Periictal diffusion abnormalities of the thalamus in partial status  epilepticus.
OBJECTIVE
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 = 0.039) as well as seizure origin in the posterior quadrants (p = 0.038). A trend towards PLEDs originating in the posterior quadrants was also noted (p = 0.077).


CONCLUSIONS
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.
Katramados
Angelos M
AM
Departments of Neurology, Henry Ford Health Sciences Center, Detroit, Michigan, USA. angelo@neuro.hfh.edu
Burdette
David
D
Patel
Suresh C
SC
Schultz
Lonni R
LR
Gaddam
Shailaja
S
Mitsias
Panayiotis D
PD
D000368:Aged; D000369:Aged, 80 and over; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000503:physiopathology; D038524:Diffusion Magnetic Resonance Imaging; D004292:Dominance, Cerebral / Q000502:physiology; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000175:diagnosis / Q000503:physiopathology*; D017029:Epilepsy, Complex Partial / Q000175:diagnosis / Q000503:physiopathology*; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009415:Nerve Net / Q000503:physiopathology; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000175:diagnosis / Q000503:physiopathology*; D013786:Thalamic Diseases / Q000175:diagnosis / Q000503:physiopathology*; D013788:Thalamus / Q000503:physiopathology