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Neuroimaging findings in children with benign focal epileptiform discharges
Rani Sarkis1, Elaine Wyllie, Richard C Burgess
1Epilepsy Center/Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA. sarkisr@ccf.org
Insights
Neuroimaging is not routinely recommended for children with benign focal epileptiform discharges (BFEDs) or benign focal epilepsy of childhood with centrotemporal spikes (BECTS) unless atypical features are present. Abnormal MRI findings were common but often of unclear clinical significance.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Epilepsy
Background:
- Benign focal epileptiform discharges (BFEDs) are common EEG findings in children.
- Benign focal epilepsy of childhood with centrotemporal spikes (BECTS) is a specific subtype of BFEDs.
- The utility of routine neuroimaging in these pediatric epilepsy syndromes is debated.
Purpose of the Study:
- To investigate the reasons for neuroimaging in children with BFEDs.
- To analyze neuroimaging findings in children with BFEDs and BECTS.
- To correlate imaging findings with clinical characteristics.
Main Methods:
- Retrospective chart review of pediatric patients with BFEDs on EEG who underwent brain MRI.
- Analysis of indications for MRI and reported neuroimaging findings.
- Comparison of MRI results between BECTS and broader BFEDs cohorts.
Main Results:
- 97 patients with BFEDs and MRI were identified; 45 had BECTS.
- Common MRI indications included headaches and seizure changes.
- 42% of patients had abnormal MRI findings, including T2 hyperintensities and hippocampal atrophy, often of unclear significance.
Conclusions:
- Routine MRI is not recommended for BECTS unless atypical features are present.
- Atypical features warranting MRI include seizure variability, headaches, and abnormal neurological or EEG findings.
- Most intracranial abnormalities found on MRI in this cohort were of unclear clinical significance, potentially related to remote infarcts or early lesions.
Purpose:
To determine reasons for neuroimaging and neuroimaging findings in children with benign focal epileptiform discharges (BFEDs).
Methods:
We performed a retrospective chart review of children who had BFEDs on routine EEG and underwent brain MRI.
Results:
We identified 97 patients with BFEDs and MRI. Forty-five of these 97 patients also had seizures consistent with benign focal epilepsy of childhood with centrotemporal spikes (BECTS). Rationale for imaging in the 45 BECTS patients included historical features such as headaches (14), increase in seizure frequency (5), and new events (5). Nine MRIs were obtained prior to referral and 12 for unspecified reasons. MRI findings were not significantly different between BECTS and BFEDs patients. Fourty-one patients (42%) had abnormal findings on MRI, including T2 hyperintensities (10), hippocampal atrophy (6), malformation of cortical development (4), volume loss (5), Chiari malformation (4), and others (18).
Conclusion:
MRIs are not routinely recommended in patients with BECTS unless atypical features are present. Atypical features which may prompt MRI include change in clinical seizure types or frequency, historical features such as headaches, abnormal neurological exam, and atypical EEG features. 42% of our selected patients had intracranial abnormalities, most of which were of unclear clinical significance. Remote infarcts and early lesions accounted for most MRI findings suggesting they may be related to BFEDs.
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