DSC MRI and cytokines after tonic clonic seizures
Abstract
ABSTRACT
OBJECTIVE: Inflammatory events in brain parenchima and glial tissue are involved in epileptogenesis. Blood concentration of cytokines is shown to be elevated after tonic- clonic seizures. As a result of inflamation, blood-brain barier leekage occurs. This can be documented by immaging techniques, such is dynamic susceptibility contrast enchanced (DSC) MRI perfusion. Our aim was to check for postictal brain inflammation by studying DSC MRI perfusion and plasma level of cytokines. We looked for correlations between number and type of introducing seizures, postictal plasma level of cytokines and parameters of DSC MRI perfusion. Furthermore, we looked for correlation of those parameters and course of the disease over one year follow up. METHODS: We prospectively enroled 30 patients, 8-24 hours after single or repeated tonic-clonic seizures. RESULTS: 25 of them had normal perfusion parametrs, while 5 had hyperperfusion. Patients with hyperperfusion were tested again, 3 months later. Two of 5 had hyperperfusion also on control measurements. Number of index seizures negatively correlated with concentration of proinflamatory cytokines IL-10, IFN-ϒ and TNF-α in a whole cohort. In patients with hyperperfusion, there were significantly lower concentrations of antiinflamatory cytokine IL-4 and higher concentrations of proinflamatory TNF-α. SIGNIFICANCE: Long lasting blood- brain barier dysruption may be crucial for epileptogenesis in selected patients.
IZVLEČEK
NAMEN:Vnetno dogajanje v možganskem parenhimu in glialnem tkivu je del procesa epileptogeneze. Koncentracija citokinov v krvi je povečana po tonično-kloničnih epileptičnih napadih. Posledica vnetja je povečana prepustnost krvnožilne možganske pregrade, ki jo lahko ocenjujemo s slikovnimi tehnikami, kot je dinamična kontrastno dovzetna MR perfuzija (DSC-MRI). Namen naše raziskave je bila ocena vnetnega dogajanja v možganih po epileptičnem napadu z DSC-MRI in količino citokinov v plazmi. Ocenjevali smo povezavo med tipom in številom epileptičnih napadov, nivojem citokinov v plazmi po epileptičnem napadu in parametri DSC-MRI. Ocenjevali smo tudi povezavo med naštetimi paremetri in enoletnim spremljanjem razvoja bolezni.
METODE: V raziskavo smo vključili 30 bolnikov, 8-24 ur po enem ali ponavljajočih se tonično-kloničnih napadih.
REZULTATI: 25 bolnikov je imelo normalne parametre perfuzije, pri 5 bolnikih smo našli področja hipoperfuzije. Pri 2 bolnikih je hipoperfuzija vztrajala tudi na kontrolni DSC-MRI po 3 mesecih. Število napadov je negativno koreliralo s koncentracijo citokinov IL-10, IFN-ϒ in TNF-α v plazmi pri vseh bolnikih. Pri bolnikih s hipoperfuzijo smo ugotavljali statistično značilne nižje vrednosti protivnetnih citokinov IL-4 in višje vrednosti provnetnih TNF-α .
ZAKLJUČEK: Dolgotrajna prepustnost krvnožilne možganske pregrade je pomembna v procesu epiletogeneze v izbrani skupini bolnikov.
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Radiology and Oncology (ISSN 1318-2099) is a multidisciplinary journal devoted to-the publishing of original and high quality articles in diagnostic and interventional radiology, computerized tomography, ultrasound, magnetic resonance, nuclear medicine, radiotherapy, clinical and experimental oncology, radiobiology, radiophysics, and radiation protection. Therefore, the scope of the journal is to cover beside radiology diagnostic and therapeutic aspects in oncology, which distinguishes it from other journals in the field.
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