Status epilepticus (SE) is a neurological emergency associated with a high rate of mortality and
morbidity. The longer status epilepticus lasts the higher is the chance for nerve cells of the brain to
get damaged, loose their function and eventually die. Therefore, the treatment of SE should start as
early as possible. Some forms of SE are relatively easy to treat. In some types of SE, however, the
seizure activity persists despite the usage of multiple antiseizure drugs.
Brain imaging, especially magnetic resonance imaging (MRI) is an essential part of a diagnostic work-
up of patients with SE. Some patients with SE develop changes on MRI, which are caused by ongoing
seizure activity. These changes may persist or disappear within of days after onset of SE. It is not
clear, however, why only some patients develop SE associated MRI changes. It is also not well
established whether there are specific patterns of MRI abnormalities caused by SE. Other open
questions are related to the behavior of MRI changes in SE over time: 1) is the severity of SE
associated with the persistent MRI abnormalities? 2) could MRI changes predict the prognosis and
outcome of SE? 3) will patients with persistent MRI changes develop irreversible brain damage, for
instance, atrophy of some brain structures?
In order to answer these questions, we are planning to recruit in prospective manner 230 patients
with SE at the Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of
Salzburg. Many of these patients will undergo MRI due to their clinical needs. In case if patients have
SE-associated changes, they will undergo follow-up MRIs one week and one month after the onset of
SE. These MRI will be thoroughly analyzed by two independent expert neuroradiologists. The results
will be compared with the MRIs of two control groups: 1) patients who have epilepsy and single
seizures (not SE) and 2) patients who have MRI changes, but no epilepsy or SE. MRIs of all study
participants (patients with SE and control group patients) will undergo sophisticated analyses of MRIs
by different software in order to look for aberrant connections between different parts of the brain
and signs for brain atrophy. MRI changes will be correlated to the clinical and
electroencephalographic data of patients with SE.
We hypothesize that 1) SE is associated with specific patterns of MRI changes, 2) most of these
changes disappear within one or latest four weeks after the onset of SE, 3) widespread and persisting
MRI changes are linked with severe course of SE and unfavorable outcome.
Therefore, we expect that the results of this study will help us to define an MRI prognostic marker of
SE, which in itself may have an important implication for treatment of patients with SE.