[Structural MRI changes in children with epilepsy aged 2-18 years]

Epilepsy can be one of symptoms of the damage to CNS in children, therefore neuroradiological examinations are necessary to complete diagnostics. The guidelines for imaging children with recent-onset epilepsy were published by experts of International League Against Epilepsy.

The aim of this retrospective research was to analyze results of MRI in children aged 2 to 18 years, hospitalized between years 2008 and 2010 in the Department of Pediatric Neurology of the Chair of Neurology of Children and Adolescents of Jagiellonian University after the first epileptic attack, with recent-onset epilepsy or chronic epilepsy.

119 children were included, within children hospitalized as urgent to exclude severe cause and children admitted for diagnostics, whose cerebral MRI revealed pathological changes.

The most common anatomical change in MRI was asymmetry of ventricles, revealed in 32 children, within 13 with localized seizures. In 21 children non specific hiperintensive lesions of the white matter were detected, in 19 children seizures were not focal. Cortical atrophy was present in 11 children, seizures in 7 were focal. Venous angioma was diagnosed in 8 children (partial attacks were observed in 4). Dilated Virchow-Robin perivascular spaces were detected in 7 children, within 4 with partial seizures. Vasogenic scar or porencephaly was diagnosed in 6 children, and arachnoid cyst in 9, within 7 with focal seizures. In 4 children epilepsy was a result of hypoxic-ischemic damage, and in 3 resulted from neuroinfection. In 4 children brain neoplasm was detected (in 3 seizures were focal and in one status epilepticus occurred), in 3 other children pineal cyst was detected. In 9 children malformations of CNS were detected, and in single cases epilepsy was associated with Leigh syndrome or NF I, and in one child pituitary microadenoma was detected.

Severe pathological process for surgical intervention manifested as focal attacks or status epilepticus, indicating the necessity of urgent neuroradiological examinations. In each case of the first attack or epilepsy neuroradiological tests are compulsory not as urgent, for confirming or excluding static lesions. This is important to establish prognosis and long-term management of the child with epilepsy. Children with idiopathic generalized epilepsy were not included, because hospitalization rarely is necessary.