Frequency, prognosis and surgical treatment of structural abnormalities seen with magnetic resonance imaging in childhood epilepsy

Berg, Anne T.; Mathern, Gary W.; Bronen, Richard A.; Fulbright, Robert K.; DiMario, Francis J.; Testa, Francine M.; Levy, Susan R.

doi:10.1093/brain/awp187

Cited by 125 publications

(107 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Of those with clinical scans only, we had obtained and had been able to reinterpret most scans for research purposes. 10 Of children who were pharmacoresistant, only one did not have any imaging beyond the initial evaluation period. Thus, for primary analyses, we probably identified most if not all major structural abnormalities.…”

Section: Discussionmentioning

confidence: 99%

“…Brain imaging data came from the cumulated records and were used regardless of timing on the grounds that the structural abnormalities were such that they could have been ascertained at the initial diagnosis. 10 A composite variable was created to reflect the presence of either an imaging or examination abnormality (negative if examination and imaging results were normal; positive if either or both were abnormal). Children with no imaging were classified based on the examination results only.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Age at onset of epilepsy, pharmacoresistance, and cognitive outcomes

et al. 2012

Self Cite

View full text Add to dashboard Cite

Objectives: Increasing evidence suggests that uncontrolled seizures have deleterious effects on cognition and behavior, particularly in the developing brain. Methods:In a community-based cohort, 198 children, aged Ͻ8 years with new-onset epilepsy were followed prospectively and reassessed with the Wechsler Intelligence Scales for Children, Third Edition (WISC-III) 8-9 years later. Linear regression analyses with interactions between age at onset (age) and pharmacoresistance (PR) were used to test whether earlier onset conveyed greater vulnerability to the effects of uncontrolled seizures. Full-scale IQ (FSIQ) and the 4 subdomain scores were examined. Adjustment for adaptive behavior scores in a subset was performed. A dichotomous indicator for IQ Ͻ80 or Ն80 was used to permit inclusion of children who were not tested, particularly those who were untestable.Results: FSIQ was not correlated with age. PR was associated with an 11.4 point lower FSIQ (p ϭ 0.002) and similar decrements in each WISC-III domain. There were substantial age-PR interactions for FSIQ (p ϭ 0.003) and 3 domain scores, indicating a lessening impact of PR with increasing age. The dichotomous IQ indicator was strongly correlated with age at onset in the pharmacoresistant group (p Ͻ 0.0001) and not in the non-pharmacoresistant group (p ϭ 0.61). Adjustment for adaptive behavior measured near onset did not alter the conclusions. Conclusions:Uncontrolled seizures impair cognitive function with effects being most severe in infancy and lessening with increasing age at onset. These findings further emphasize the need for early aggressive treatment and seizure control in infants and young children. Seizures and epilepsy are increasingly being recognized to have moderate to profound effects on cognitive function. There is an increasing body of literature demonstrating that, in children with refractory epilepsy who are evaluated for epilepsy surgery, earlier age at onset is associated with lower IQ or developmental scores, 1-5 and longer duration of epilepsy before surgery is negatively correlated with IQ and ability to rebound after surgery 2,4,6 . A drug treatment trial for infantile spasms reported a striking correlation between both age at onset and delay to treatment with developmental scores assessed later at age 4 years.7 These studies focused on severe epilepsy (spasms) or pharmacoresistant surgical epilepsy and by design do not allow comparisons with cognitive outcomes in well-controlled epilepsy. Consequently, they cannot directly address the separate roles of onset age vs seizures in the developing brain.In a prospective community-based study of children with epilepsy, we examined the association of cognitive scores assessed 8 -9 years after initial diagnosis and age at onset of epilepsy, pharmacoresistance, and the interaction between the two. We specifically hypothesized that the

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Age at onset of epilepsy, pharmacoresistance, and cognitive outcomes

et al. 2012

Self Cite

View full text Add to dashboard Cite

show abstract

“…Recruitment, characterization, and follow-up of this cohort have been described in detail elsewhere. 2,3 Imaging was performed on a 1.5-T Siemens Sonata MRI scanner between 2008 and 2012. Whole-brain coronal T1-weighted magnetization-prepared rapid acquisition with gradient echo MRI was acquired with the following image parameters: echo time, 3.05 ms; repetition time, 1,730 ms; flip angle, 15°; inversion time, 1,100 ms; and voxel size, 0.94 3 0.94 3 1.6 mm.…”

mentioning

confidence: 99%

Sodium valproate use is associated with reduced parietal lobe thickness and brain volume

2013

Self Cite

View full text Add to dashboard Cite

Sodium valproate use is associated with reduced parietal lobe thickness and brain volume ABSTRACT Objective: We hypothesized that total brain volume, white matter volume, and lobar cortical thickness would be different in epilepsy patients. We studied valproate relative to nonvalproate by using patients with epilepsy and healthy controls.Methods: Patients with focal intractable epilepsy from a tertiary epilepsy center were the primary group for analysis. A confirmatory analysis was carried out in an independent group of subjects imaged as part of a community-based study of childhood-onset epilepsy. Total brain volume; white matter volume; and frontal, parietal, occipital, and temporal lobe thickness were measured by processing whole-brain T1-weighted MRI using FreeSurfer 5.1.Results: Total brain volume, white matter volume, and parietal thickness were reduced in the valproate group relative to controls and nonvalproate users (valproate, n 5 9; nonvalproate, n 5 27; controls, n 5 45; all male). These findings were confirmed in an independent group (valproate, n 5 7; nonvalproate, n 5 70; controls, n 5 20; all male).Conclusions: Sodium valproate use in epilepsy is associated with parietal lobe thinning, reduced total brain volume, and reduced white matter volume. Level of evidence:This study provides Class IV evidence that use of valproate in epilepsy is associated with reduced parietal lobe thickness, total brain volume, and white matter volume.

show abstract

“…Only 2 had hippocampal sclerosis according to the pathology reports. 27 Both had diffuse processes, multiple surgeries, and were not typical temporal lobectomy patients although one initially presented with febrile status epilepticus and developed HS shortly after that event.…”

Section: Resultsmentioning

confidence: 99%

“…27 Because of interest in the hippocampus and the evolution of MTLE, only cohort members whose epilepsy could be characterized as nonsyndromic with focal features were included for these analyses. The group with unknown underlying cause was the primary focus as this eliminated the heterogeneity associated with the wide variety of known lesions.…”

Section: Clinical Characterization Of Mtlementioning

confidence: 99%

Hippocampal size anomalies in a community-based cohort with childhood-onset epilepsy

Berg¹,

Pardoe²,

Fulbright³

et al. 2011

Neurology

Self Cite

View full text Add to dashboard Cite

Objectives: Epidemiologic evidence suggests the natural history of refractory mesial temporal lobe epilepsy is complicated, yet little is known about the hippocampus from the nontertiary center perspective. Methods:In a community-based cohort, individuals with nonsyndromic focal epilepsy with onset Ͻ16 years and controls had research MRI scans. Hippocampal (HC) volumes were manually measured, corrected for total brain volume, and converted to Z scores (Z HC ) based on the controls' values. Volumes in cases and controls were compared.Results: Average volumes were not significantly different in cases with unknown cause (n ϭ 117) relative to controls (n ϭ 63). The group with structural and other conditions (n ϭ 23) had significantly smaller volumes. Asymmetry (larger/smaller HC) did not vary among the 3 groups. Hippocampal variances were significantly larger in each epilepsy group relative to controls. In the unknown cause group, 25 (21%) had extreme values: 15 (13%) with Z HC Ͼ1.96; 10 (9%) with Z HC ϽϪ1.96. By contrast, 2/63 (3%) controls had extreme values (p ϭ 0.001). Within the unknown cause group, temporal lobe epilepsy (TLE) cases were more likely to have extreme hippocampal volumes than non-TLE (31% vs 15%, p ϭ 0.03). Extreme volumes were generally interpreted as normal visually. These anomalies were not associated with seizure remission or pharmacoresistance. Conclusions:Classic mesial TLE with hippocampal sclerosis is an uncommon finding in the general population. Volume anomalies, both large and small, are often bilateral. The significance of these findings is unclear; however, speculations regarding preexisting hippocampal pathology (e.g., dysplasia) as a factor in TLE and other neocortical epilepsies have been made by others. Neurology ® 2011;76:1415-1421 GLOSSARY HC ϭ hippocampal; HS ϭ hippocampal sclerosis; MTLE ϭ mesial temporal lobe epilepsy; NSE-structural ϭ nonsyndromic epilepsy with focal features with identified lesions or other evidence of an underlying structural lesion; NSE-UNK ϭ nonsyndromic epilepsy with focal features and no identifiable cause or feature to suggest a lesion or other cause; TLE ϭ temporal lobe epilepsy.

show abstract

Frequency, prognosis and surgical treatment of structural abnormalities seen with magnetic resonance imaging in childhood epilepsy

Cited by 125 publications

References 27 publications

Age at onset of epilepsy, pharmacoresistance, and cognitive outcomes

Age at onset of epilepsy, pharmacoresistance, and cognitive outcomes

Sodium valproate use is associated with reduced parietal lobe thickness and brain volume

Hippocampal size anomalies in a community-based cohort with childhood-onset epilepsy

Contact Info

Product

Resources

About