Table 1
Demographical and clinical data
| Sex age, | Smoking status | Illness Duration (yr) | syndrome | EEG | FREQUENCY | N-INDEX | AED | TYPE /NHS3 | Structural MRI | Follow up | |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | F 65 | / | 7 | PFS | G | V | 4 | LAM, LEV | 2(5/10) | Leucopathy | 0 |
| 2 | F 38 | 5 | 7 | PFS | G | R | 1 | LEV* | 2(2/10) | N | 0 |
| 3 | M 26 | / | 3 | / | N | R | 1 | LEV* | 2(2/12) | N | 0 |
| 4 | F 65 | / | / | / | G | 1st | 1 | / | 1(11) | N | 0 |
| 5 | F 23 | / | 15 | FS | F (RF) | V | 1 | TPM, LAM, DPH | 2(2/12) | Resection RF | >100 |
| 6 | M 35 | / | 20 | FS | F (RF) | R | 1 | LAM | 2(2/10) | N | 0 |
| 7 | M 42 | / | 1 | Fs | F(RT) | 1st | 1 | LEV* | 1(18) | N | 5 |
| 8 | F 20 | 10 | 7 | IGE | G | O | 1 | VA | 2(2/13) | N | 0 |
| 9 | F 24 | / | 1 | / | N | 2nd | 1 | / | 1(12) | N | 0 |
| 10 | M 21 | 20 | 6 | PFS | N | 0 | 1 | LEV* | 1(13) | N | 0 |
| 11 | M 29 | / | 12 | IGE | G | O | 1 | VA | 2(2/14) | N | 0 |
| 12 | M 46 | / | / | FS | F(LT) | 1st | 1 | LEV* PREG** | 1(13) | Encephalomalacy LT | 0 |
| 13 | F 57 | / | / | / | F(RF) | 1st | 1 | / | |||
| 14 | M 27 | / | 7 | FS | F(LT) | R | 1 | LEV* | 1(18) | N | 6 |
| 15 | F 54 | / | 8 | PFS | N | O | 1 | LEV | 1(11) | N | 0 |
| 16 | M 44 | 10 | 5 | FS | F(LF) | O | 3 | LAM | 1(12) | N | 0 |
| 17 | F 45 | / | 20 | PFS | N | R | 1 | LAM | 1(15) | N | 0 |
| 18 | M 30 | 10 | 12 | FS | F(RF) | O | 1 | LAM | 1(18) | Gliosis RF | 5 |
| 19 | M 63 | / | 4 | FS | F(RT) | O | 5 | LEV | 2(2/18) | MTS R | 12 |
| 20 | M4 0 | / | 20 | FS | F(RT) | O | 1 | CBZ | 2(2/15) | N | 12 |
| 21 | M 41 | / | 20 | FS | F(LT) | V | 5 | CBZ,VA | 1(10) | N | 50 |
| 22 | M 23 | / | 8 | IGE | G | V | 3 | LAM | 1(18) | N | 47 |
| 23 | F 29 | / | 11 | FS | F(RT) | V | 2 | TPM,LAM | 1(20) | Cortical. Dysplasia RT | 5 |
| 24 | M 27 | / | 12 | IGE | G | O | 7 | VA* | 1(9) | N | 2 |
| 25 | M 21 | 10 | 6 | IGE | G | O | 6 | VA | 2(2/8) | N | 0 |
| 26 | F 50 | 20 | 34 | FS | F(LT) | R | 1 | / | 1(8) | Aneurysm L MCA | 0 |
| 27 | F 43 | / | 25 | PFS | N | V | 3 | LAM | 1(11) | Gliosis RF | 0 |
| 28 | M 50 | / | 40 | IGE | G | V | 1 | LAM,LEV | 1(19) | Cerebellar atrophy | 18 |
| 29 | M 39 | / | 32 | / | G | R | 1 | / | 1(8) | N | 0 |
| 30 | M 19 | 10 | 5 | / | G | R | 1 | CBZ* | 1(9) | N | 0 |
[i] AED = antiepileptic drugs; CBZ = carbamazepine; DPH = diphenylhydantoin; F = female; Follow up = seizure burden in one year after study inclusion; F = frontal; FS = focal symptomatic; G = generalized; IGE = idiopathic generalized epilepsy; L = left; LAM = lamotrigine; LEV = levetiracetam; M = male; MCA = middle cerebral artery; N = index; number of index seizures; NHS3 score = National Hospital Seizure Severity 3 score; N = normal; O = often (1/month); PFS = probable focal symptomatic; PREG = pregabalin; R = right, R = rare(1/year); Type/NHS3 = number of types/National Hospital Seizure Severity 3 score; T = temporal; TPM = topiramate; V = very often (> 1/month); VA = valproate
Table 2
EEG and syndrome
| EEG and syndrome | N (%) | ||
|---|---|---|---|
| Frequency | R | 8 (27) | |
| O | 11(37) | ||
| V | 6(20) | ||
| Syndrome | PFS | 6(20) | |
| FS | 12(40) | ||
| IGE | 6(20) | ||
| undetermined | 6(20) | ||
| EEG | Normal | 4(13) | |
| Focal | 12(40) | ||
| Generalized | 5(17) | ||
| IGE | 6(20) | ||
| undetermined | 3(10) | ||
| Focus | |||
| RT | 4(33) | ||
| LT | 5(41) | ||
| RF | 2(16) | ||
| LF | 1(8) |
[i] FS = focal symptomatic; F = frontal; IGE = idiopathic generalized epilepsy; L = left; O = often; PFS = probable focal symptomatic; R = rare; R = right; T = temporal; V = very often
Figure 1
increased blood flow (arrow) in the region of the left medial cerebral artery; signal changes adjacent to left frontal bone (asterix) are the artefact (patient 15)
Table 3
MRI perfusion parameters after index seizures (grey matter)
| N | M | Me | SD | ||
|---|---|---|---|---|---|
| N | BF | 25 | 101,7 | 93 | 40,8 |
| N | BV | 25 | 8 | 7 | 3,9 |
| N | MTT | 25 | 6,9 | 6,9 | 2,9 |
| N | TTP | 25 | 13,9 | 13,8 | 2,3 |
| P | BF | 5 | 265,85** | 234 | 56,3 |
| P | BV | 5 | 25,5** | 27,6 | 4,7 |
| P | MTT | 5 | 5,7 | 5 | 1,2 |
| P | TTP | 5 | 14,5 | 13,5 | 4,5 |
BF = blood flow; BV = blood volume; M = mean; Me = median; MTT = mean transit time; N = »negative« (“normoperfusion”); P = »positive« patients (“hyperperfusion”); SD = standard deviation; TTP = time to peak
Table 4
Blood cytokine concentration after index seizure(s)
| N | M | Me | SD | Ref. | No (%) above/below reference | |
|---|---|---|---|---|---|---|
| IL-4(pg/ml) | 29* | 0.9 | 0.6 | 1.3 | ≤ 1 | 7(24) |
| IL-6 (pg/ml) | 29* | 5.7 | 3.7 | 5.1 | ≤ 3.9 | 15(52) |
| IL-10 (pg/ml) | 29* | 42.8 | 11.4 | 10.2 | ≤ 10.9 | 16(55) |
| IL-12 (pg/ml) | 29* | 66 | 58.5 | 40.3 | ≤ 204 | 29(100) |
| TNFα (pg/ml) | 29* | 8.5 | 7.6 | 4 | 4.7-12.4 | 1(3) |
| IFN-γ (pg/ml) | 29* | 27.5 | 15 | 54.4 | ≤ 1.2 | 7(24) |
| IL-1Ra (pg/ml) | 29* | 1302.7 | 676 | 1797 | 168-744 | 14(48) |
| Hs CRP (mg/l) | 29* | 2.9 | 1.1 | 4,5 | < 3 | 29(100) |
M = mean; Me = median; N = number; Ref = reference values; SD = standard deviation
Table 5
Median concentrations of cytokines (pg/ml) and hs CRP(mg/l) in three subgroups of patients (see text for details)
Table 6
Basic and control concentrations of cytokines (pg/ml) in patients with hyperperfusion after index seizure(s)
| Patient | IL-4 | IL-6 | IL-10 | IL-12 | TNF-α | IFN-γ | IL-1Ra | hsCRP | |
|---|---|---|---|---|---|---|---|---|---|
| 2 | (1st) | 0,08 | <2 | 116 | 54,5 | 8,19 | 13,08 | 352 | 1,5 |
| (control) | 0,3 | <2 | 134 | 99,6 | 8,97 | 9,23 | 822 | 1,7 | |
| 3 | (1st) | / | / | / | / | / | / | / | / |
| (control) | 1,77 | <2 | 12,6 | 127 | 11,5 | 108 | 1479 | 0,9 | |
| 7* | (1st) | 0,41 | 2,47 | 10,02 | 24,8 | 11,7 | 44,56 | 676 | 1,9 |
| (control) | 0,35 | <2 | 29,8 | 41,8 | 12,1 | 31 | 361 | 1,8 | |
| 15* | (1st) | 0,61 | 9,49 | 0,22 | 196 | 9,57 | 10,81 | 1060 | 1,4 |
| (control) | 0,00 | <2 | 0,58 | 150 | 14,1 | 14,7 | 593 | 0,7 | |
| 25 | (1st) | 0,38 | <2 | 11,51 | 34,6 | 11,1 | 14,97 | 462 | 1,1 |
| (control) | 1,01 | <2 | 12,0 | 42,5 | 20,2 | 16,2 | 660 | 1,4 |