# Therapeutic Time Window With DWI-ADC (Diffusion-Weighted Imaging-Apparent Diffusion Coefficient) Match and Periodic Discharges for Status Epilepticus

## TL;DR

A patient with prolonged seizures showed delayed MRI and EEG findings, suggesting a missed treatment window for effective seizure management.

## Contribution

The study highlights the potential of DWI-ADC match as an indicator for a missed therapeutic window in status epilepticus.

## Key findings

- Periodic discharges on EEG indicated seizure cessation after medication.
- Cortical arterial spin labeling findings persisted in regions with cytotoxic edema.
- No seizure recurrence occurred without additional anti-seizure medication.

## Abstract

A man in his 70s with alcoholic dementia was admitted for acute, prolonged impaired consciousness. Blood and cerebrospinal fluid findings were unremarkable. Brain MRI revealed multiple high-signal cortical regions. Following diazepam and levetiracetam administration, electroencephalography (EEG) revealed <1 Hz lateralized periodic discharges, indicating that the seizures were ceasing. The periodic discharges had disappeared during the gradual recovery process by day 10; however, cortical arterial spin labeling findings persisted only in regions exhibiting cytotoxic edema. Without additional anti-seizure medication, no seizure recurred, but cognitive dysfunction remained. He was transferred to a rehabilitation hospital with the continued oral administration of levetiracetam at 1,000 mg/day. DWI-ADC (diffusion-weighted imaging-apparent diffusion coefficient) match may suggest an indication of a missed suitable treatment window for seizures.