Brain Perfusion Following Single Seizures

Summary: Purpose: The aim of this study was to assess the regional relative interictal and postictal perfusion changes in temporal and parietal lobe epilepsy. Methods: We investigated interictal and postictal magnet resonance perfusion changes in five patients with temporal lobe epilepsy either with hippocampal sclerosis (n = 3) or without (n = 2), and in one patient with extratemporal (parietal lobe) epilepsy. T2 ∗ -weighted single-shot echo-planar images were acquired after bolus application of 0.2 mmol/kg gadoliniumdiethylene triamine pentaacetic acid (GD-DTPA) at baseline and after intervals of 2‐12 min, 15‐23 min, 28‐50 min, 63‐72 min, and 180‐240 min. The bolus-peak ratio was calculated in regions of interest in the hippocampus (HIP), parahippocampal gyrus (PHG), thalamus (THA), cortex (COR), and white matter (WM), yielding relative perfusion changes. Results: Interictally, we found relative hyperperfusion of the ictogenic side in five of six patients in the HIP. Postictally, the perfusion decreased in the HIP by 25‐39% as compared to baseline, whereas the PHG showed a reverse pattern. In the late postictal phase, perfusion increased in the HIP again and decreased in the PHG. In the THA, the inter- and postictal changes were small (5‐19%). COR and WM showed equivocal results. Conclusion: Postictal relative hypoperfusion in the HIP appears to be associated with the cessation of neuronal ictal discharge, whereas postictal hyperperfusion in the PHG lags behind and may reflect increased metabolism to restore the interictal state of neuronal excitability. Ke yW ords: Brain perfusion— MRI—Temporal lobe epilepsy—Bolus-peak-ratio—Postictal.