Patients with super-refractory status epilepticus (SRSE) could end up with brain atrophy after a prolonged seizure and treatment, according to a new study published in the Journal of the American Medical Association Neurology.

Researchers studied 19 patients with SRSE and measured their ventricular brain ration (VBR) during two different MRI scans following an SRSE, an average of two and 11 days after onset and resolution SRSE with an average of 40 days between the two). Researchers wanted to measure how exactly their brains responded after such episodes, given that many patients show decreased cognitive ability after the seizures. Not all of them even survive the episode—about 30 to 50 percent of SRSE sufferers die from it.  

Other individual studies have shown that SRSE could lead to a loss of brain volume, but the researchers wanted to examine a larger cohort.

In the MRIs taken at 2 and 11 days after onset and resolution SRSE, the researchers looked at VBR, a measurement that “a frequently used measure of cerebral atrophy calculated as the area of the lateral ventricles divided by the brain area in a given plane.” A change or decrease in VBR can be a good way to predict decreased cognitive function in people with diseases such as schizophrenia and dementia.

According to the study authors, all of the patients ended up with some kind of measureable brain atrophy, though some was more pronounced than others. The researchers found that the average change in VBR among the 19 patients was 23 percent. That change could be caused not just by the prolonged seizures themselves, the researchers found, but also could be affected by the length and intensity of the anesthetic treatment of the seizures.

The patients received an average of two and a half anesthetic treatments for an average of 13 days, staying in the hospital for an average of 40 days. And the researchers found that the longer the anesthetic treatments were used and the longer a patient stayed in the hospital, the more likely they were to have a higher change in VBR between the two MRIs. And the older the patients, the lower the change in VBR. These VBR changes were not necessarily associated with cognitive changes.

It is possible these VBR changes could be caused by the treatment itself, ongoing smaller seizures not measured by doctors, hospital complications, the length or severity of the SRSE or other factors. 

Because the amount of atrophy was not correlated with functional outcome, VBR change should not necessarily be relied upon as an indicator of recovery, the researchers cautioned.