title: Progressive Brain Atrophy in Super-refractory Status Epilepticus.
abstract: OBJECTIVE
  Prolonged seizures in super-refractory status epilepticus (SRSE) have been shown to cause neuronal death and reorganization, and visual inspection in individual case studies has demonstrated progressive cortical and subcortical atrophy. At present, magnetic resonance imaging (MRI) studies that evaluate brain atrophy in SRSE are lacking.
  
  
  OBJECTIVE
  To document and quantify the development of atrophy over time in SRSE.
  
  
  METHODS
  This retrospective medical record review included all patients with SRSE who were admitted to a tertiary referral campus of the Mayo Clinic Hospital with SRSE from January 1, 2001, to December 31, 2013. Patients with (1) an initial MRI scan performed within 2 weeks of SRSE onset, (2) a second MRI scan within 6 months of SRSE resolution, and (3) a minimum duration of 1 week between MRI scans were included. The ventricular brain ratio (VBR) was measured on T2-weighted fluid-attenuated inversion recovery (FLAIR) images at disease onset and during follow-up. Measurements were performed on axial FLAIR images with section thickness of less than 5 mm. The plane immediately superior to the caudate head was chosen for analysis. The hypothesis that atrophy develops during SRSE despite seizure control (electroencephalogram background suppression with anesthetic drugs) was tested. Data were analyzed from June 1 to December 31, 2015.
  
  
  METHODS
  Change in VBR (ΔVBR) as a percentage of the starting measure.
  
  
  RESULTS
  Nineteen patients met the inclusion criteria; these included 10 men (53%) and 9 women (47%) with a median age of 41 (interquartile range [IQR], 25-68) years. Anesthetic agents were required for a median of 13 (IQR, 5-37) days. Initial MRI was performed a median of 2 (IQR, 1-7.5) days from the onset of SRSE, and the second MRI was performed a median of 11 (IQR, 5-15.5) days from the resolution of SRSE, with a median of 40 (IQR, 15-65) days between MRI scans. Median ΔVBR was 23.3% (IQR, 10.5%-70.3%). A significant correlation between the duration of anesthetic agent use and ΔVBR was found (Spearman r = 0.54; P = .02).
  
  
  CONCLUSIONS
  Atrophy developed in all patients with SRSE who underwent serial imaging, despite administration of agents for seizure control. The degree of atrophy appears to be related to the duration of SRSE.
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Sara
authors.initials: S
authors.lastname: Hocker
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Elanagan
authors.initials: E
authors.lastname: Nagarajan
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
authors.affiliation: Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota.
authors.forename: Dennis
authors.initials: D
authors.lastname: Hanson
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Britton
mesh_terms: D000328:Adult; D000368:Aged; D018681:Anesthetics, General / Q000627:therapeutic use; D001284:Atrophy / Q000473:pathology; D002552:Cerebral Ventricles / Q000000981:diagnostic imaging*; D018450:Disease Progression; D000069279:Drug Resistant Epilepsy / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology; D055815:Young Adult
chemical_list: D018681:Anesthetics, General