MRI Evidence for Progressive Hippocampal Atrophy in Children with Complex Partial Epilepsy
Abstract number :
2.208
Submission category :
Year :
2001
Submission ID :
2129
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
T-V.D. Tran, BA, Neurology, Children[ssquote]s National Medical Center, Washington, DC; E.C. Dubovsky, MD, Neuroradiology, Children[ssquote]s National Medical Center, Washington, DC; P.L. Pearl, MD, Neurology, Children[ssquote]s National Medical Center, W
RATIONALE: Evidence for progressive neuronal injury resulting from seizures is difficult to identify. We report four children with complex partial seizures (CPS) and MRI evidence for progressive hippocampal formation (HF) atrophy.
METHODS: Serial high resolution oblique coronal fast spin echo T2-weighted images, perpendicular to HF, were obtained (TR: 4000; TE: 100; ET:16; FOV;20; 4mm thick contiguous; matrix:512x256/4NEX) at 1.5 T. in 4 children who had epilepsy onset from 2.4 to 6 years. 3 children had initial MRI performed within 1 month of unprovoked seizures onset, the other had MRI 8 years after onset. Repeat studies ranged from 6 months to 5.7 years. One child had two MRI studies; three had three MRI studies. All children had episodes of status epilepticus and CPS. HF volumes were traced on the anterior 7 HF images beginning at the level of the mammillary bodies. Data were compared to HF growth curves from 86 normal children (46 girls, 40 boys; range 9 months-14 years). 3 children had video ictal EEG confirmation of a unilateral temporal lobe focus, 1 child had a multi-focal EEG and an area of parietal encephalomalacia.
RESULTS: Three children developed left mesial temporal sclerosis (MTS), and one right MTS. Two children had normal MRI following status epilepticus but before onset of habitual CPS. Two others had repeated episodes of status after the initial MRI. Initial MRI was normal in two children and showed unilateral MTS in the other two. All studies showed progressive unilateral HF atrophy -- 13, 14, 21, and 33% decrease in affected HFV while contralateral, non-affected HFV remained unchanged. There was a corresponding increase in hippocampal asymmetry of 10, 15, 16, and 29% well beyond 2SD normal controls (RHFV/LHFV: 1.10 to 1.28; 1.35 to 1.48; 1.25 to 1.44; 0.95 to 0.67 (normal:1.02 [plusminus]0.04).
CONCLUSIONS: Serial imaging in these patients lends evidence that MTS may be a progressive pathologic process and that repeated seizures may result in continued damage to the hippocampal formation in some children.
Support: Supported by NINDS KO8-NS1663 (WDG) and two Gill Fellowship Awards (TDT, JRW) from the George Washington University School of Medicine
Disclosure: Grant - Supported by NINDS KO8-NS1663 (WDG) and two Gill Fellowship Awards (TDT, JRW) from the George Washington University School of Medicine