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Value of Repeat Brain MRI in Children with Focal Epilepsy and Negative Findings on Initial MRI
Tae Yeon Jeon1, Ji Hye Kim1, Jeehun Lee2
1Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
Objective:
To evaluate the value of repeat brain magnetic resonance imaging (MRI) in identifying potential epileptogenic lesions in children with initial MRI-negative focal epilepsy.
Materials And Methods:
Our Institutional Review Board approved this retrospective study and waived the requirement for informed consent. During a 15-year period, 257 children (148 boys and 109 girls) with initial MRI-negative focal epilepsy were included. After re-evaluating both initial and repeat MRIs, positive results at repeat MRI were classified into potential epileptogenic lesions (malformation of cortical development and hippocampal sclerosis) and other abnormalities. Contributing factors for improved lesion conspicuity of the initially overlooked potential epileptogenic lesions were analyzed and classified into lesion factors and imaging factors.
Results:
Repeat MRI was positive in 21% (55/257) and negative in 79% cases (202/257). Of the positive results, potential epileptogenic lesions comprised 49% (27/55) and other abnormalities comprised 11% of the cases (28/257). Potential epileptogenic lesions included focal cortical dysplasia (n = 11), hippocampal sclerosis (n = 10), polymicrogyria (n = 2), heterotopic gray matter (n = 2), microlissencephaly (n = 1), and cortical tumor (n = 1). Of these, seven patients underwent surgical resection. Contributing factors for new diagnoses were classified as imaging factors alone (n = 6), lesion factors alone (n = 2), both (n = 18), and neither (n = 1).
Conclusion:
Repeat MRI revealed positive results in 21% of the children with initial MRI-negative focal epilepsy, with 50% of the positive results considered as potential epileptogenic lesions. Enhanced MRI techniques or considering the chronological changes of lesions on MRI may improve the diagnostic yield for identification of potential epileptogenic lesions on repeat MRI.
Insights
Repeat brain MRI identifies potential epileptogenic lesions in 21% of children with initial MRI-negative focal epilepsy. These findings can improve diagnosis and treatment planning for pediatric epilepsy.
Area of Science:
- Neurology
- Pediatric Epilepsy
- Neuroimaging
Background:
- Focal epilepsy in children often presents with initial MRI-negative findings.
- Identifying the epileptogenic zone is crucial for effective treatment.
Purpose of the Study:
- To assess the diagnostic value of repeat brain MRI in children with initial MRI-negative focal epilepsy.
- To identify potential epileptogenic lesions missed on initial imaging.
Main Methods:
- Retrospective study of 257 children with initial MRI-negative focal epilepsy over 15 years.
- Re-evaluation of initial and repeat brain MRIs.
- Classification of positive findings into potential epileptogenic lesions and other abnormalities.
Main Results:
- Repeat MRI was positive in 21% of cases.
- Potential epileptogenic lesions were identified in 49% of positive repeat MRIs.
- Common lesions included focal cortical dysplasia and hippocampal sclerosis.
Conclusions:
- Repeat brain MRI is valuable in diagnosing pediatric focal epilepsy when initial scans are negative.
- Enhanced MRI techniques and analysis of chronological changes may improve lesion detection.
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