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Rasmussen's encephalitis: structural, functional, and clinical correlates of contralesional epileptiform activity

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机构： [1]Department of Neuroradiology, University Hospital Bonn, Bonn, Germany [2]Department of Epileptology, University Hospital Bonn, Bonn, Germany [3]Department of Neurology, Great Ormond Street Hospital for Children, London, UK [4]Developmental Neurosciences Research and Teaching Department, UCL NIHR BRC Great Ormond Street Institute of Child Health, London, UK [5]Section for Translational Epilepsy Research, Department of Neuropathology, University Hospital Bonn, Bonn, Germany [6]Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands [7]Amsterdam Neuroscience, Brain Imaging Amsterdam, Amsterdam, The Netherlands [8]Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands [9]Department of Neurosurgery, University Hospital Bonn, Bonn, Germany [10]Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK [11]Chalfont Centre for Epilepsy, Chalfont St Peter, UK [12]Department of Neurology, West China Hospital, Sichuan University, Chengdu, China [13]Institute of Experimental Epileptology and Cognition Research, University Hospital Bonn, Bonn, Germany [14]Young Epilepsy Lingfeld, Lingfeld, UK

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关键词： Epilepsy EEG Neuroimmunology Neuropsychology MRI

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Progressive inflammation of one hemisphere characterises Rasmussen's encephalitis (RE), but contralesional epileptiform activity has been repeatedly reported. We aimed to quantify contralesional epileptiform activity in RE and uncover its functional and structural underpinnings. We retrospectively ascertained people with RE treated between 2000 and 2018 at a tertiary centre (Centre 1) and reviewed all available EEG datasets. The temporal occurrence of preoperative contralesional epileptiform activity (interictal/ictal) was evaluated using mixed-effects logistic regression. Cases with/without contralesional epileptiform activity were compared for cognition, inflammation (ipsilesional brain biopsies), and MRI (cortical and fixel-based morphometry). EEG findings were validated in a second cohort treated at another tertiary centre (Centre 2) between 1995 and 2020. We included 127 people with RE and 687 EEG samples. Preoperatively, contralesional epileptiform activity was seen in 30/68 (44%, Centre 1) and 8/59 (14%, Centre 2). In both cohorts, this activity was associated with younger onset age (OR = 0.9; 95% CI 0.83-0.97; P = 0.006). At centre 1, contralesional epileptiform activity was associated with contralesional MRI alterations, lower intelligence (OR = 5.19; 95% CI 1.28-21.08; P = 0.021), and impaired verbal memory (OR = 10.29; 95% CI 1.97-53.85; P = 0.006). After hemispherotomy, 11/17 (65%, Centre 1) and 28/37 (76%, Centre 2) were seizure-free. Contralesional epileptiform activity was persistent postoperatively in 6/12 (50%, Centre 1) and 2/34 (6%, Centre 2). Preoperative contralesional epileptiform activity reduced the chance of postoperative seizure freedom in both cohorts (OR = 0.69; 95% CI 0.50-0.95; P = 0.029). Our findings question the concept of strict unilaterality of RE and provide the evidence of contralesional epileptiform activity as a possible EEG predictor for persisting postoperative seizures.© 2024. The Author(s).

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大类 | 2 区

医学

小类 | 2 区临床神经病学

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第一作者机构： [1]Department of Neuroradiology, University Hospital Bonn, Bonn, Germany [2]Department of Epileptology, University Hospital Bonn, Bonn, Germany

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通讯机构： [1]Department of Neuroradiology, University Hospital Bonn, Bonn, Germany [2]Department of Epileptology, University Hospital Bonn, Bonn, Germany

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Rasmussen's encephalitis: structural, functional, and clinical correlates of contralesional epileptiform activity

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