Periictal diffusion abnormalities of the thalamus in partial status epilepticus

Abstract

SUMMARYPurpose: To identify and describe thalamic dysfunction in patients with temporal as well as extratemporal status epilepticus (SE) and to also analyze the specific clinical, radiological, and electroencephalography (EEG) characteristics of patients with acute thalamic involvement. Methods: We retrospectively identified patients who presented with clinical and electrographic evidence of partial SE and had thalamic abnormalities on diffusion-weighted imaging (DWI) within 5 days of documentation of lateralized epileptiform discharges (group 1). The spatial and temporal characteristics of the periodic lateralized epileptiform discharges (PLEDs) and the recorded electrographic seizures were analyzed and correlated with magnetic resonance imaging (MRI)-DWI hyperintense lesions. The findings of group 1 patients were compared with those of patients with partial SE without thalamic abnormalities on DWI (group 2).Results: The two groups were similar with regard to clinical presentation and morphology of epileptiform discharges. Group 1 patients had thalamic hyperintense lesions on DWI that appeared in the region of the pulvinar nucleus, ipsilateral to the epileptiform activity. Statistically significant relationship was noted between the presence of thalamic lesions and ipsilateral cortical laminar involvement (p ¼ 0.039) as well as seizure origin in the posterior quadrants (p ¼ 0.038). A trend towards PLEDs originating in the posterior quadrants was also noted (p ¼ 0.077). Discussion: Thalamic DWI hyperintense lesions may be observed after prolonged partial SE and are likely the result of excessive activity in thalamic nuclei having reciprocal connections with the involved cortex. The thalamus likely participates in the evolution and propagation of partial seizures in SE.

MR Findings of Seizure-Related Cerebral Cortical Lesions during Periictal Period

“…Coexisting thalamic abnormalities in seizure patients are likely the result of excessive activity in the thalamic nuclei having reciprocal connections with the affected cerebral cortices (25)(26)(27). Therefore, the thalamus may be related to the evolution and propagation of ictal discharge (27). In agreement with previous results (2, 28), we observed hippocampal involvement in 10 patients (Fig.…”

“…In previous studies, investigators have suggested that thalamic nuclei are involved in various epilepsy syndromes. Coexisting thalamic abnormalities in seizure patients are likely the result of excessive activity in the thalamic nuclei having reciprocal connections with the affected cerebral cortices (25)(26)(27). Therefore, the thalamus may be related to the evolution and propagation of ictal discharge (27).…”

How I Treat Patients with EEG Patterns on the Ictal–Interictal Continuum in the Neuro ICU

“…3). The degree of ADC decrease has been found to correlate with neuronal cell loss in animal studies [29] and restricted diffusion has been seen in the hippocampal formation, cortex, and the posterior thalamus after SE [24,30,31] in humans. So far no studies investigated diffusion abnormalities of the IIC.…”

Thalamic Lesions: A Radiological Review

“…These peri-ictal diffusion abnormalities of the thalamus, likely the result of excessive activity in the thalamic nuclei having reciprocal connections with the involved cortex, are associated with seizure origin in the posterior quadrant and with the presence of ipsilateral cortical laminar involvement on DWI [23]. …”