Prognostic value of MR spectroscopy in patients with acute excitotoxic encephalopathy

Takanashi, Jun‐ichi; Murofushi, Yuka; Hirai, Nozomi; Sano, Kentaro; Matsuo, Emiyu; Saito, K.; Yasukawa, Kumi; Hamada, Hiromichi

doi:10.1016/j.jns.2019.116636

Cited by 14 publications

(11 citation statements)

References 16 publications

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“…Increased levels of Myo-Inositol (mI) may reflect neuroinflammation, which when coupled with choline elevations in demyelinating pathologies may reflect glial proliferation. 18 The presence of elevated Glx levels has been reported in cases of acute excitotoxic leukoencephalopathy 19 and viral-associated acute leukoencephalopathy with restricted diffusion. 20 Both conditions are thought to be mediated by excitotoxic injury to the cerebral white matter and exhibit prominent reduced diffusivity within white matter lesions.…”

Section: Discussionmentioning

confidence: 98%

Brain MR Spectroscopic Findings in 3 Consecutive Patients with COVID-19: Preliminary Observations

Rapalino¹,

Weerasekera

Moum

et al. 2020

AJNR Am J Neuroradiol

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Brain multivoxel MR spectroscopic imaging was performed in 3 consecutive patients with coronavirus disease 2019 . These included 1 patient with COVID-19-associated necrotizing leukoencephalopathy, another patient who had a recent pulseless electrical activity cardiac arrest with subtle white matter changes, and a patient without frank encephalopathy or a recent severe hypoxic episode. The MR spectroscopic imaging findings were compared with those of 2 patients with white matter pathology not related to Severe Acute Respiratory Syndrome coronavirus 2 infection and a healthy control subject. The NAA reduction, choline elevation, and glutamate/glutamine elevation found in the patient with COVID-19-associated necrotizing leukoencephalopathy and, to a lesser degree, the patient with COVID-19 postcardiac arrest, follow a similar pattern as seen with the patient with delayed posthypoxic leukoencephalopathy. Lactate elevation was most pronounced in the patient with COVID-19 necrotizing leukoencephalopathy.

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Section: Discussionmentioning

confidence: 98%

Brain MR Spectroscopic Findings in 3 Consecutive Patients with COVID-19: Preliminary Observations

Rapalino¹,

Weerasekera

Moum

et al. 2020

AJNR Am J Neuroradiol

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“…Tighter control of seizures with EEG monitoring might have suppressed excitotoxicity and the development of AE. Indeed, prolonged seizures cause excitotoxicity [ 24 ], and the association of excitotoxicity with the pathophysiology of AE, such as AESD, has been reported [ 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Prognostic effects of treatment protocols for febrile convulsive status epilepticus in children

et al. 2022

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Background Febrile status epilepticus is the most common form of status epilepticus in children. No previous reports compare the effectiveness of treatment strategies using fosphenytoin (fPHT) or phenobarbital (PB) and those using anesthetics as second-line anti-seizure medication for benzodiazepine-resistant convulsive status epilepticus (CSE). We aimed to examine the outcomes of various treatment strategies for febrile convulsive status epilepticus (FCSE) in a real-world setting while comparing the effects of different treatment protocols and their presence or absence. Methods This was a single-center historical cohort study that was divided into three periods. Patients who presented with febrile convulsive status epilepticus for ≥60 min even after the administration of at least one anticonvulsant were included. During period I (October 2002–December 2006), treatment was performed at the discretion of the attending physician, without a protocol. During period II (January 2007–February 2013), barbiturate coma therapy (BCT) was indicated for FCSE resistant to benzodiazepines. During period III (March 2013–April 2016), BCT was indicated for FCSE resistant to fPHT or PB. Results The rate of electroencephalogram monitoring was lower in period I than period II+III (11.5% vs. 85.7%, p<0.01). Midazolam was administered by continuous infusion more often in period I than period II+III (84.6% vs. 25.0%, p<0.01), whereas fPHT was administered less often in period I than period II+III (0% vs. 27.4%, p<0.01). The rate of poor outcome, which was determined using the Pediatric Cerebral Performance Category scale, was higher in period I than period II+III (23.1% vs. 7.1%, p=0.03). The rate of poor outcome did not differ between periods II and III (4.2% vs. 11.1%, p=0.40). Conclusions While the presence of a treatment protocol for FCSE in children may improve outcomes, a treatment protocol using fPHT or PB may not be associated with better outcomes.

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“…Increased ATP synthesis results in a decrease in phosphocreatine and an increase in Cr levels in these cells. Creatine/phosphocreatine peaks decreased in subcortical white matter in magnetic resonance spectroscopy in patients with AESD with mild to severe sequelae within 7 days of onset ( 15 ). Early seizures in AESD require more ATP synthesis than FS, whereas elevated Cr levels in the brain might be released into the systemic circulation because of the disrupted blood brain barrier in AESD ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

Predicting the Onset of Acute Encephalopathy With Biphasic Seizures and Late Reduced Diffusion by Using Early Laboratory Data

et al. 2021

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Background: Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) often causes various neurological sequelae, necessitating early and objective differentiation of AESD from a febrile seizure (FS). Therefore, we developed a scoring system that predicts AESD onset using only early laboratory data.Methods: We selected patients with AESD or FS admitted to the Tottori University Hospital between November 2005 and September 2020 and collected laboratory data from onset to discharge in patients with FS and from onset to the second neurological events in patients with AESD.Results: We identified 18 patients with AESD and 181 patients with FS. In comparison with patients with FS, patients with AESD showed statistically significant increases in ammonia (NH3), blood sugar (BS), and serum creatinine (Cr) levels, and the white blood cell (WBC) count, and a significant decrease in pH at <3 h from onset. We set the cut-off values and adjusted the weight of each of these parameters based on data obtained <3 h from onset and proposed a scoring system for predicting AESD. This system showed 91% sensitivity and 94% specificity for distinguishing AESD from FS. These accuracies were only slightly improved by the addition of information related to consciousness and seizure duration (sensitivity, 91%; specificity, 96%).Conclusion: NH3, BS, and Cr levels, WBC count, and pH were significantly different between patients with AESD and patients with FS at <3 h from seizure onset. This scoring system using these data may enable the prediction of AESD onset for patients under sedation or without precise clinical information.

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Prognostic value of MR spectroscopy in patients with acute excitotoxic encephalopathy

Cited by 14 publications

References 16 publications

Brain MR Spectroscopic Findings in 3 Consecutive Patients with COVID-19: Preliminary Observations

Brain MR Spectroscopic Findings in 3 Consecutive Patients with COVID-19: Preliminary Observations

Prognostic effects of treatment protocols for febrile convulsive status epilepticus in children

Predicting the Onset of Acute Encephalopathy With Biphasic Seizures and Late Reduced Diffusion by Using Early Laboratory Data

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