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Published on: September 20, 2024
[Brain MRI data in children with so called primary generalized seizures]
Anna Zajac1, Izabela Herman-Sucharska, Sławomir Kroczka
1Klinika Neurologii Dzieciecej, Uniwersytetu Jagiellońskiego, Collegium Medicum, Kraków. neupedkr@cm-uj.krakow.pl
Insights
In children with suspected primary generalized seizures, MRI revealed focal pathology in 38%. This highlights the need for thorough evaluation to identify potential partial seizure components, improving diagnostic accuracy.
Area of Science:
- Pediatric Neurology
- Epileptology
- Neuroimaging
Context:
- Diagnosing primary generalized seizures can be challenging due to difficulties in assessing focal onset information.
- Accurate seizure classification is crucial for effective treatment and management in pediatric epilepsy.
Purpose:
- To investigate the necessity of meticulously searching for a partial seizure component in children diagnosed with primary generalized seizures.
- To determine the prevalence of focal pathologies on MRI in this patient group.
Summary:
- This study analyzed 45 children with presumed primary generalized seizures. Magnetic Resonance Imaging (MRI) revealed abnormalities in 31 out of 45 patients (69%). Focal pathologies, including subarachnoidal cysts, ventricular asymmetry, demyelination, and tumors, were identified in a significant portion of cases.
- Specifically, 38% of children exhibited focal pathology on MRI, suggesting that the initial diagnosis of primary generalized seizures may require re-evaluation.
Impact:
- Findings underscore the importance of comprehensive neuroimaging, such as MRI, in the diagnostic workup of children with seemingly generalized seizures.
- Identifying focal abnormalities can lead to a more precise diagnosis, potentially altering treatment strategies and improving patient outcomes in pediatric epilepsy.
Introduction:
Diagnosis of primary generalised seizures may be not precise because difficulties exist with the assessment of information of focal onset of these seizures.
The Aim:
The aim was to examine if the careful searching for partial component of seizures is necessary in children with so called primary generalized seizures.
Material And Methods:
The examined group included 45 children aged 6 month to 18 year (mean 11 year) within 19 girls and 26 boys, hospitalized during the year 2006 in the Department of Pediatric Neurology UJ CM in Krakow. The history indicated the primary generalized character of seizures. The tonic-clonic seizures were observed in 39 children, myoclonic in 3, infantile spasms in 1 and absence in other 2. In 6 patients familiar epilepsy was diagnosed in first-degree cousins. Neuropediatric examination was normal apart from 4 children with dysmorphic features of the face. Intellectual development was normal in 43 children, however it was close to the lower range in one and mildly delayed in the other one. Generalized paroxysmal bioelectric activity was detected in 43 children and in 2 children EEG pattern was normal. MRI was performed in SE T1, FSE T2, PD, FLAIR and IR T1 sequences with 3 or 5 millimetre thickness of layer in the sagital, coronal and transversal plane, using a 1.5 T signa horizon HiSpeed General Electric. These examinations were performed in the Voxel MR Laboratory in University Children's Hospital in Krakow.
Results:
MRI results were normal in 14/45 children and in others pathological. In 9/45 MR revealed subarachnoidal cyst, in 8 lateral ventricles asymmetry, in 5 mild demyelination, in 9 subarachnoid space and lateral ventricles dilatation. In 2/45 children brain tumors (hamartoma of the hypothalamus and DNET of the temporal lobe), in 1 gliosis of the occipital lobe were revealed, however other insignificant changes were also observed. Dual or multiple MRI pathology was revealed in 14 children. In17/45 children abnormalities were localized.
Conclusions:
Existence of focal pathology in MRI of 38% children with the history of so called primary generalized seizures suggested the necessity of more careful searching for partial component of seizures.
Related Concept Videos
01:13Seizures: Classification
Seizures are typically classified into two main categories: focal and generalized seizures.
Focal Seizures
Focal seizures originate from specific regions of the brain. These seizures are further sub-classified into two types:
01:20Seizures l: Introduction