The Role of Imaging in the Diagnosis, Management and Prognosis of Possible Non-convulsive Status Epilepticus

NCT ID: NCT06017973

Last Updated: 2024-12-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-10-01

Study Completion Date

2027-09-30

Brief Summary

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The investigators propose a prospective study of 20 control subjects and 180 consecutive patients with possible non-convulsive status epilepticus (NCSE). The investigators will obtain three functional images of the brain:

1. Fluorodeoxyglucose positron emission tomography (FDG-PET)
2. Perfusion (and structural) magnetic resonance (MR) images
3. Computed tomography (CT) perfusion.

Brain hypermetabolism/hyperperfusion is a strong argument to confirm a diagnosis of non-convulsive status epilepticus.

The aim is to determine which of the three functional imaging techniques is the most sensitive and easy to obtain in the detection of hypermetabolism/hyperperfusion. The investigators will determine which EEG patterns are associated with hypermetabolism/perfusion.

The investigators will further study and describe the management with antiseizure medication and outcome of the group with possible non-convulsive status epilepticus WITH hypermetabolism/hyperperfusion versus the group with possible non-convulsive status epilpticus WITHOUT hypermetabolism/hyperperfusion.

The investigators will make recommendations for an imaging protocol in possible NCSE for widespread use. The aim is to offer guidelines to incorporate imaging in the diagnosis, management and prognosis of NCSE in patients with the ictal-interictal continuum.

Detailed Description

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Conditions

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Status Epilepticus Ictal-interictal Continuum Positron-emission Tomography Perfusion Weighted MRI Perfusion CT

Keywords

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possible non-convulsive status epilepticus ictal-interictal continuum EEG MRI FDG-PET CT perfusion

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Possible non-convulsive status epilepticus with ictal-interictal continuum EEG patterns

Patients with a possible non-convulsive status epilepticus, according to American Clinical Neurophysiology Criteria (ACNS) (2021).

Group Type OTHER

MRI scan including arterial spin labelling of the brain

Intervention Type DIAGNOSTIC_TEST

Arterial Spin Labelling sequence, T2-weighted FLAIR images and T1-weighted images and diffusion weighted imaging sequence will be recorded

CT perfusion scan of the brain

Intervention Type DIAGNOSTIC_TEST

Siemens Naeotom Alpha with quantum technology (photon-counting)

FDG-PET scan of the brain

Intervention Type DIAGNOSTIC_TEST

An FDG-PET scan will be acquired on a GE Signa 3T PET-MR scanner. FDG-PET images will be assessed for focal hypermetabolism, including semiquantitative analysis of the maximal standard uptake value (SUVmax) relative to the SUVmax of the pons (SUVr pons)

Healthy control subjects

Healthy control subjects.

Group Type OTHER

MRI scan including arterial spin labelling of the brain

Intervention Type DIAGNOSTIC_TEST

Arterial Spin Labelling sequence, T2-weighted FLAIR images and T1-weighted images and diffusion weighted imaging sequence will be recorded

CT perfusion scan of the brain

Intervention Type DIAGNOSTIC_TEST

Siemens Naeotom Alpha with quantum technology (photon-counting)

FDG-PET scan of the brain

Intervention Type DIAGNOSTIC_TEST

An FDG-PET scan will be acquired on a GE Signa 3T PET-MR scanner. FDG-PET images will be assessed for focal hypermetabolism, including semiquantitative analysis of the maximal standard uptake value (SUVmax) relative to the SUVmax of the pons (SUVr pons)

Interventions

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MRI scan including arterial spin labelling of the brain

Arterial Spin Labelling sequence, T2-weighted FLAIR images and T1-weighted images and diffusion weighted imaging sequence will be recorded

Intervention Type DIAGNOSTIC_TEST

CT perfusion scan of the brain

Siemens Naeotom Alpha with quantum technology (photon-counting)

Intervention Type DIAGNOSTIC_TEST

FDG-PET scan of the brain

An FDG-PET scan will be acquired on a GE Signa 3T PET-MR scanner. FDG-PET images will be assessed for focal hypermetabolism, including semiquantitative analysis of the maximal standard uptake value (SUVmax) relative to the SUVmax of the pons (SUVr pons)

Intervention Type DIAGNOSTIC_TEST

Other Intervention Names

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Brain perfusion Brain perfusion Brain metabolism

Eligibility Criteria

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Inclusion Criteria

\- The patient has possible non-convulsive status epilepticus with scalp or invasive EEG with ictal-interictal continuum patterns on EEG

Exclusion Criteria

* The patient has a contra-indication for MRI such as metal implants
* The patient has contrast sensitivity
* The patiensuffers from claustrophobia or cannot tolerate confinement during PET-MRI scanning procedures
Minimum Eligible Age

16 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Universitaire Ziekenhuizen KU Leuven

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Wim Van Paesschen, MD PhD

Role: PRINCIPAL_INVESTIGATOR

UZ Leuven

Locations

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University Hospitals Leuven, department of Neurology

Leuven, , Belgium

Site Status RECRUITING

Countries

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Belgium

Central Contacts

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Wim Van Paesschen, MD PhD

Role: CONTACT

Phone: +3216344332

Email: [email protected]

Jeroen Gijs, MD

Role: CONTACT

Phone: +3216344280

Email: [email protected]

Facility Contacts

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Wim Van Paesschen, MD, PhD

Role: primary

Van Paesschen Wim, MD, PhD

Role: backup

References

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Osman GM, Araujo DF, Maciel CB. Ictal Interictal Continuum Patterns. Curr Treat Options Neurol. 2018 Apr 18;20(5):15. doi: 10.1007/s11940-018-0500-y.

Reference Type BACKGROUND
PMID: 29666958 (View on PubMed)

Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S, Shorvon S, Lowenstein DH. A definition and classification of status epilepticus--Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia. 2015 Oct;56(10):1515-23. doi: 10.1111/epi.13121. Epub 2015 Sep 4.

Reference Type BACKGROUND
PMID: 26336950 (View on PubMed)

Hirsch LJ, Fong MWK, Leitinger M, LaRoche SM, Beniczky S, Abend NS, Lee JW, Wusthoff CJ, Hahn CD, Westover MB, Gerard EE, Herman ST, Haider HA, Osman G, Rodriguez-Ruiz A, Maciel CB, Gilmore EJ, Fernandez A, Rosenthal ES, Claassen J, Husain AM, Yoo JY, So EL, Kaplan PW, Nuwer MR, van Putten M, Sutter R, Drislane FW, Trinka E, Gaspard N. American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology: 2021 Version. J Clin Neurophysiol. 2021 Jan 1;38(1):1-29. doi: 10.1097/WNP.0000000000000806. No abstract available.

Reference Type BACKGROUND
PMID: 33475321 (View on PubMed)

Cormier J, Maciel CB, Gilmore EJ. Ictal-Interictal Continuum: When to Worry About the Continuous Electroencephalography Pattern. Semin Respir Crit Care Med. 2017 Dec;38(6):793-806. doi: 10.1055/s-0037-1607987. Epub 2017 Dec 20.

Reference Type BACKGROUND
PMID: 29262437 (View on PubMed)

Rubinos C, Reynolds AS, Claassen J. The Ictal-Interictal Continuum: To Treat or Not to Treat (and How)? Neurocrit Care. 2018 Aug;29(1):3-8. doi: 10.1007/s12028-017-0477-5.

Reference Type BACKGROUND
PMID: 29139014 (View on PubMed)

Rodriguez Ruiz A, Vlachy J, Lee JW, Gilmore EJ, Ayer T, Haider HA, Gaspard N, Ehrenberg JA, Tolchin B, Fantaneanu TA, Fernandez A, Hirsch LJ, LaRoche S; Critical Care EEG Monitoring Research Consortium. Association of Periodic and Rhythmic Electroencephalographic Patterns With Seizures in Critically Ill Patients. JAMA Neurol. 2017 Feb 1;74(2):181-188. doi: 10.1001/jamaneurol.2016.4990.

Reference Type BACKGROUND
PMID: 27992625 (View on PubMed)

Struck AF, Westover MB, Hall LT, Deck GM, Cole AJ, Rosenthal ES. Metabolic Correlates of the Ictal-Interictal Continuum: FDG-PET During Continuous EEG. Neurocrit Care. 2016 Jun;24(3):324-31. doi: 10.1007/s12028-016-0245-y.

Reference Type BACKGROUND
PMID: 27169855 (View on PubMed)

Subramaniam T, Jain A, Hall LT, Cole AJ, Westover MB, Rosenthal ES, Struck AF. Lateralized periodic discharges frequency correlates with glucose metabolism. Neurology. 2019 Feb 12;92(7):e670-e674. doi: 10.1212/WNL.0000000000006903. Epub 2019 Jan 11.

Reference Type BACKGROUND
PMID: 30635488 (View on PubMed)

Venkatraman A, Khawaja A, Bag AK, Mirza M, Szaflarski JP, Pati SBB. Perfusion MRI Can Impact Treatment Decision in Ictal-Interictal Continuum. J Clin Neurophysiol. 2017 Jul;34(4):e15-e18. doi: 10.1097/WNP.0000000000000350.

Reference Type BACKGROUND
PMID: 27749504 (View on PubMed)

Gugger JJ, Llinas RH, Kaplan PW. The role of CT perfusion in the evaluation of seizures, the post-ictal state, and status epilepticus. Epilepsy Res. 2020 Jan;159:106256. doi: 10.1016/j.eplepsyres.2019.106256. Epub 2019 Dec 12.

Reference Type BACKGROUND
PMID: 31862478 (View on PubMed)

Trinka E, Leitinger M. Management of Status Epilepticus, Refractory Status Epilepticus, and Super-refractory Status Epilepticus. Continuum (Minneap Minn). 2022 Apr 1;28(2):559-602. doi: 10.1212/CON.0000000000001103.

Reference Type BACKGROUND
PMID: 35393970 (View on PubMed)

Other Identifiers

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S67933

Identifier Type: -

Identifier Source: org_study_id