperperfusion was found on ASL without any DWI findings being obtained. In all 10 patients with an epileptogenic lesion, there was a tight topographical relationship between the lesion and the localization of ictal MRI findings. In the other five patients, ictal MRI findings were useful to demonstrate the pathophysiological mechanism of NCSE of non-lesional elderly epilepsy, or 'de novo' NCSE of frontal origin as situation-related NCSE. Ictal MRI findings are generally transient; however, in three cases they still persisted, even though ictal EEG findings had completely improved. CONCLUSION: The present study clearly demonstrates that the initial use of ASL and DWI could help to diagnose partial NCSE and also combined use of the MRI and EEG allows documentation of the pathophysiological mechanism in each patient. CI - Copyright (c) 2016 Elsevier B.V. All rights reserved. FAU - Shimogawa, Takafumi AU - Shimogawa T AD - Department of Neurosurgery, Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokura Minami-Ku, Kitakyushu 800-0296, Japan; Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; Department of Neurosurgery, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka 813-0017, Japan. Electronic address: shimogawa28@gmail.com. FAU - Morioka, Takato AU - Morioka T AD - Department of Neurosurgery, Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokura Minami-Ku, Kitakyushu 800-0296, Japan; Department of Neurosurgery, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka 813-0017, Japan. Electronic address: takato@ns.med.kyushu-u.ac.jp. FAU - Sayama, Tetsuro AU - Sayama T AD - Department of Neurosurgery, Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokura Minami-Ku, Kitakyushu 800-0296, Japan; Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. Electronic address: tsayama@ns.med.kyushu-u.ac.jp. FAU - Haga, Sei AU - Haga S AD - Department of Neurosurgery, Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokura Minami-Ku, Kitakyushu 800-0296, Japan. Electronic address: sei.haga@gmail.com. FAU - Kanazawa, Yuka AU - Kanazawa Y AD - Department of Cerebrovascular Disease, Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokura Minami-Ku, Kitakyushu 800-0296, Japan. Electronic address: yu8850@gmail.com. FAU - Murao, Kei AU - Murao K AD - Department of Cerebrovascular Disease, Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokura Minami-Ku, Kitakyushu 800-0296, Japan. Electronic address: mrok19840314@gmail.com. FAU - Arakawa, Shuji AU - Arakawa S AD - Department of Cerebrovascular Disease, Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokura Minami-Ku, Kitakyushu 800-0296, Japan. Electronic address: shuji6031@gmail.com. FAU - Sakata, Ayumi AU - Sakata A AD - Department of Clinical Chemistry and Laboratory Medicine, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. Electronic address: asakata@med.kyushu-u.ac.jp. FAU - Iihara, Koji AU - Iihara K AD - Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. Electronic address: kiihara@ns.med.kyushu-u.ac.jp. LA - eng PT - Journal Article DEP - 20161221 PL - Netherlands TA - Epilepsy Res JT - Epilepsy research JID - 8703089 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Brain/*diagnostic imaging/*physiopathology MH - Electroencephalography MH - Female MH - Follow-Up Studies MH - Humans MH - *Magnetic Resonance Imaging/methods MH - Male MH - Middle Aged MH - Retrospective Studies MH - Status Epilepticus/*diagnostic imaging/*physiopathology/therapy MH - Time Factors MH - Treatment Outcome OTO - NOTNLM OT - Arterial spin labeling OT - Cytotoxic edema OT - Diffusion-weighted image OT - Ictal hyperperfusion OT - Nonconvulsive status epilepticus EDAT- 2017/01/17 06:00 MHDA- 2018/01/04 06:00 CRDT- 2017/01/17 06:00 PHST- 2016/08/29 00:00 [received] PHST- 2016/11/20 00:00 [revised] PHST- 2016/12/13 00:00 [accepted] PHST- 2017/01/17 06:00 [pubmed] PHST- 2018/01/04 06:00 [medline] PHST- 2017/01/17 06:00 [entrez] AID - S0920-1211(16)30391-6 [pii] AID - 10.1016/j.eplepsyres.2016.12.008 [doi] PST - ppublish SO - Epilepsy Res. 2017 Jan;129:162-173. doi: 10.1016/j.eplepsyres.2016.12.008. Epub 2016 Dec 21.