title: Frequency, prognosis and surgical treatment of structural abnormalities seen with magnetic resonance imaging in childhood epilepsy.
abstract: The epidemiology of lesions identified by magnetic resonance imaging (MRI), along with the use of pre-surgical evaluations and surgery in childhood-onset epilepsy patients has not previously been described. In a prospectively identified community-based cohort of children enrolled from 1993 to 1997, we examined (i) the frequency of lesions identified by MRI; (ii) clinical factors associated with 'positive' MRI scans; and (iii) the utilization of comprehensive epilepsy evaluations and neurosurgery. Of the original cohort of 613 children, 518 (85%) had usable MRI scans. Eighty-two (16%) had MRI abnormalities potentially relevant to epilepsy ('positive' scans). Idiopathic epilepsy syndromes were identified in 162 (31%) of whom 3% had positive scans. The remainder had non-idiopathic epilepsy syndromes of which 22% had positive MRI findings. Multiple logistic regression analysis identified non-idiopathic epilepsy and abnormal motor-sensory (neurological) examinations as predictors of a positive MRI scan. Of the non-idiopathic patients with normal neurological exams and who were not pharmacoresistant, 10% had positive MRI scans, including four patients with gliomas. Evaluations at comprehensive epilepsy centres occurred in 54 pharmacoresistant cases. To date 5% of the imaged cohort or 8% of non-idiopathic epilepsy patients have undergone surgical procedures (including vagal nerve stimulator implantation) to treat their epilepsy (n = 22) or for tumours (n = 6) without being drug resistant. Applying our findings to the general population of children in the USA, we estimate that there will be 127/1 000 000 new cases per year of pharmacoresistant epilepsy, and 52/1 000 000 childhood-onset epilepsy patients undergoing epilepsy evaluations. In addition, approximately 27/1 000 000 will have an epilepsy-related surgical procedure. These findings support recommendations for the use of MRI in evaluating newly diagnosed paediatric epilepsy patients, especially with non-idiopathic syndromes, and provide estimates on the utilization of comprehensive evaluations and surgery.
authors.affiliation: Department of Biology, Northern Illinois University, DeKalb, IL 60115, USA. atberg@niu.edu
authors.forename: Anne T
authors.initials: AT
authors.lastname: Berg
authors.forename: Gary W
authors.initials: GW
authors.lastname: Mathern
authors.forename: Richard A
authors.initials: RA
authors.lastname: Bronen
authors.forename: Robert K
authors.initials: RK
authors.lastname: Fulbright
authors.forename: Francis
authors.initials: F
authors.lastname: DiMario
authors.forename: Francine M
authors.initials: FM
authors.lastname: Testa
authors.forename: Susan R
authors.initials: SR
authors.lastname: Levy
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D000927:Anticonvulsants / Q000627:therapeutic use; D001921:Brain / Q000473:pathology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003071:Cognition / Q000502:physiology; D015331:Cohort Studies; D004351:Drug Resistance; D004827:Epilepsy / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007223:Infant; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures; D011379:Prognosis; D012598:Sclerosis; D014057:Tomography, X-Ray Computed
chemical_list: D000927:Anticonvulsants