Clinico - diagnostic and therapeutic relevance of computed tomography scan of brain in children with partial seizures

Abstract

Background:Therapeutic relevance of computed tomography (CT) in children with partial seizures is reported to be remarkably low (1-2%). However, in the developing countries where infections involving the nervous system are common, routine CT scan of brain may help in finding treatable causes of seizures.Objective:Aim of this study was to evaluate the significance of CT scan of brain in the management of children with partial seizures.Materials and Methods:Children with partial epilepsy, whose predominant seizure type was focal motor seizures, were included in the study. CT scan of brain was done in all children aged between 1 month and 12 years with partial seizures of unknown etiology prospectively. The clinical findings of these children were noted along with the CT findings.Results:Between August 2001 and July 2002, of the 200 children with seizure disorder 50 children who satisfied the inclusion criteria were included in the study. CT scan of brain was normal in 16 children (32%) and was abnormal in 34 children (68%). Twenty children (~60% of abnormal scan) had potentially correctable lesions: Tuberculoma (n = 13), neurocysticercosis (n = 3), and brain abscess (n = 4). Five children had changes representing static pathology that did not influence patient management. The clinical features correlated with CT findings in 78% children.Conclusion:Children with partial motor seizures have high probability of having abnormal findings on CT scan of brain, especially, neuro-infections which are potentially treatable. Therefore, CT scan brain should be carried out in all children with partial motor seizures especially, in developing countries.

Predictive Factors for Abnormal Brain CT-Scan in Childhood Epilepsy at Yaoundé (Cameroon)

“…The incidence of abnormal CT in our study (61.9%) was higher than in the most of previous reports where it was between 22% and 52% [10] [12] [13] [15]- [17]. The only study which found a higher CT abnormalities incidence (68%) than ours is that of Patel et al (2013) who worked on a very selective symptomatic sample of 59 children with predominantly focal motor-partial epilepsy in India [6]. Our patients were referred to the radiology department by experienced neuro-pediatricians who were sorting the patients initially by clinical examination and EEG.…”

“…They recommended that this investigation should not be a part of the routine work-up of children with generalized seizures [20]. In the studies of Patel (2013), and Yang (1979), included children had a high prevalence of neurologic deficits, which could justify the high frequency of CT lesions in focal seizures. Obajimi et al found 74.4% of CT abnormalities in partial epilepsy (vs 50% in generalized epilepsy) among 103 epileptic children in Nigeria.…”

“…According to Adhikari et al, central nervous system infections are the main cause of seizures and acquired epilepsy in the developing countries [1]. Neurocysticercosis and neurotuberculosis are cited as common causes of epilepsy in tropical countries and particularly in India [8] [15]. But in a study conducted in Cameroon in 1998, Dongmo et al compared 93 epileptic patients with 174 control subjects in an area of high endemicity of neurocysticercosis.…”

“…It is also ideal in the characterization of calcifications which can be suggestive of specific pathology. That is why the CT-scan is still an important diagnostic tool in epilepsy in poor countries where MRI is neither available nor affordable [7] [8]. Knowing that many causes of epilepsy are not accessible to CT-scan imaging and that this radiating technique remains expensive for many poor families in countries with limited resources, it is necessary to determine some criteria for selecting patients who more probably would have abnormal CT-scan examination.…”

“…Several studies have already been conducted to identify predictors of brain damage in case of seizures but very few focused specifically on pediatric epileptic population [8]- [17] and to the best of our knowledge, only two of them were carried out in sub-Saharan Africa [16] [17].…”