Epilepsy and destructive brain insults in early life: a topographical classification on the basis of MRI findings.
Destructive insults of early development can lead to a wide variety of lesional patterns and are a well known cause of epilepsy. The aim of this study is to present a topographic magnetic resonance imaging (MRI) classification of these lesions in adult patients with epilepsy. Thirty-three consecutive patients were divided in three groups according to the topographic distribution of their lesion on MRI: hemispheric (H, n = 7); main arterial territory (AT, n = 18); arterial borderzone (Bdz, n = 8). We analyzed clinical, MRI and magnetic resonance angiography (MRA) data. Status epilepticus (SE) during childhood was more common in group H (7/7) than in the groups AT (1/18) and Bdz (0/8) (P < 0.001). MRA pattern of impaired flow signal in the distal segments of all three major arteries in the affected hemisphere was present in 85.7% of group H patients, and was exclusive to this group. 88.8% (16/18) of patients from group AT presented congenital motor deficit, in contrast to 37.5% (3/8) of group Bdz, and in none of group H (P < 0.001). All patients with Bdz lesions had antecedent of fetal distress, in contrast to 1/7 from group H and 5/18 of group AT (P = 0.001). The MRAs of patients with Bdz lesions were often normal except in those with larger lesions. Our data suggest that in adult patients with epilepsy due to precocious destructive brain insults, a MRI topographical classification distributes them in relatively homogenous clinical groups.
Departamento de Neurologia, FCM-UNICAMP, CEP 13083-970 Campinas, SP, Brazil.
Ricardo A
RA
Teixeira
Verônica A
VA
Zanardi
Li M
LM
Li
Sergio L M
SL
Santos
Fernando
F
Cendes
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001921:Brain / Q000098:blood supply* / Q000473:pathology* / Q000502:physiology; D002545:Brain Ischemia / Q000150:complications*; D001931:Brain Mapping; D004827:Epilepsy / Q000209:etiology*; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged