Alok Kumar Singh1, Ravindra Kumar Garg2, Rakesh Kumar Gupta3, Hardeep Singh Malhotra1, Gaurav Raj Agrawal4, Nuzhat Husain5, Chandra Mani Pandey6, Prativa Sahoo7, Neeraj Kumar1. 1. Department of Neurology, King George Medical University Uttar Pradesh, Lucknow, India. 2. Department of Neurology, King George Medical University Uttar Pradesh, Lucknow, India. Electronic address: rkgarg@kgmcindia.edu. 3. Department of Radiology and Imaging, Department of Radiology and Imaging, Fortis Memorial Research Institute, Gurgaon, India. 4. Department of Radiodiagnosis, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India. 5. Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India. 6. Department of Biostatistics & Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. 7. Healthcare, Philips India Limited, Bangalore, India.
Abstract
BACKGROUND: The factors responsible for seizure recurrence in patients with Solitary calcified neurocysticercosis (NCC) are not well understood. Blood brain barrier (BBB) breach may be associated with seizure recurrence. Dynamic contrast enhanced (DCE) MRI derived indices kep, ktrans and ve are useful in quantifying BBB permeability. In this study, we assessed the possible role of DCE-MRI and matrix metalloproteinases (MMP)-9 levels in predicting seizure recurrence. METHODS: In this prospective-observational study, patients with new-onset seizures and a solitary calcified NCC were included. DCE-MRI was done to quantify BBB integrity. DCE-MRI parameters were measured as kep, ktrans and ve. MMP-9 levels were estimated. Patients were followed for 1 year, when DCE-MRI and MMP-9 levels were repeated. Patients were classified into two groups on the basis of seizure recurrence, which was defined as the recurrence of an episode of seizure at least 1 week after the initiation of the anti-epileptic drugs. Logistic regression analysis was done. RESULTS: At 1-year of follow up, 8 out of 32 patients had seizure recurrence. Baseline DCE-MRI derived kep (p = 0.015) and MMP-9 levels (p = 0.019) were significantly higher in the seizure "recurrence" group compared with the "no recurrence" group. On within-group analysis, a significant increase in kep (p = 0.012), ve (p = 0.012), and MMP-9 levels (p = 0.017) was observed in the seizure "recurrence" group while a decrease was seen in ve and MMP-9 levels in the "no recurrence" group. CONCLUSION: Higher values of DCE-MRI indices and MMP-9 levels, with a corresponding trend in the follow-up, can be useful in predicting lesions with a higher propensity for seizure recurrence.
BACKGROUND: The factors responsible for seizure recurrence in patients with Solitary calcified neurocysticercosis (NCC) are not well understood. Blood brain barrier (BBB) breach may be associated with seizure recurrence. Dynamic contrast enhanced (DCE) MRI derived indices kep, ktrans and ve are useful in quantifying BBB permeability. In this study, we assessed the possible role of DCE-MRI and matrix metalloproteinases (MMP)-9 levels in predicting seizure recurrence. METHODS: In this prospective-observational study, patients with new-onset seizures and a solitary calcified NCC were included. DCE-MRI was done to quantify BBB integrity. DCE-MRI parameters were measured as kep, ktrans and ve. MMP-9 levels were estimated. Patients were followed for 1 year, when DCE-MRI and MMP-9 levels were repeated. Patients were classified into two groups on the basis of seizure recurrence, which was defined as the recurrence of an episode of seizure at least 1 week after the initiation of the anti-epileptic drugs. Logistic regression analysis was done. RESULTS: At 1-year of follow up, 8 out of 32 patients had seizure recurrence. Baseline DCE-MRI derived kep (p = 0.015) and MMP-9 levels (p = 0.019) were significantly higher in the seizure "recurrence" group compared with the "no recurrence" group. On within-group analysis, a significant increase in kep (p = 0.012), ve (p = 0.012), and MMP-9 levels (p = 0.017) was observed in the seizure "recurrence" group while a decrease was seen in ve and MMP-9 levels in the "no recurrence" group. CONCLUSION: Higher values of DCE-MRI indices and MMP-9 levels, with a corresponding trend in the follow-up, can be useful in predicting lesions with a higher propensity for seizure recurrence.
Authors: Michele Simonato; Denes V Agoston; Amy Brooks-Kayal; Chris Dulla; Brandy Fureman; David C Henshall; Asla Pitkänen; William H Theodore; Roy E Twyman; Firas H Kobeissy; Kevin K Wang; Vicky Whittemore; Karen S Wilcox Journal: Nat Rev Neurol Date: 2021-02-16 Impact factor: 42.937