Neuroimaging of Ethiopian patients with epilepsy: a retrospective review

Epilepsy is arguably the most common neurological condition encountered by neurologists in Africa. Neuroimaging (CT and MRI) represents the most important recent contribution to the diagnosis, classification and management of the patient with epilepsy.

To describe the role of neuroimaging in the evaluation of Ethiopian patients with epilepsy, by identifying intracranial pathology, and formulating syndromic and etiological diagnoses.

We performed a retrospective review of neuroimaging in 181 patients with epilepsy presenting to a specialized referral hospital (Addis Ababa University Tikur Anbessa Teaching Hospital) and a private clinic (Yehuleshet Higher Clinic) in Addis Ababa, Ethiopia between September 2008 and August 2010. Each patient had an interictal EEG recording.

Neuroimaging demonstrated abnormal intracranial structural lesions in 65 of 181 or 35.9% of epileptic patients (31% with CT; 38% with MRI). Brain lesions were single in 28 (42.8%) and multiple in 23 (35.4%) patients. The lesions were lateralized in 35 patients (53.8%), with 23 (35.4%) on the left add 12 (18.5%) on the right. Twenty seven (41.5%) of these lesions originated in or involved the temporal or frontal lobes. Over one third of the lesions were lobar equally divided among temporal, frontal and parietal regions. The imaging findings demonstrated intracranial space occupying lesions (ICSOL) in 17 (9.4%) patients (with 64.7% brain tumors), cerebral infarctions in 15 (8.3%), cortical atrophy in 9 (5.0%), and gliosis in 7(3.9%). The interictal EEG recordings revealed epileptiform abnormalities in 60/181 patients (33.1%).

Neuroimaging detected intracranial pathology in more than one third of Ethiopian patients with epilepsy. A significant proportion of the cases demonstrated focal epileptiform discharges and non-epileptiform features with abnormal intracranial pathologies. Further prospective neuroimaging studies are recommended. Brain scan and EEG did help in the diagnosis, classification and treatment of epileptics.