3.0 T MRI of 2000 consecutive patients with localisation-related epilepsy

Craven, Ian; Griffiths, Paul D.; Bhattacharyya, Dipak Kumar; Grünewald, R. A.; Hodgson, Timothy J.; Connolly, Daniel; Coley, Stuart C.; Batty, Ruth; Romanowski, C.A.J.; Hoggard, Nigel

doi:10.1259/bjr/30177037

Cited by 30 publications

(22 citation statements)

References 28 publications

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“…Cases of epilepsy that were milder may not have been referred as often to our study. This may explain the overall high prevalence of abnormal findings here when compared with prior large case series elsewhere (Craven et al, 2012). It is conversely possible that the most severe cases of epilepsy were not included in this study due to premature mortality, immobility, or economic hardship.…”

Section: Discussionsupporting

confidence: 48%

Yield of Brain MRI in Clinically Diagnosed Epilepsy in the Kingdom of Bhutan: A Prospective Study

Bruno

Klein

Nidup³

et al. 2017

Annals of Global Health

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Introduction To report the diagnostic yield of brain MRI and identify clinical associations of abnormal MRI findings among people with epilepsy (PWE) in a neurocysticercosis-endemic, resource-limited setting, and to identify the proportion and putative structural brain causes of drug resistant epilepsy cases. Methods PWE were prospectively enrolled at the Jigme Dorji Wangchuck National Referral Hospital in Bhutan (2014–2015). Each participant completed clinical questionnaires and a 1.5 tesla brain MRI. Each MRI was reviewed by at least one radiologist and neurologist in Bhutan and the U.S.A. A working definition of drug resistant epilepsy for resource-limited settings was given as (a) seizures for >1 year, (b) at least one seizure in the prior year, and (c) presently taking 2 or more antiepileptic drugs (AEDs). Logistic regression models were constructed to test the cross-sectional association of an abnormal brain MRI with clinical variables. Results 217 participants [125 (57%) female; 54 (25%) <18 years old; 199 (92%) taking AEDs; 154 (71%) with a seizure in the prior year] were enrolled. There was a high prevalence of abnormal brain MRIs (176/217, 81%). Mesial temporal sclerosis was the most common finding (n=115, 53%, including 24 children), exceeding the number of PWE with neurocysticercosis (n=26, 12%, including one child) and congenital/perinatal abnormalities (n=29, 14%, including 14 children). The number of AEDs (odds ratio=0.59, p=0.03) and duration of epilepsy (odds ratio=1.11, p=0.02) were significantly associated with an abnormal MRI. Seizure in the prior month was associated with the presence of mesial temporal sclerosis (odds ratio=0.47, p=0.01). 25 (12%) participants met our definition of drug resistant epilepsy with mesial temporal sclerosis (n=10), congenital malformations (n=5), and neurocysticercosis (n=4) being the more frequent findings. Conclusions The prevalence of abnormalities on brain MRI for PWE in resource-limited settings is high due to a diffuse range of etiologies, most commonly mesial temporal sclerosis. Drug resistant epilepsy accounted for 12% of the referral population in a conservative estimation.

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Section: Discussionsupporting

confidence: 48%

Yield of Brain MRI in Clinically Diagnosed Epilepsy in the Kingdom of Bhutan: A Prospective Study

Bruno

Klein

Nidup³

et al. 2017

Annals of Global Health

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“…Third, they consider review papers, evidence-based guidelines, and reports on the role of structural MRI in the diagnosis and management of seizure disorders, [14][15][16][17][18][19][20][21][22][23][24][25] with particular attention to studies that meet at least some standards for evidence classification. First, they build upon previous ILAE neuroimaging reports.…”

Section: Methodsmentioning

confidence: 99%

“…Second, they derive from clinical protocols conducted at the institutions of the members of the Neuroimaging Task Force with basic sequences available on most MR scanners and thus generalizable to many centers, regardless of the clinical setting and country. Third, they consider review papers, evidence-based guidelines, and reports on the role of structural MRI in the diagnosis and management of seizure disorders, [14][15][16][17][18][19][20][21][22][23][24][25] with particular attention to studies that meet at least some standards for evidence classification. These sources of information were complemented by a literature review based on an Ovid MEDLINE query between 2002 and 2018.…”

Section: Methodsmentioning

confidence: 99%

Recommendations for the use of structural magnetic resonance imaging in the care of patients with epilepsy: A consensus report from the International League Against Epilepsy Neuroimaging Task Force

et al. 2019

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Structural magnetic resonance imaging (MRI) is of fundamental importance to the diagnosis and treatment of epilepsy, particularly when surgery is being considered. Despite previous recommendations and guidelines, practices for the use of MRI are variable worldwide and may not harness the full potential of recent technological advances for the benefit of people with epilepsy. The International League Against Epilepsy Diagnostic Methods Commission has thus charged the 2013‐2017 Neuroimaging Task Force to develop a set of recommendations addressing the following questions: (1) Who should have an MRI? (2) What are the minimum requirements for an MRI epilepsy protocol? (3) How should magnetic resonance (MR) images be evaluated? (4) How to optimize lesion detection? These recommendations target clinicians in established epilepsy centers and neurologists in general/district hospitals. They endorse routine structural imaging in new onset generalized and focal epilepsy alike and describe the range of situations when detailed assessment is indicated. The Neuroimaging Task Force identified a set of sequences, with three‐dimensional acquisitions at its core, the harmonized neuroimaging of epilepsy structural sequences—HARNESS‐MRI protocol. As these sequences are available on most MR scanners, the HARNESS‐MRI protocol is generalizable, regardless of the clinical setting and country. The Neuroimaging Task Force also endorses the use of computer‐aided image postprocessing methods to provide an objective account of an individual's brain anatomy and pathology. By discussing the breadth and depth of scope of MRI, this report emphasizes the unique role of this noninvasive investigation in the care of people with epilepsy.

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“…For MRI, guidelines specify a 1.5-tesla MRI with ageappropriate seizure protocol 43 whereas 3-tesla is rapidly becoming the standard in epilepsy evaluations. 44 EEG is important, but there are different protocols, not addressed by guidelines, for how EEG can be performed. Perhaps most important today is genetic testing.…”

Section: Patient-expressed Priorities Vs the Standard Approach: Do Wementioning

confidence: 99%

Priorities in pediatric epilepsy research

Berg¹,

Baca²,

Loddenkemper³

et al. 2013

Neurology

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The Priorities in Pediatric Epilepsy Research workshop was held in the spirit of patient-centered and patient-driven mandates for developing best practices in care, particularly for epilepsy beginning under age 3 years. The workshop brought together parents, representatives of voluntary advocacy organizations, physicians, allied health professionals, researchers, and administrators to identify priority areas for pediatric epilepsy care and research including implementation and testing of interventions designed to improve care processes and outcomes. Priorities highlighted were 1) patient outcomes, especially seizure control but also behavioral, academic, and social functioning; 2) early and accurate diagnosis and optimal treatment; 3) role and involvement of parents (communication and shared decision-making); and 4) integration of school and community organizations with epilepsy care delivery. Key factors influencing pediatric epilepsy care included the child's impairments and seizure presentation, parents, providers, the health care system, and community systems. Care was represented as a sequential process from initial onset of seizures to referral for comprehensive evaluation when needed. We considered an alternative model in which comprehensive care would be utilized from onset, proactively, rather than reactively after pharmacoresistance became obvious. Barriers, including limited levels of evidence about many aspects of diagnosis and management, access to care-particularly epilepsy specialty and behavioral health care-and implementation, were identified. Progress hinges on coordinated research efforts that systematically address gaps in knowledge and overcoming barriers to access and implementation. The stakes are considerable, and the potential benefits for reduced burden of refractory epilepsy and lifelong disabilities may be enormous.

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3.0 T MRI of 2000 consecutive patients with localisation-related epilepsy

Cited by 30 publications

References 28 publications

Yield of Brain MRI in Clinically Diagnosed Epilepsy in the Kingdom of Bhutan: A Prospective Study

Yield of Brain MRI in Clinically Diagnosed Epilepsy in the Kingdom of Bhutan: A Prospective Study

Recommendations for the use of structural magnetic resonance imaging in the care of patients with epilepsy: A consensus report from the International League Against Epilepsy Neuroimaging Task Force

Priorities in pediatric epilepsy research

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