Refractory Epilepsy-MRI, EEG and CT scan, a Correlative Clinical Study

Authors

  • Dijana Nikodijevic University Clinic of Neurology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje
  • Natalija Baneva–Dolnenec University Clinic of Neurology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje
  • Dragana Petrovska-Cvetkovska University Clinic of Neurology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje
  • Daniela Caparoska Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje

DOI:

https://doi.org/10.3889/oamjms.2016.029

Keywords:

refractory epilepsy, neurophysiology methods, neuroimaging methods, diagnosis

Abstract

OBJECTIVES: Refractory epilepsies (RE), as well as, the surgically correctable syndromes, are of great interest, since they affect the very young population of children and adolescents. The early diagnosis and treatment are very important in preventing the psychosocial disability. Therefore MRI and EEG are highly sensitive methods in the diagnosis and localization of epileptogenic focus, but also in pre-surgical evaluation of these patients. The aim of our study is to correlate the imaging findings of EEG, MRI and CT scan in refractory symptomatic epilepsies, and to determine their specificity in detecting the epileptogenic focus.

METHODS: The study was prospective with duration of over two years, open-labelled, and involved a group of 37 patients that had been evaluated and diagnosed as refractory epilepsy patients. In the evaluation the type and frequency of seizures were considered, together with the etiologic factors and their association, and finally the risk for developing refractory epilepsy was weighted. EEG and MRI findings and CT scan results were evaluated for their specificity and sensitivity in detecting the epileptogenic focus, and the correlation between them was analyzed.

RESULTS: Regarding the type of seizures considered in our study, the patients with PCS (partial complex seizures) dominated, as opposed to those with generalized seizures (GS) (D=1.178, p < 0.05). Positive MRI findings were registered in 28 patients (75.7%). Most of them were patients with hippocampal sclerosis, 12 (42.8%), and also they were found to have the highest risk of developing refractory epilepsy (RE) (Odds ratio = 5.7), and the highest association between the etiologic factor and refractory epilepsy (p < 0.01). In detecting the epileptogenic focus, a significant difference was found (p < 0.01) between MRI and CT scan findings, especially in patients with hippocampal sclerosis and cerebral malformations. There was a strong correlation between the MRI findings and the etiologic factor (R = 1), and for CT scan and etiologic factor an R=0.75 correlation. There was a significant difference between imaging methods MRI/CT (p < 0.1), and CT/EEG (p < 0.05) in detecting the etiologic factor, and little difference was noticed between findings of EEG/MRI.

CONCLUSION: Our study confirms that for an accurate diagnosis of refractory epilepsy in patients, a combination of neuroimaging and neurophysiologic methods is required. MRI showed to be highly sensitive in detecting the etiologic factor in RE patients, whereas EEG was sensitive in localization of the epileptogenic focus, with high correlation between these two methods. An early diagnosis of these patients is very important in having a better therapeutic response and prognosis for them.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Neligan A, Bell GS, Sander JW, Shorvon SD. How refractory is refractory epilepsy? Patterns of relapse and remission in people with refractory epilepsy. Epilepsy Research. 2011;96(3):225-230.

http://dx.doi.org/10.1016/j.eplepsyres.2011.06.004 DOI: https://doi.org/10.1016/j.eplepsyres.2011.06.004

PMid:21724372

Burneo JG, Shariff SZ, Liu K, Leonard S, Saposnik G, Garg AX. Disparities in surgery among patients with intractable epilepsy in a universal health system. Neurology. 2015;86(1):72-78.

http://dx.doi.org/10.1212/WNL.0000000000002249 DOI: https://doi.org/10.1212/WNL.0000000000002249

PMid:26643546

Bandt SK, Leuthardt EC. Minimally Invasive Neurosurgery for Epilepsy Using Stereotactic MRI Guidance. Neurosurgery Clinics of North America. 2016;27(1):51-58.

http://dx.doi.org/10.1016/j.nec.2015.08.005 DOI: https://doi.org/10.1016/j.nec.2015.08.005

PMid:26615107

Estupi-án-Díaz BO, Morales-Chacón LM, García-Maeso I, Lorigados-Pedre L, Báez-Martín M, García-Navarro ME, Trápaga-Quincoses O, Quintanal-Cordero N, Prince-López J, Bender-del Busto JE; Grupo Interdisciplinario de Cirugía de Epilepsia, Centro Internacional de Restauración Neurológica. Corpora amylacea in the neocortex in patients with temporal lobe epilepsy and focal cortical dysplasia. Neurologia. 2015;30(2):90-6. DOI: https://doi.org/10.1016/j.nrleng.2013.06.014

http://dx.doi.org/10.1016/j.nrl.2013.06.008 DOI: https://doi.org/10.1016/j.nrl.2013.06.008

PMid:25440067

Bonilha L, Keller SS. Quantitative MRI in refractory temporal lobe epilepsy: relationship with surgical outcomes. Quantitative Imaging in Medicine and Surgery. 2015;5(2):204–224.

PMid:25853080 PMCid:PMC4379322

Degnan AJ, Samtani R, Paudel K, Levy LM. Neuroimaging of epilepsy: A review of MRI findings in uncommon etiologies and atypical presentations of seizures. Future Neurology. 2014;9(4):431-448.

http://dx.doi.org/10.2217/fnl.14.32 DOI: https://doi.org/10.2217/fnl.14.32

Roy T, Pandit A. Neuroimaging in epilepsy. Ann Indian Acad Neurol Annals of Indian Academy of Neurology. 2011;14(2):78.

http://dx.doi.org/10.4103/0972-2327.82787 DOI: https://doi.org/10.4103/0972-2327.82787

PMid:21808467 PMCid:PMC3141493

Harvey AS, Mandelstam SA, Maixner WJ, Leventer RJ, Semmelroch M, MacGregor D, Kalnins RM, Perchyonok Y, Fitt GJ, Barton S, Kean MJ, Fabinyi GC, Jackson GD. The surgically remediable syndrome of epilepsy associated with bottom-of-sulcus dysplasia. Neurology. 2015;84(20):2021-8.

http://dx.doi.org/10.1212/WNL.0000000000001591 DOI: https://doi.org/10.1212/WNL.0000000000001591

PMid:25888556

Published

2016-02-16

How to Cite

1.
Nikodijevic D, Baneva–Dolnenec N, Petrovska-Cvetkovska D, Caparoska D. Refractory Epilepsy-MRI, EEG and CT scan, a Correlative Clinical Study. Open Access Maced J Med Sci [Internet]. 2016 Feb. 16 [cited 2024 Mar. 28];4(1):98-101. Available from: https://oamjms.eu/index.php/mjms/article/view/oamjms.2016.029

Issue

Section

B - Clinical Sciences

Similar Articles

You may also start an advanced similarity search for this article.