Locations of Brain Lesions Predict Prognosis in Infantile Spasms : A Multi-center Study
Abstract number :
3.365
Submission category :
5. Neuro Imaging / 5A. Structural Imaging
Year :
2024
Submission ID :
366
Source :
www.aesnet.org
Presentation date :
12/9/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Ohcheol Kwon, MD – Asan Medical Center
Min-Jee Kim, MD, PhD – Asan Medical Center
Mi-Sun Yum, MD, PhD – Ulsan University
Woo Joong Kim, MD, PhD – Seoul National University Hospital
Jon Soo Kim, MD, PhD – Chungbuk National University Hospital
Hunmin Kim, MD – Seoul National University Bundang Hospital
Hyewon Woo, MD – Chungbuk National University Hospital
Jiwon Lee, MD, PhD – Samsung Seoul Hospital
Jeehun lee, PhD – Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Byung Chan Lim, MD, PhD – Seoul National University Children's Hospital
Sun Ah Choi, MD, PhD – Ewha Womans University Mokdong Hospital, Seoul, Korea
Ji Yeon Han, MD – Seoul National University Bundang Hospital
Tae-Sung Ko, MD, PhD – Asan Medical Center
Rationale: To identify neuroimaging biomarkers that can reliably predict prognosis of patients with infantile spasms (IS).
Methods: A multi-center observational study was conducted across six hospitals in Korea. Among 436 infants diagnosed with IS from May 1994 to April 2022, data from 255 IS patients with MRI abnormalities were analyzed. MRI abnormalities were categorized into: cortical, subcortical, or both types of lesions; brainstem abnormalities; cerebellar abnormalities; and white matter (WM) abnormalities. Outcomes such as vigabatrin treatment responsiveness, spasm control, and intractable seizures at the last follow-up were assessed in relation to these MRI findings.
Results: Among 255 patients with structural etiology, those with uncontrolled spasms during follow-up and uncontrolled epileptic seizures at last follow-up were 32.5% (n = 83) and 56.1% (n = 143), respectively. Brainstem or cerebellum lesions were associated with poor spasm control (OR = 2.931, p = 0.001; OR = 2.282, p = 0.007) and intractable seizures at the last follow-up (OR = 2.307, p = 0.020; OR = 1.958, p = 0.033). Additionally, cortical lesions demonstrated strong association with intractable seizure at the last follow-up (OR = 2.119, p = 0.003). Regarding antiseizure medication, 29.4% (71/241) of patients achieved spasms control after treatment with vigabatrin and those with brainstem or cerebellum lesions showed poor response to vigabatrin treatment (OR = 4.188, p = 0.005; OR = 2.189, p = 0.046). No specific MRI findings were associated with steroid or ketogenic diet treatment outcomes.
Conclusions: This retrospective study shows the relationship between brain lesion locations and seizure outcomes in IS patients. Hindbrain lesions are associated with spasm control, while cortical lesions are linked to intractable epilepsy later. These findings suggest different network involvement in infantile spasms and later epilepsy.
Funding: no
Neuro Imaging