When Should a Brain MRI Be Performed in Children with New-Onset Seizures? Results of a Large Prospective Trial

Abstract

BACKGROUND AND PURPOSE:There is a paucity of data regarding the incidence of structural brain lesions in children with new-onset unprovoked seizures. Our aim was to determine the frequencies and types of epileptogenic lesions detected on a dedicated epilepsy protocol MR imaging according to age group, the presence of developmental delay, and the number and types of seizures. MATERIALS AND METHODS:Consecutive children between 6 months and 18 years of age with new-onset unprovoked seizures were included. The frequencies and types of epileptogenic lesions were determined and then stratified according to sex, age groups, the presence of developmental delay, and the number and types of seizures at presentation. Multivariate analysis was used to identify variables significantly associated with the presence of epileptogenic lesions.RESULTS: One thousand children were included. An epileptogenic lesion was identified in 26%, with malformations of cortical development being the most common lesion (32%), followed by hypoxic-ischemic injury (20%) and vascular etiologies (16%). Univariate analysis showed a significant increase in the frequency of epileptogenic lesions with decreasing age, the presence of developmental delay, and the number and types of seizures at presentation. The presence of developmental delay and seizure type at presentation remained significant in a multivariate analysis. CONCLUSIONS:We documented a relatively high rate of epileptogenic lesions in children with new-onset seizures, with the presence of developmental delay and specific seizure types being associated with a higher likelihood of detecting an epileptogenic lesion on neuroimaging. This study fulfills the requirements of the study design recommended by the Practice Committee of the American Academy of Neurology, and we hope that our results will assist the relevant societies and committees in formulating neuroimaging guidelines for children with new-onset seizures.ABBREVIATIONS: DD ¼ developmental delay; MCD ¼ malformations of cortical development; MTS ¼ mesial temporal sclerosis; NCS ¼ neurocutaneous syndromes; PVL ¼ periventricular leukomalacia A brain MR imaging is useful in the work-up of patients with new-onset seizures because it can help define the electroclinical syndrome, identify surgically remediable lesions, and assist in predicting medical refractoriness. 1,2 In addition, according to the new proposed definition of epilepsy, a brain MR imaging may

A tale of two cohorts: Differing outcomes in infantile‐onset focal epilepsy

“…This rate of identification is higher in infants compared to the wider focal pediatric epilepsy population, in whom we previously reported that 46% of children (age 1 month to 17 years) with focal seizures had identified etiology 10 . In the current study, we found that structural abnormalities were the most common cause, emphasizing the need for high‐quality neuroimaging in infantile‐onset focal epilepsy 13–15 . Our detected rate of known etiologies is similar to a recent population‐based study from Sweden, 4 which enrolled all infants with epilepsy presenting in the first 2 years of life and found a known etiology in 59% (including structural in 34%, genetic in 15%, and metabolic in 8.6%).…”

“…10 In the current study, we found that structural abnormalities were the most common cause, emphasizing the need for high-quality neuroimaging in infantile-onset focal epilepsy. [13][14][15] Our detected rate of known etiologies is similar to a recent population-based study from Sweden, 4 which enrolled all infants with epilepsy presenting in the first 2 years of life and found a known etiology in 59% (including structural in 34%, genetic in 15%, and metabolic in 8.6%). The rate of structural etiologies in our cohort was higher (52%), likely because we included only those with focal-onset seizures.…”

Drug-resistant epilepsy treated with a vagus nerve stimulator – case report and literature review

“…MR imaging of the brain should be performed in any child with unprovoked, newly developed seizures [7,8,9,10,11]. According to the ILAE, conditions that can cause a seizure also include, but are not limited to: pre -and perinatal trauma and stroke [12]. The described patient likely developed epilepsy on the background of a history of hemorrhagic stroke.…”

Epilepsy diagnosis and treatment in children – new hopes and challenges – literature review

“…Magnetic resonance imaging (MRI) of the brain should be performed in any child with unprovoked, new-onset seizures, especially if sedation is not required. The International League Against Epilepsy emphasizes the need to consider etiology at every stage of diagnosis, including structural etiology, which is best assessed by brain MRI to help classify a possible epileptic syndrome [11]. Obtaining a negative image on MRI is an indication for single-photon emission computed tomography (SPECT) imaging, which is also helpful in identifying an epileptogenic focus before performing surgery to treat drugresistant epilepsy [12][13].…”