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      Relationship between cortex and pulvinar abnormalities on diffusion-weighted imaging in status epilepticus.

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          Abstract

          The aim of this study was to analyze the pattern of magnetic resonance diffusion-weighted imaging (DWI) findings in status epilepticus in terms of clinical characteristics. Participants comprised 106 patients with status epilepticus who were admitted to our hospital and underwent DWI. Forty-five patients (42.5 %) showed abnormal findings on DWI and were divided into two groups, comprising 26 patients (24.5 %) with cortex lesions alone and 19 patients (17.9 %) with cortex and pulvinar lesions in the same hemisphere. A long duration of status epilepticus (>120 min) tended to be more prevalent among patients with cortex and pulvinar lesions (57.9 %) than among patients with cortex lesions alone (30.8 %) by univariate and multivariate analyses. Todd's palsy tended to be more frequent in patients with abnormalities on DWI (24/45, 53.3 %) than in patients with normal DWI (21/61, 34.4 %). Six of the 26 patients with cortex lesions alone (23.1 %) had taken anti-epileptic drugs before the attack compared to none of the 19 patients with both cortex and pulvinar lesions. The trend toward a longer duration of status epilepticus in patients with both cortex and pulvinar lesions favors a spreading pattern of seizure discharge from cortex to pulvinar via cortico-pulvinar pathways, and anti-epileptic drugs might, to some extent, prevent spreading of seizure discharge from cortex to pulvinar. In addition, existence of high-intensity areas on DWI at the onset of epilepsy may be a predictive factor for the occurrence of Todd's palsy.

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          Author and article information

          Journal
          J. Neurol.
          Journal of neurology
          Springer Nature America, Inc
          1432-1459
          0340-5354
          Jan 2016
          : 263
          : 1
          Affiliations
          [1 ] Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
          [2 ] Department of Neurology, Hiratsuka Kyosai Hospital, Hiratsuka, Japan.
          [3 ] Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan. ftanaka@yokohama-cu.ac.jp.
          Article
          10.1007/s00415-015-7948-4
          10.1007/s00415-015-7948-4
          26530510
          51f88d50-d685-471f-9134-fcbb01e483b3
          History

          Diffusion-weighted imaging,Duration of status epilepticus,Status epilepticus,Todd’s palsy,Anti-epileptic drugs,Cortico-pulvinar pathway

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