Ann Clin Neurophysiol.  2024 Apr;26(1):14-21. 10.14253/acn.23013.

Significance of thalamic hyperperfusion patterns in computed tomography perfusion in patients with nonconvulsive status epilepticus: possible utility in predicting antiseizure medication resistance

• Sohn G

• KMID: 2554849
• DOI: http://doi.org/10.14253/acn.23013

Abstract

Background
This study aimed to determine the characteristics of computed tomography perfusion (CTP) patterns and their utility in predicting antiseizure medication (ASM) resistance in patients with nonconvulsive status epilepticus (NCSE).
Methods
We retrospectively reviewed patients diagnosed with NCSE at Inje University Haeundae Paik Hospital Epilepsy Center between March 2015 and March 2022. CTP patterns were analyzed for those patients. A hyperperfusion pattern (HPP) in CTP was defined as a region of both increased cerebral blood flow and cerebral blood volume that did not necessarily follow the vascular territories. The primary endpoint was the responses to ASMs according to CTP patterns.
Results
Fourteen (74%) of the 19 included patients met the criteria for definite NCSE, with the remaining 26% showing nonepileptiform activities with fluctuating quasirhythmic delta activities at >0.5 Hz on electroencephalogram. Three of the four patients who had HPPs with thalamic involvement were refractory to ASMs, whereas all eight patients who had HPPs without thalamic involvement were responsive to ASMs (p = 0.018). Although HPPs themselves were not associated with ASM responses, HPPs with thalamic involvement were associated with resistance to ASMs.
Conclusions
HPP with thalamic involvement in CTP might be associated with ASM resistance. Therefore, CTP may be useful for predicting ASM resistance in NCSE patients.

Keyword

Nonconvulsive seizure disorder; Neuroimaging; Drug resistant epilepsy; Prognosis; Nonconvulsive seizure disorder; Nonconvulsive seizure disorder; Neuroimaging; Drug resistant epilepsy; Prognosis; Neuroimaging; Drug resistant epilepsy; Prognosis

Figure

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  Fig. 1. Flow chart of patient selection. NCSE, nonconvulsive status epilepticus; HIE, hypoxic-ischemic encephalopathy; CTP, computed tomography perfusion; EPC, epilepsia partialis continua; SE, status epilepticus; BDZ, benzodiazepine.

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  Fig. 2. Seizure-related CTP patterns and diffusion-weighted imaging (DWI) signal changes. (A) Hyperperfusion pattern (HPP) with thalamic involvement and seizure-related DWI signal changes. (B) HPP only. CTP, computed tomography perfusion.

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  Fig. 3. EEG and neuroimaging findings in NCSE. CTP (+), HPP in CTP; DWI (+), signal changes present in DWI. EEG, electroencephalogram; ESz, electrographic seizure; CTP, computed tomography perfusion; DWI, diffusion-weighted imaging; NCSE, nonconvulsive status epilepticus.

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