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Prevalence of MRI abnormalities in people with epilepsy in rural China
Indran Davagnanam1, Zhibin Chen1, Chandrashekar Hoskote1
1From the Academic Department of Neuroradiology (I.D.), Department of Brain Repair and Rehabilitation, and NIHR University College London Hospitals (J.S.D., J.W.S.), Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK; Clinical Epidemiology (Z.C.), School of Public Health and Preventive Medicine, and Department of Neuroscience (Z.C., P.K.), Central Clinical School, Monash University, Melbourne; Department of Medicine (Z.C., P.K.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Lysholm Department of Neuroradiology (C.H.), National Hospital for Neurology & Neurosurgery, Queen Square, London, UK; Institute of Neurology (D.D.), Huashan Hospital, Fudan University, Shanghai; Beijing Neurosurgical Institute (W.W.); Jiaozuo People's Hospital (B.Y.), Henan Province; Ningxia Medical University (Y.W.); Jincheng Emergency Medical Rescue Center (T.W.), Shanxi Province; Affiliated Second Hospital (W.L.), Hebei Medical University, China; Chalfont Centre for Epilepsy (J.S.D., J.W.S.), Chalfont St. Peter, UK; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Heemstede, Netherlands.
Objective:
To assess the prevalence of brain MRI abnormalities in people with epilepsy in rural China and to compare it with that of individuals in the United Kingdom.
Methods:
Brain MRI scans were obtained in people with epilepsy who participated in a rural community-based program in China between July 2010 and December 2012. Individual epileptogenic lesion types were reviewed and their associations with seizure control examined. The MRI findings were compared with 2 previous similar studies in the United Kingdom.
Results:
Among the 597 individuals (58% male, median age 38 years) with MRI scans analyzed, 488 (82%) had active epilepsy. The MRI was abnormal in 389 individuals (65%), with potentially epileptogenic lesion in 224 (38%) and nonspecific abnormalities in 165 (28%), and 108 (18%) were potentially resectable. The potentially epileptogenic lesions were less frequently detected in children (<18 years old, 12 of 68, 18%) than in adults (212 of 529, 40%; p < 0.001). In people with potentially epileptogenic lesions, 67% (150 of 224) had failed ≥2 antiseizure medications. They had higher risk of uncontrolled epilepsy than those with normal MRI (risk ratio [RR] 1.25; p < 0.001) and those with nonspecific abnormality (RR 1.15; p = 0.002) after adjustment for age and sex. The diagnostic yield of MRI was similar to that reported in community- and hospital-based studies in the United Kingdom.
Conclusions:
More than one-third of people with chronic epilepsy in rural China have potentially epileptogenic lesions identifiable on brain MRI, with two-thirds fulfilling the definition of pharmacoresistance. These findings highlight the magnitude of the unmet needs for epilepsy surgery in China.
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