Neuroimaging Profile of drug-resistant Epilepsy from a Tertiary Care Center in South India

Drug-resistant epilepsy (DRE) is a common and important neurological problem to identify with scope for curative surgical treatment if underlying cause is delineated. There are very few prospective structured studies in our population. This study aimed to look at the neuroimaging profile of DRE presenting in a tertiary care center in South India.

All patients diagnosed clinically as DRE as per International League Against Epilepsy (ILAE) criteria and who underwent magnetic resonance imaging (MRI) over a period of 24 months were included in the study. Their clinical and MRI features were documented and analyzed.

A total of 150 patients diagnosed with DRE were included in the study. Clinically, 96 of them presented with generalized tonic-clonic seizures (GTCS), 36 with complex partial seizures (CPS), 14 with simple focal seizures, and two each with atonic seizures and focal seizures with secondary generalization. Magnetic resonance imaging (done in 1.5 T) was normal in 32%. In those with abnormal MRI, mesial temporal sclerosis (MTS) was the commonest pathology seen in 41.3%, followed by cortical malformations (6.7%), tumors (2.6%), vascular malformations (2.7%), and other nonspecific lesions (12%).

The clinical and neuroimaging profile of DRE showed that DRE is more common in younger age (of less than 30 years); presents mainly with GTCS or CPS; mesial temporal sclerosis is the commonest underlying pathology which was bilateral in 8.6%; temporal lobe lesions predominate (49.3% of all DRE); and cortical malformation, low-grade tumors, and vascular lesions are other important causes.