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Ring or disc-like enhancing lesions in partial epilepsy in India
Insights
Cranial CT scans revealed ring or disc lesions in children with partial motor seizures. These lesions, identified as tuberculomas, responded well to anti-tubercular therapy, suggesting they are a common cause of seizures in this population.
Area of Science:
- Neurology
- Pediatrics
- Infectious Diseases
Background:
- Partial motor seizures in children can have various underlying causes.
- Cranial imaging is crucial for diagnosing the etiology of seizures.
Purpose of the Study:
- To investigate the nature of cranial lesions in children with partial motor seizures.
- To determine the efficacy of anti-tubercular therapy for identified lesions.
Main Methods:
- Clinical evaluation and cranial computed tomography (CT) scans were performed on 100 children with partial motor seizures.
- Patients with enhancing ring or disc lesions received three-drug anti-tubercular therapy and anticonvulsants.
- Follow-up scans were obtained for a subset of patients.
Main Results:
- Abnormal CT scans were found in 73% of children.
- Enhancing ring (35%) or disc-like (21%) lesions were identified in 56 patients, correlating with seizure origin.
- The majority of lesions showed decreased size or disappeared after anti-tubercular therapy, with some developing calcification.
Conclusions:
- Ring or disc-like enhancing lesions on cranial CT scans in children with partial motor seizures are likely tuberculomas.
- These tuberculomas are a common cause of partial motor seizures in the studied area.
- Anti-tubercular therapy is effective in managing these lesions.
Abstract:
One-hundred unselected children presenting with partial motor seizures were subjected to clinical work-up and cranial computed tomography (CT scan). Seventy-three children had an abnormal scan. On these, 56 patients had either a ring (35 patients) or a disc-like (21 patients) enhancing lesion which coincided with the probable site of origin of the seizures in all cases. The lesions were surrounded by perifocal oedema which was occasionally severe enough to produce a mass effect. The significance of these disc or ring lesions is discussed in the light of recent literature. All patients with such lesions were put on three-drug anti-tubercular therapy along with anticonvulsants. A repeat scan could be obtained in 20 patients, 10 weeks to 11/2 years after the initial scan. This showed a decrease in size or disappearance of the lesion in the majority (13 patients). Four patients showed a spot of calcification in the area of the original lesion and another two showed a typical 'target sign', i.e. calcification within a ring. It is concluded that these ring or disc lesions represent tuberculomas which are, thus, the commonest cause of partial motor seizures in children in this area.