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Predictors of hippocampal, cerebral, and cerebellar volume reduction in childhood epilepsy
J A Lawson1, S Vogrin, A F Bleasel
1Department of Paediatric Neurology, Sydney Children's Hospital & School of Paediatrics, University of New South Wales, Randwick, New South Wales, Australia.
Insights
Pediatric epilepsy patients show significant brain volume reduction, even with infrequent seizures. Factors like intellectual disability and seizure duration contribute to these structural abnormalities.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Epilepsy Research
Background:
- Epilepsy in children can lead to structural brain changes.
- Understanding these changes is crucial for diagnosis and treatment.
Purpose of the Study:
- To investigate factors associated with brain volume reduction in children with epilepsy.
- To identify specific risk factors contributing to these changes.
Main Methods:
- Studied 231 children with epilepsy (under 18) undergoing MRI with volumetric analysis.
- Assessed risk factors including age of onset, seizure history, family history, intellectual disability, and febrile convulsions.
- Compared brain volumes to 44 healthy child controls.
Main Results:
- Children with epilepsy had 10% reduced brain volume compared to controls.
- Brain volume was linked to age, gender, intellectual disability, seizure years, and status epilepticus.
- Hippocampal volume correlated with total brain volume, age, ischemic injury, and complex febrile convulsions.
Conclusions:
- Children with epilepsy exhibit significant brain volume reduction, partly due to acquired insults.
- This reduction may indicate innate structural abnormalities, even with mild seizure activity.
- Complex febrile convulsions are associated with hippocampal volume reduction, requiring control for total brain volume in analyses.
Purpose:
We examined the factors related to brain volume reduction in a pediatric sample of patients that included those with nonintractable epilepsy.
Methods:
Entry criteria were children less than 18 years old with epilepsy referred for MRI, including a whole brain volumetric sequence. The sample size was 231. Risk factors were ascertained from interviews and reviews of medical records. Factors included age of onset, seizure years, family history, status epilepticus, intellectual disability, and febrile convulsions. MRI data were obtained for 44 normal childhood control subjects.
Results:
Cerebral and cerebellar volumes were significantly associated with age, gender, moderate-to-severe intellectual disability (p < 0.001), seizure years, and status epilepticus (p < 0.03). Compared with controls, the brain volume of all patients was reduced by 10% (p < 0.001). Hippocampal volume was significantly associated with total brain volume, age (p < 0.001), focal cerebral ischemic injury, and complex febrile convulsions (p < 0.05).
Conclusions:
Significant brain volume reduction is present in children with epilepsy. A component of this reduction is due to acquired insults. The reduction is seen even in children with infrequent seizures over a brief time, suggesting an innate structural abnormality. When evaluating possible etiologic factors in the development of hippocampal volume reduction, one must control for total brain volume. We have confirmed the association of complex febrile convulsions with unilateral hippocampal volume reduction.
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