Epilepsy & Seizure
Online ISSN : 1882-5567
ISSN-L : 1882-5567
最新号
選択された号の論文の7件中1~7を表示しています
Original Article
  • Takato Morioka, Fumihito Mugita, Satoshi Inoha, Tomoaki Akiyama, Hiron ...
    2025 年17 巻 論文ID: A000162
    発行日: 2025年
    公開日: 2025/01/27
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    Background: The 2021 version of the Standardized Critical Care EEG Terminology published by the American Clinical Neurophysiology Society (ACNS 2021) specifies the diagnostic criteria for non-convulsive status epilepticus (NCSE) using continuous electroencephalographic (cEEG) monitoring. Since few facilities have access to cEEG, routine EEG, which can only be performed during consultation hours, is generally used for emergencies. We examined if the diagnostic ability is enhanced by adding arterial spin labeling (ASL) perfusion imaging to 1.5-Tesla magnetic resonance imaging (MRI). Patients and Methods: Eighty EEGs, performed on patients with neurological emergencies for 2 years, were reviewed which included three patients diagnosed with electrographic seizures (ESz). Results: Based on the ACNS21, EEG could diagnose Esz, but could not diagnose NCSE, being a 30-minute recording. In contrast, ASL clearly identified focal, ictal hyperperfusion. The signal intensity was maximized at a post-labeling delay (PLD) of 1.5-1.75 s. The signal intensity gradually decreased. However, even at a PLD of 2.0 s, the intensity remained strong in areas with a close anatomical relationship to the epileptogenic lesions. Further, the same region showed high signal intensity on diffusion-weighted imaging (DWI). Conclusion: Although ESz can be diagnosed based on the ACNS 2021 using EEG alone, diagnosing NCSE can be challenging. Therefore, our suggestion is to initially perform MRI to capture the hemodynamics of ictal hyperperfusion using ASL with multiple PLDs, and monitor the coupling state of metabolism and blood flow with DWI. Finally, an accurate pathophysiological diagnosis of NCSE should be confirmed by EEG.

  • Takato Morioka, Fumihito Mugita, Satoshi Inoha, Takafumi Shimogawa, No ...
    2025 年17 巻 論文ID: A000163
    発行日: 2025年
    公開日: 2025/02/04
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    Background: We evaluated the usefulness of capturing periictal hyperperfusion for the pathophysiological diagnosis of acute symptomatic seizures (ASS) using 1.5-Tesla (T) arterial spin labeling (ASL) perfusion images and examined the relationship between the time from ASS cessation to ASL imaging and the visualization of periictal hyperperfusion.Patients & Methods: In four patients who presented short ASS, we retrospectively analyzed the performance status and findings of 1.5-T ASL with triple post-labeling delays (PLDs) of 1.5, 1.75 and 2.0 s, as well as routine electroencephalography (EEG).Results: In two patients where ASL imaging was performed 1 or 9 h after ASS, periictal ASL hyperperfusion was markedly visualized. In one patient where images were taken 11 h later, fairly good visualization was obtained. The increase in signal intensity peaked at a PLD of 1.5 s and gradually attenuated with PLDs of 1.75 and 2.0 s. However, the areas where the signal remained intense even at a PLD of 2.0 s had a strong anatomical relationship with the lesion. No clear periictal hyperperfusion was visualized on ASL images taken 13 h later. Although paroxysmal discharges were recorded in one patient where EEG was performed 40 min after ASS, no paroxysms were detected in the other three patients whose EEG was recorded 8 h to 2 days later.Conclusion: We consider it appropriate to first perform ASL within 11 h, and then verify the results with subsequent EEG to accurately diagnose the pathophysiology of ASS.

  • Fumihito Mugita, Takato Morioka, Satoshi Inoha, Hiroshi Oketani, Tomoa ...
    2025 年17 巻 論文ID: A000166
    発行日: 2025年
    公開日: 2025/06/20
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    Purpose: The mechanism underlying sulcal hyperintensity observed on fluid-attenuated inversion recovery magnetic resonance imaging (MRI) (sulcal FLAIR hyperintensity [S-FLAIR-HI]) without apparent abnormalities in the cerebrospinal fluid (CSF) is believed to involve alterations in regional hemodynamics, including venous congestion caused by mass effect, leading to a pathological increase in the blood pool-to-CSF ​​ratio. While S-FLAIR-HI is observed in chronic subdural hematoma (CSDH), its exact incidence, mechanism of occurrence, and relationship with seizures remain unclear.

    Methods: Clinical data and MRI findings, including FLAIR and 1.5-Tesla pseudo-continuous arterial spin labeling perfusion imaging performed within 1 day before surgery in 34 patients with CSDH, were retrospectively reviewed. The focus was on the laterality of arterial transit artifact(s) in the sulcus (sulcal ATA [S-ATA]), which are intravascular signals that increase with a delay in arterial transit time, and (peri-)ictal hyperperfusion linked to seizure activity by neurovascular coupling.

    Results: S-FLAIR-HI was observed in 12 (35.3%) of the 34 patients with CSDH, 11 of whom exhibited an increase in S-ATA on the ipsilateral side. Increased S-ATA levels were also observed in 10 of the 22 patients without S-FLAIR-HI. However, none of the 12 patients with S-FLAIR-HI developed seizures. In addition, 2 patients who exhibited perioperative seizures did not undergo S-FLAIR-HI.

    Discussion: S-FLAIR-HI, observed preoperatively in approximately one-third of patients with CSDH, is a nonspecific finding caused by alterations in regional hemodynamics. Furthermore, there is no evidence supporting the direct involvement of S-FLAIR-HI in the development of seizures.

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