Magnetic Resonance Imaging Findings in Epileptic Children and its Relation to Clinical and Demographic Findings

  • Susan Amirsalari Department of Pediatrics, Baqiyatallah University of Medical Sciences, Tehran, Tehran, Iran.
  • Amin Saburi Mail Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Tehran, Iran.
  • Reza Hadi Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Tehran, Iran.
  • Mohammad Torkaman Department of Pediatrics, Baqiyatallah University of Medical Sciences, Tehran, Tehran, Iran.
  • Fatemeh Beiraghdar Nephrology & Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
  • Shahla Afsharpayman Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Tehran, Iran.
  • Yasaman Ghazavi Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Terhan, Iran.
Keywords:
Children, Epilepsy, Electroencephalography (EEG), Magnetic resonance imaging (MRI)

Abstract

Epilepsy is an important disease with a cumulative incidence of 3% all over the life and more than half of them are started from childhood. In this study we surveyed magnetic resonance imaging (MRI) findings in epileptic children and its relation with clinical and demographic findings in order to find better diagnostic and treatment modalities for these children in the future. In this cross sectional study, we investigated consecutively all 1 to 15-year-old epileptic children who referred to the pediatric neurology outpatient clinic from 2004 to 2010. Two hundred children were enrolled for investigation. There were 85 (42.5%) girls and 115 (57.7%) boys, aged 1 to 15-year-old (7.7±4). 196 (98%) of the children had abnormal electroencephalography (EEG). Abnormal MRI was seen in 57 (28.5%) patients and consisted of brain atrophy (10%), increasing white matter signal intensity in T2-weighted images (8%), benign cysts (5%), brain tumors (4%) and vascular abnormalities (1.5%). Abnormal MRI findings had significant relation with abnormal EEG, age, positive family history for epilepsy, dysmorphic appearance, and abnormal physical exam. Considering 98% EEG abnormalities in these epileptic children, benign nature of MRI findings in most of our cases, the high price of MRI and the small minority of patients who benefit from active intervention as a result of MRI, we suggest to use EEG for confirmation of epilepsy and perform MRI for patient with abnormal physical exams, focal neurologic deficits or focal EEG abnormalities.

References

Wright NB. Imaging in epilepsy: a paediatric perspective. Br J Radiol 2001;74(883):575-89.

Forsgren L. Incidence and prevalence. In: Wallace SJ, Farrell K, editors. Epilepsy in Children. 2nd ed. London, UK: Arnold Publishers; 2004. p. 21-5.

Guerrini R. Epilepsy in children. Lancet 2006;367(9509):499-524.

Serdaroğlu A, Ozkan S, Aydin K, Gücüyener K, Tezcan S, Aycan S. Prevalence of epilepsy in Turkish children between the ages of 0 and 16 years. J Child Neurol 2004;19(4):271-4.

Guissard G, Damry N, Dan B, David P, Sékhara T, Ziereisen F, Christophe C. Imaging in paediatric epilepsy. Arch Pediatr 2005;12(3):337-46.

Wright J, Pickard N, Whitfield A, Hakin N. A populationbased study of the prevalence, clinical characteristics and effect of ethnicity in epilepsy. Seizure 2000;9(5):309-13.

Hirtz D, Ashwal S, Berg A, Bettis D, Camfield C, Camfield P, Crumrine P, Elterman R, Schneider S, Shinnar S. Practice parameter: evaluating a first nonfebrile seizure in children: report of the quality standards subcommittee of the American Academy of Neurology, The Child Neurology Society, and The American Epilepsy Society. Neurology 2000;55(5):616-23.

Vattipally VR, Bronen RA. MR imaging of epilepsy: strategies for successful interpretation. Neuroimaging Clin N Am 2004;14(3):349-72.

Topalkara K, Akyuz A, Sumer H, Bekar D, Topaktas S, Dener S. An epilepsy prevalence study performed using stratified sampling method among urban residents of Sivas. Epilepsi 1999;5:24-9.

Okan N, Okan M, Eralp O, Aytekin AH. The prevalence of neurological disorders among children in Gemlik (Turkey). Dev Med Child Neurol 1995;37(7):597-603.

Annegers JF, Hauser WA, Lee JR, Rocca WA. Incidence of acute symptomatic seizures in Rochester, Minnesota, 1935-1984. Epilepsia 1995;36(4):327-33.

Duncan JS. Imaging and epilepsy. Brain 1997;120(Pt2):339-77.

Commission on Neuroimaging of the International League Against Epilepsy. Recommendations for neuroimaging of patients with epilepsy. Epilepsia 1997;38(11):1255-6.

Krumholz A, Wiebe S, Gronseth G, Shinnar S, Levisohn P, Ting T, Hopp J, Shafer P, Morris H, Seiden L, Barkley G, French J; Quality Standards Subcommittee of the American Academy of Neurology; American Epilepsy Society. Practice Parameter: evaluating an apparent unprovoked first seizure in adults (an evidencebased review): report of the Quality Standards Subcommittee of the American Academy of Neurologyand the American Epilepsy Society. Neurology 2007;69(21):1996-2007.

Hsieh DT, Chang T, Tsuchida TN, Vezina LG, Vanderver A, Siedel J, Brown K, Berl MM, Stephens S, Zeitchick A, Gaillard WD. New-onset afebrile seizures in infants: role of neuroimaging. Neurology 2010;74(2):150-6.

Arthur TM, deGrauw TJ, Johnson CS, Perkins SM, Kalnin A, Austin JK, Dunn DW. Seizure recurrence risk following a first seizure in neurologically normal children. Epilepsia 2008;49(11):1950-4.

Berg AT, Mathern GW, Bronen RA, Fulbright RK, DiMario F, Testa FM, Levy SR. Frequency, prognosis and surgical treatment of structural abnormalities seen with magnetic resonance imaging in childhood epilepsy. Brain 2009;132(Pt 10):2785-97.

Shinnar S, O'Dell C, Mitnick R, Berg AT, Moshe SL. Neuroimaging abnormalities in children with an apparent first unprovoked seizure. Epilepsy Res 2001;43(3):261-9.

Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia 1989;30(4):389-99.

Engel J Jr; International League Against Epilepsy (ILAE). A proposed diagnostic scheme for people with epileptic seizures and with epilepsy: report of the ILAE Task Force on Classification and Terminology. Epilepsia 2001;42(6):796-803.

Frankenburg WK, Dodds J, Archer P, Shapiro H, Bresnick B. The Denver II: a major revision and restandardization of the Denver Developmental Screening Test. Pediatrics 1992;89(1):91-7.

Sato S, Rose DF. The electroencephalogram in the evaluation of the patient with epilepsy. Neurol Clin 1986;4(3):509-29.

Centers for Disease Control and Prevention (CDC). Prevalence of epilepsy and health-related quality of life and disability among adults with epilepsy: South Carolina, 2003 and 2004. MMWR Morb Mortal Wkly Rep 2005;54(42):1080-2.

Mohammadi MR, Ghanizadeh A, Davidian H, Mohammadi M, Norouzian M. Prevalence of epilepsy and comorbidity of psychiatric disorders in Iran. Seizure 2006;15(7):476-82.

Jallon P, Loiseau P, Loiseau J. Newly diagnosed unprovoked epileptic seizures: presentation at diagnosis in CAROLE study. Coordination Active du Réseau Observatoire Longitudinal de l' Epilepsie. Epilepsia 2001;42(4):464-75.

Armon K, Stephenson T, Gabriel V, MacFaul R, Eccleston P, Werneke U, Smith S. Determining the common medical presenting problems to an accident and emergency department. Arch Dis Child 2001;84(5):390-2.

Gaillard WD, Chiron C, Cross JH, Harvey AS, Kuzniecky R, Hertz-Pannier L, Vezina LG; ILAE, Committee for Neuroimaging, Subcommittee for Pediatric. Guidelines for imaging infants and children with recent-onset epilepsy. Epilepsia 2009;50(9):2147-53.

Illes J, Rosen AC, Huang L, Goldstein RA, Raffin TA, Swan G, Atlas SW. Ethical consideration of incidental findings on adult brain MRI in research. Neurology 2004;62(6):888-90.

Landfish N, Gieron-Korthals M, Weibley RE, Panzarino V. New onset childhood seizures. Emergency department experience. J Fla Med Assoc 1992;79(10):697-700.

Warden CR, Brownstein DR, Del Beccaro MA. Predictors of abnormal findings of computed tomography of the head in pediatric patients presenting with seizures. Ann Emerg Med 1997;29(4):518-23.

Sharma S, Riviello JJ, Harper MB, Baskin MN. The role of emergent neuroimaging in children with new-onset afebrile seizures. Pediatrics 2003;111(1):1-5.

Maytal J, Krauss JM, Novak G, Nagelberg J, Patel M. The role of brain computed tomography in evaluating children with new onset of seizures in the emergency department. Epilepsia 2000;41(8):950-4.

McAbee GN, Barasch ES, Kurfist LA. Results of computed tomography in "neurologically normal" children after initial onset of seizures. Pediatr Neurol 1989;5(2):102-6.

Khodapanahandeh F, Hadizadeh H. Neuroimaging in children with first afebrile seizures: to order or not to order? Arch Iran Med 2006;9(2):156-8.

Mohamed Y, Alias NN, Shuaib IL, Tharakan J, Abdullah J, Munawir AH, Naing NN. Referral of epileptic patients in North East Coast of West Malaysia an area with poor MRI coverage: an analysis. Southeast Asian J Trop Med Public Health 2006;37(6):1199-208.

Kalnin AJ, Fastenau PS, deGrauw TJ, Musick BS, Perkins SM, Johnson CS, Mathews VP, Egelhoff JC, Dunn DW, Austin JK. Magnetic resonance imaging findings in children with a first recognized seizure. Pediatr Neurol 2008;39(6):404-14.

Berg AT, Testa FM, Levy SR, Shinnar S. Neuroimaging in children with newly diagnosed epilepsy: A communitybased study. Pediatrics 2000;106(3):527-32.

Kolk A, Beilmann A, Tomberg T, Napa A, Talvik T. Neurocognitive development of children with congenital unilateral brain lesion and epilepsy. Brain Dev2001;23(2):88-96.

Doescher JS, deGrauw TJ, Musick BS, Dunn DW, Kalnin AJ, Egelhoff JC, Byars AW, Mathews VP, Austin JK. Magnetic resonance imaging (MRI) and electroencephalographic (EEG) findings in a cohort of normal children with newly diagnosed seizures. J Child Neurol 2006;21(6):491-5.

Hamiwka LD, Singh N, Niosi J, Wirrell EC. Diagnostic inaccuracy in children referred with "first seizure": role for a first seizure clinic. Epilepsia 2007;48(6):1062-6.

How to Cite
1.
Amirsalari S, Saburi A, Hadi R, Torkaman M, Beiraghdar F, Afsharpayman S, Ghazavi Y. Magnetic Resonance Imaging Findings in Epileptic Children and its Relation to Clinical and Demographic Findings. Acta Med Iran. 50(1):37-42.
Section
Articles