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Magnetic resonance imaging in symptomatic/cryptogenic partial epilepsies of infants and children
1Department of Pediatrics and Radiology, National Taiwan University Hospital, Taipei, R.O.C.
Insights
Magnetic resonance imaging (MRI) detected brain lesions in 41.7% of children with symptomatic/cryptogenic partial epilepsies (S/CPEs). Identifying these lesions is crucial for diagnosing and treating pediatric epilepsy causes.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Epileptology
Background:
- Symptomatic/cryptogenic partial epilepsies (S/CPEs) in children often require detailed investigation to identify underlying brain lesions.
- Early diagnosis and characterization of these lesions are essential for effective management and treatment strategies.
Purpose of the Study:
- To determine the detection rate of brain lesions in infants and children with S/CPEs using magnetic resonance imaging (MRI).
- To identify the common types of brain lesions and their etiologies in pediatric S/CPEs.
Main Methods:
- Retrospective analysis of 300 pediatric patients diagnosed with S/CPEs (onset < 13 years) over 7 years.
- Inclusion of magnetic resonance imaging (MRI), electroencephalography (EEG), and clinical/neurologic evaluations.
- Categorization of detected brain lesions by type (malformations, vascular, neurocutaneous, space-taking, destructive) and etiology (infection, ischemia, trauma, etc.).
Main Results:
- MRI detected brain lesions in 41.7% (125/300) of pediatric S/CPE cases.
- Congenital malformations, vascular malformations, neurocutaneous syndromes, and space-taking lesions were common.
- Destructive lesions (porencephaly, atrophy) and infarction-related lesions (encephalomalacia, leukomalacia) were linked to various insults including hypoxic-ischemic encephalopathy (HIE) and infection.
- Mesial temporal sclerosis (MTS) was found in 20% of temporal lobe epilepsy cases, associated with febrile seizures and encephalitis.
Conclusions:
- MRI is a valuable tool for detecting a wide range of pathologies causing S/CPEs in children.
- Identifying the underlying brain lesion is critical as many causes of pediatric S/CPEs are potentially treatable.
- Comprehensive clinical, laboratory, and neuroimaging investigations are necessary for accurate diagnosis and management.
Abstract:
In order to identify the brain lesions of symptomatic/cryptogenic partial epilepsies (S/CPEs) in infants and children, magnetic resonance imaging (MRI) studies, thorough encephalographic (EEGic) studies, and detailed clinical and neurologic evaluations were obtained in 300 infants and children who were diagnosed to have S/CPEs with onset before the age of 13 years during the past 7 years. The overall detection rate of brain lesions by MRI was 41.7% (125/300). Congenital malformations (18 cases), vascular malformations (9 cases), neurocutaneous syndromes (13 cases), and space-taking lesions (20 cases) constitute a large percentage of SPEs in infants and children. A variety of insults such as infection, ischemia, hemorrhage, trauma and metabolic disorders can result in destructive parenchymal loss lesions including porencephaly, focal atrophy, hemiatrophy, and diffuse brain atrophy (20 cases). Major etiologic factors leading to infarction, encephalomalacia, leukomalacia, included trauma, hvpoxicischemic encephalopathy (HIE), systemic lupus erythematosus (SLE), encephalitis, vasculitis, venous thrombosis, vasculopathies, and heart problems (22 cases). Mesial temporal sclerosis (MTS) could be evidenced in around 20% (18/95) of cases with temporal lobe epilepsy (TLE), which was strongly associated with past histories of febrile seizures and encephalitis complicated by status epileptics. However, cases with porencephaly, global atrophy or delayed myelination of unilateral temporal lobe on MRI were more related to HIE. With the advent of neuroimaging techniques, particularly MRI, a wide variety of underlying pathology can be detected as a cause of symptomatic partial epilepsies in pediatric patients. The occurrence of S/CPE indicates the presence of localized brain dysfunction, and many of the causes are potentially treatable. An orderly and thorough clinical and laboratory investigations, as well as neuroimaging studies should be made to diagnose and treat any underlying conditions.