The role of magnetic resonance imaging in the follow‐up of children with convulsive status epilepticus

Abstract

CSEConvulsive status epilepticus GOSH Great Ormond Street Hospital HIMAL Hippocampal malrotation PFS Prolonged febrile seizure STEPIN Status Epilepticus Imaging and Neurocognitive Study AIM The aim of this study was to determine the yield of magnetic resonance imaging (MRI) after an episode of childhood convulsive status epilepticus (CSE) and to identify the clinical predictors of an abnormal brain scan.METHOD Children were recruited following an episode of CSE from an established clinical network in north London. Eighty children (age range 1mo-16y; 39 males; 41 females) were enrolled and seen for clinical assessment and brain MRI within 13 weeks of suffering from an episode of CSE. Scans were reviewed by two neuroradiologists and classified as normal (normal ⁄ normal-variant) or abnormal (minor ⁄ major abnormality). Factors predictive of an abnormal scan were investigated using logistic regression.RESULTS Eighty children were recruited at a mean of 31.8 days (5-90d) after suffering from CSE.Structural abnormalities were found in 31%. Abnormal neurological examination at assessment (odds ratio [OR] 190.46), CSE that was not a prolonged febrile seizure (OR 77.12), and a continuous rather than an intermittent seizure (OR 29.98) were all predictive of an abnormal scan. No children with previous neuroimaging had new findings that altered their clinical management.INTERPRETATION Brain MRI should be considered for all children with a history of CSE who have not previously undergone MRI, especially those with non-prolonged febrile seizure CSE, those with persisting neurological abnormalities 2 to 13 weeks after CSE, and those with continuous CSE.Convulsive status epilepticus (CSE) in children is common [1][2][3] and potentially life-threatening, 1,4 with high associated morbidity. Guidelines on acute management of CSE 5 focus on drug therapy 6 and seizure termination, but guidance on optimal follow-up investigations remains unclear. 7 In particular, one investigation frequently considered is the need for and type of neuroimaging. Since the outcome is largely dependent on the aetiology, 1,8 determining the underlying diagnosis is important for both treatment and prognosis, and neuroimaging may thus be useful.From historical data, a minimum yield of detectable lesions of 7.8% has been estimated amongst all children with CSE who underwent neuroimaging. 7 In practice, this may be conservative, particularly if imaging is restricted to children at particular risk of structural brain lesions. It would be beneficial to determine yield in the general population of children with CSE and identify risk factors for structural lesions so that unnecessary imaging is avoided and those children likely to benefit are treated appropriately.The Status Epilepticus Imaging and Neurocognitive Study (STEPIN) is a prospective study on the effects of childhood CSE within the first year of suffering from an episode of CSE. In this paper, we report on the clinical and magnetic resonance imaging (MRI) findings within 13 weeks of CSE and on facto...

Early developmental outcomes in children following convulsive status epilepticus: A longitudinal study

“…We prospectively recruited children aged 1–42 months who had at least one episode of CSE between December 2006 and March 2010. Patients were recruited from north London hospitals using a recruitment strategy similar to the North London Convulsive Status Epilepticus Surveillance study (Chin et al., ), which is described in detail elsewhere (Yoong et al., ). In brief, we collected baseline clinical data and arranged for the child to have a magnetic resonance imaging (MRI) scan and neuropsychological assessments at University College London Institute of Child Health (ICH)/Great Ormond Street Hospital (GOSH) at the parents' earliest convenience.…”

Consequences of febrile seizures in childhood

“…The edema manifested as increases in hippocampal volume and increases in T2 relaxation time. A second cohort of 33 children ascertained in London did not have acute MRI, but had imaging at 3 months, 6 months and 1 year following the acute event in order to define the course of hippocampal injury after the initial hippocampal edema had resolved [16]. FEBSTAT has recruited 199 children with FSE and therefore has greater power to detect abnormalities than the London study.…”

“…The London study identified one child (3%) with a minor abnormality [hippocampal malrotation (HIMAL)] and no children with a major abnormality [16]. The London study identified one child (3%) with a minor abnormality [hippocampal malrotation (HIMAL)] and no children with a major abnormality [16].…”

“…The London study identified one child (3%) with a minor abnormality [hippocampal malrotation (HIMAL)] and no children with a major abnormality [16]. If children with pre-existing neurological impairments who present with status epilepticus associated with fever are included in the London cohort, then the prevalence of imaging abnormalities is 24% [16]. The most likely reason for this is definition.…”

Blood–brain barrier, epileptogenesis, and treatment strategies in cortical dysplasia

“…We fashioned our HT group to evaluate febrile convulsions. Febrile convulsions are common among children, and 31% of the MR imaging (MRI) studies of children with febrile status epilepticus have shown anomalies (Yoong et al., 2012). Other studies also asserted that the presence of an underlying focal CD leads to a prolongation of febrile seizures (Bocti et al., 2003; Scantlebury & Heida, 2010) as well as higher mortality rates (Pujar et al., 2011).…”