High-resolution MRI enhances identification of lesions amenable to surgical therapy in children with intractable epilepsy.
OBJECTIVE
Many children with refractory epilepsy can achieve better seizure control with surgical therapy. An abnormality on magnetic resonance imaging (MRI), along with corroborating localization by other modalities, markedly increases chances of successful surgical outcome. We studied the impact of high-resolution MRI on the surgical outcome of intractable epilepsy.


METHODS
High-resolution MRI using four-coil phased surface array was obtained as part of the comprehensive presurgical protocol for children with focal onset intractable seizures evaluated by our epilepsy center during the first half of 2002.


RESULTS
Thirteen consecutive children, ages 5 to 18 years, entered this prospective study. For four patients with a lesion on a recent MRI examination with a standard head coil, management did not change with high-resolution MRI. Standard MRI in the other nine patients did not identify a lesion. However, high-resolution MRI with the phased-array surface coil found previously undiagnosed focal abnormalities in five of nine patients. These abnormalities included hippocampal dysplasia, hippocampal atrophy, and dual pathology with frontal cortical dysplasia. In four of nine patients, no identifiable lesion was identified on the high-resolution MRI. All patients underwent invasive monitoring. In three of five patients, newly diagnosed lesions correlated with EEG abnormalities, and resection was performed.


CONCLUSIONS
In our center, high-resolution MRI identified lesions not detected by standard MRI in more than half the children (56%). Technical advances such as four-coil phased surface array MRI can help identify and better delineate lesions, improving the diagnosis of patients who are candidates for surgical treatment of refractory epilepsy.
Department of Pediatrics, Division of Pediatric Neurology, University Hospitals of Cleveland and Case Western Reserve University, Cleveland, Ohio, USA. monisha.goyal@uhhs.com
Monisha
M
Goyal
Barbara A
BA
Bangert
Jonathan S
JS
Lewin
Mark L
ML
Cohen
Shenandoah
S
Robinson
D000293:Adolescent; D001921:Brain / Q000473:pathology* / Q000601:surgery; D001931:Brain Mapping; D002648:Child; D004569:Electroencephalography / Q000706:statistics & numerical data; D004827:Epilepsy / Q000473:pathology* / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D006624:Hippocampus / Q000473:pathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods*; D008297:Male; D011300:Preoperative Care; D011446:Prospective Studies; D016896:Treatment Outcome