Clara Jünemann

Objective: Peri‐ictal magnetic resonance imaging (MRI) abnormalities (PMA) are increasingly recognized in patients with status epilepticus (SE), but the clinical factors influencing their occurrence and extent remain incompletely understood. We aimed to quantify PMA and investigate the associations of PMA occurrence and volume with SE duration, etiology, and mortality. Methods: In this multicenter cohort study, comprising a retrospectively identified cohort and a prospectively recruited cohort, adult patients with SE who underwent brain MRI within 48 h of SE onset were included. PMA were identified on diffusion‐weighted imaging (DWI) and quantified using an automated postprocessing pipeline to calculate total PMA volume. Multivariable regression analyses were used to examine factors associated with PMA occurrence, extent, and mortality. Results: Of 260 patients, 91 (35%) had PMA on DWI. In multivariable analyses, SE duration and etiology were independently associated with PMA occurrence and volume. SE lasting >60 min had higher odds of PMA (odds ratio [OR] = 3.90, 95% confidence interval [CI] = 1.79–8.82, p < .001) and significantly greater PMA volume, whereas acute triggering factors in patients with epilepsy were linked with lower odds (OR = .15, 95% CI = .05–.44, p < .001). PMA occurrence was associated with more than threefold higher odds of mortality (adjusted OR = 3.85, 95% CI = 1.55–10.24, p = .005). Each 10‐fold increase in PMA volume was associated with 43% higher odds of mortality (adjusted OR = 1.43, 95% CI = 1.14–1.80, p = .002). In a sensitivity analysis restricted to in‐hospital mortality, each 10‐fold increase in PMA volume was associated with 47% higher odds of mortality (adjusted OR = 1.47, 95% CI = 1.15–1.89, p = .002). Significance: PMA extent is determined by SE duration and underlying etiology. Although MRI timing relative to SE termination could not always be determined, quantitative PMA assessment provides prognostic information beyond PMA presence alone, as increasing PMA volume is associated with progressively higher mortality. These findings support quantitative PMA burden as a potential imaging biomarker of SE severity and adverse outcome.

Background: To address the paucity of data on outcomes and costs of status epilepticus (SE) following the updated 2015 International League Against Epilepsy (ILAE) definition and changes in clinical practice guidelines in Germany. Methods: This prospective population‐based study (October 2018–March 2020) included adult patients from postal code area prefix 35, representative of Germany, diagnosed with SE according to the 2015 ILAE definition. Costs were calculated using German Diagnosis‐Related Groups (G‐DRG). Results: In total, 181 patients were included. Mean inpatient costs were €10,543 (median €6376; range €845–€133,267), corresponding to €939 per hospital day (median €580.8; range €76.8–€12,115). Mean length of stay (LOS) was 11 days (median 9; range 1–67). In univariable analyses, super‐refractory SE was associated with higher costs and longer LOS (both p < 0.001), while acute symptomatic etiology was associated with longer LOS ( p = 0.006). On multivariable analysis, mechanical ventilation was the strongest independent predictor of costs (Exp(B) = 2.918, 95% CI 1.753–4.857; p < 0.001), and etiology was overall significantly associated with cost variation ( p = 0.022), with acute symptomatic SE showing the highest adjusted costs. Discharge destination correlated with SE severity, with most patients with non‐refractory SE discharged home ( p = 0.028). Conclusions: This study provides population‐based data on costs and outcomes of SE in Germany, serving as a basis for future cost‐effectiveness analyses. Compared with earlier studies, lower direct costs and shorter LOS were observed. Identification of high‐risk constellations may support clinical decision‐making and optimize monitoring, treatment escalation, and allocation of intensive care resources.

Objective: To determine the diagnostic yield of genetic testing in patients undergoing presurgical evaluation for epilepsy. Methods: We conducted a cohort study including 115 adult patients who underwent presurgical evaluation in the Calgary Epilepsy Program between 2019 and 2023 and who had undergone research exome sequencing. A curated epilepsy gene panel comprising 765 Online Mendelian Inheritance in Man (OMIM)‐listed epilepsy‐associated genes was applied. Variants were classified according to American College of Medical Genetics and Genomics guidelines and assessed for clinical relevance and association with postsurgical outcomes. Results: Pathogenic or likely pathogenic variants in DEPDC5 , NPRL2 , KCNT2 , and PRRT2 were identified, respectively, in 4 individuals (3.5%, 4/115). All variants met stringent quality criteria with high pathogenicity scores (Combined Annotation Dependent Depletion (CADD) 34–37) and absent or extremely low population frequencies in gnomAD v4.1. None of these patients had intellectual disability, and only one patient ( PRRT2 ) had a positive family history. The patient with the KCNT2 variant underwent epilepsy surgery with good outcome (Engel class ID). Significance: This presurgical cohort demonstrates a low diagnostic yield of genetic testing in adult epilepsy surgery candidates. However, three of four patients with (likely) pathogenic variants did not have features that would have prompted clinical genetic testing, indicating that their genetic diagnosis would have been missed based on typical clinical genetic testing criteria in many jurisdictions.

Objective: To assess and compare the detection rates of peri‐ictal abnormalities using magnetic resonance imaging (MRI) and computed tomography perfusion (CTP) in patients with non‐convulsive status epilepticus (NCSE). Methods: We conducted a systematic literature search in five databases up to February 2025. Studies reporting peri‐ictal MRI abnormalities (PMAs) or cerebral perfusion abnormalities (CPAs) in patients with NCSE were included. Meta‐analyses of proportions were performed using a random‐effects model. Subgroup analyses and meta‐regression were used to compare detection rates across imaging modalities. Results: Nineteen studies were included (15 MRI, 4 CTP), comprising 562 patients for MRI and 72 for CTP. The pooled detection rate of peri‐ictal abnormalities was 50.0% (95% confidence interval [CI]: 34.0%–65.0%) for MRI and 79.3% (95% CI: 54.3%–92.5%) for CTP. Among the MRI modalities, arterial spin labeling (ASL) demonstrated the highest detection rate at 88.8% (95% CI: 32.9%–99.2%). CTP showed a significantly higher detection rate than MRI ( χ ² = 3.97, p = 0.046); meta‐regression indicated increased odds of detection with CTP (odds ratio [OR] = 4.06, 95% CI: 0.97–16.99, p = 0.055). No statistically significant difference was found between ASL and CTP ( χ ² = 0.22, p = 0.636). Conclusions: CTP demonstrates a higher detection rate than conventional MRI for peri‐ictal abnormalities in patients with NCSE, supporting its utility in rapid diagnosis and differential workup. Among MRI sequences, ASL showed the highest detection rates, highlighting its potential role in the diagnostic assessment of NCSE. Although MRI remains essential for clarifying etiology, its effectiveness in detecting PMA is highly dependent on the sequences used.

Objective: Status epilepticus (SE) represents one of the most common neurological emergencies. The International League Against Epilepsy (ILAE) redefined SE duration thresholds from 30 to 5 min for convulsive SE in 2015. We conducted a prospective population‐based study to determine SE incidence and outcomes under the revised criteria and compared findings with historical data using the 30‐min definition. Methods: A prospective, population‐based cohort study was conducted over a period of 18 months to determine the incidence of SE in Germany, replicating the methodology of a first study conducted in this region in 1999. The study included all adults residing within the 35‐postcode area, with participation from all regional hospitals and emergency departments. SE cases were prospectively identified and reported. To ensure comparability with the historical data, the analysis focused on the Primary Service Area (PS‐Area)—the direct catchment region of the University Hospital Marburg. Results: A total of 180 adults with SE (96 men, mean age 66.47 years, SD ± 18.5 years, range: 20–94 years). The crude annual incidence in the PS‐Area increased from 15.8/100 000 (95% confidence interval [CI] 11.2–21.6) in 1999 to 29.4/100 000 adults (95% CI 20.5–40.0). It was higher in men than in women (30.9 vs 28.1/100 000, p = .11) and in patients ≥60 years (68.5 vs 13.5/100 000; p < .0001). The calculated age‐ and gender‐adjusted incidence was 32.5/100 000 in the PS‐Area. The case–fatality rate was 5.77% (95% CI 1.2%–12.7%) and the crude annual cause‐specific mortality rate per 100 000 is 1.70 (95% CI 0.21–4.73). In 53% SE was the first seizure episode; only 47% had a history of epilepsy. When extrapolating these findings to the entire German population, there were at least 20 000 cases of SE with 1000 associated deaths annually. Significance: These findings provide new epidemiologic evidence that the incidence of SE has increased by ~12% with the adoption of the ILAE 2015 definition, underscoring the impact of updated diagnostic criteria on epidemiological estimates.