MRI observations in children with epilepsy: experience from a large cohort

Abstract

We analyzed the magnetic resonance imaging (MRI) observations and their clinical correlates in a large cohort of children with epilepsy. This observational study prospectively included 144 children with epilepsy (male/female = 73/71; mean age = 5.87 ± 4.19 yr duration = 2.74 ± 2.79 yr), who were evaluated with cranial MRI and phenotypic data. The seizures types were partial 67; generalized 72, and unclassified five. Ninety-four (65.28%) patients had abnormal MRI findings. The common MRI findings included atrophy in 58 [diffuse 33; focal 25]; signal changes in 61 [T2-weighted hyperintense with T1-weighted hypointense to isointense in 58; T1-weighted hyperintense in two patients T2-weighted hypointense in one]; and ventriculomegaly in 29. Among 41 children with both computerized tomography and MRI of brain, 10 were normal, while MRI had better delineation in 17 children and concordant in rest 14. Electroencephalography was abnormal in 104 (72.22%). The syndromic subtypes were structural/metabolic (symptomatic) in 95 (acute in eight); unknown (cryptogenic) in 45; and genetic (idiopathic) in six patients. Based on the imaging and other electroclinical features the final diagnosis in the symptomatic subgroup were hypoxic ischemic encephalopathy in 27; developmental malformation in 14; poliodystrophy in 13; leukoencephalopathy in seven; granuloma in seven; tumor in four; ischemic in three; meningoencephalitis in three; Rasmussen’s encephalitis in three; progressive cerebral degeneration in three; chromosomal in two; neurocutaneous in two; developmental in two; and metabolic; gliosis; storage, hippocampal sclerosis, calcification in one each cases. Seizure freedom for >1 yr was noted in 50%.