Magnetic resonance imaging features of cerebellar atrophy pattern after epilepsy / 中南大学学报(医学版)

OBJECTIVES@#Clinically, it has been found that some patients with epilepsy are accompanied by cerebellar atrophy that is inconsistent with symptoms, but the pattern of cerebellar atrophy after epilepsy and the role of cerebellar atrophy in the mechanism of epilepsy have not been elucidated. This study aims to explore the specific pattern of cerebellar atrophy after epilepsy via analyzing magnetic resonance images in patients with postepileptic cerebellar atrophy.@*METHODS@#A total of 41 patients with epilepsy, who received the treatment in Xiangya Hospital of Central South University from January 2017 to January 2022 and underwent cranial MRI examination, were selected as the case group. The results of cranial MRI examination of all patients showed cerebellar atrophy. In the same period, 41 cases of physical examination were selected as the control group. General clinical data and cranial MRI results of the 2 groups were collected. The maximum area and signal of dentate nucleus, the maximum width of the brachium pontis, the maximum anterior-posterior diameter of the pontine, and the maximum transverse area of the fourth ventricle were compared between the 2 groups. The indexes with difference were further subjected to logistic regression analysis to clarify the characteristic imaging changes in patients with cerebellar atrophy after epilepsy.@*RESULTS@#Compared with the control group, the maximum width of the brachium pontis and the maximum anterior-posterior diameter of the pontine were decreased significantly, the maximum transverse area of the fourth ventricle was increased significantly in the case group (all P<0.05). The difference in distribution of the low, equal, and high signal in dentate nucleus between the 2 groups was statistically significant (χ2=43.114, P<0.001), and the difference in the maximum area of dentate nucleus between the 2 groups was not significant (P>0.05). The maximum width of the brachium pontis [odds ratio (OR)=3.327, 95% CI 1.454 to 7.615, P=0.004] and the maximum transverse area of the fourth ventricle (OR=0.987, 95% CI 0.979 to 0.995, P=0.002) were independent factors that distinguished cerebellar atrophy after epilepsy from the normal control, while the anterior-posterior diameter of pontine (OR=1.456, 95% CI 0.906 to 2.339, P>0.05) was not an independent factor that distinguished them.@*CONCLUSIONS@#In MRI imaging, cerebellar atrophy after epilepsy is manifested as significant atrophy of the brachium pontis, significant enlargement of the fourth ventricle, and increased dentate nucleus signaling while insignificant dentate nucleus atrophy. This particular pattern may be associated with seizures and exacerbated pathological processes.

Relationship of white matter hyperintensities with clinical features of seizures in patients with epilepsy / A relação das hiperintensidades da substância branca com as características clínicas das crises em pacientes com epilepsia

ABSTRACT Background: Although epilepsy is primarily known as a cortical disorder, there is growing body of research demonstrating white matter alterations in patients with epilepsy. Objective: To investigate the prevalence of white matter hyperintensities (WMH) and its association with seizure characteristics in patients with epilepsy. Methods: The prevalence of WMH in 94 patients with epilepsy and 41 healthy controls were compared. Within the patient sample, the relationship between the presence of WMH and type of epilepsy, frequency of seizures, duration of disease and the number of antiepileptic medications were investigated. Results: The mean age and sex were not different between patients and healthy controls (p>0.2). WMH was present in 27.7% of patients and in 14.6% of healthy controls. Diagnosis of epilepsy was independently associated with the presence of WMH (ß=3.09, 95%CI 1.06-9.0, p=0.039). Patients with focal epilepsy had higher prevalence of WMH (35.5%) than patients with generalized epilepsy (14.7%). The presence of WMH was associated with older age but not with seizure characteristics. Conclusions: WMH is more common in patients with focal epilepsy than healthy controls. The presence of WMH is associated with older age, but not with seizure characteristics.

RESUMO Antecedentes: Embora a epilepsia seja principalmente conhecida como um distúrbio cortical, há um crescente corpo de pesquisas que demonstra alterações na substância branca em pacientes com epilepsia. Objetivo: Investigar a prevalência de hiperintensidades da substância branca (WMH) e sua associação com características das crises em pacientes com epilepsia. Métodos: A prevalência de WMH em 94 pacientes com epilepsia e 41 controles saudáveis ​​foi comparada. Na amostra de pacientes, foi investigada a relação entre a presença de WMH e o tipo de epilepsia, a frequência das crises, a duração da doença e o número de medicamentos antiepilépticos. Resultados: A média de idade e o sexo não diferiram entre pacientes e controles saudáveis ​​(p>0,2). WMH estava presente em 27,7% dos pacientes, enquanto em 14,6% dos controles saudáveis. O diagnóstico de epilepsia foi independentemente associado à presença de WMH (ß=3,09, IC95% 1,06-9,0, p=0,039). Pacientes com epilepsia focal apresentaram maior prevalência de WMH (35,5%) do que pacientes com epilepsia generalizada (14,7%). A presença de WMH foi associada à idade avançada, mas não a características das crises. Conclusões: Pacientes com epilepsia focal têm WMH mais comum do que controles saudáveis. A presença de WMH está associada à idade avançada, mas não a características das crises epilépticas.

A novel approach for pre-surgical evaluation of facial morphometry in children using magnetic resonance imaging scans of the brain: a feasibility analysis / Un enfoque novedoso para la evaluación prequirúrgica de la morfometría facial en niños mediante imágenes por resonancia magnética de cerebro: un análisis de viabilidad

Pre-surgical evaluation of facial morphometry is frequently warranted for children with facial dysmorphism. Though many methods utilized previously for such purposes, data is scarce on using magnetic resonance (MRI) brain images for such purposes. The purpose of this study was to appraise the feasibility of utilizing MRI brain scans done in epilepsy imaging protocol to assess facial morphometry. Measurements of the face; orbit, mouth, and nose of children aged 1 to 7 years were obtained using T1 sagittal, T2 axial and three dimensional (3D) MRI images of the brain (n=20). Ability to obtain facial measurements, inter and intra-observer variability calculated. The mean age of the studied children was 4±2 years, of which 40% (n=8) were boys, and 60% (n=12) were girls. Obtaining facial measurements were reliable with high intra-observer (α=0.757 to 0.999) and inter-observer agreements (α=0.823 to 0.997). The landmarks of the cranium, upper face, and upper nose could be identified (100%) in both two dimensional (2D) and 3D images when such landmarks were contained in the imaging field of view (FOV). Landmarks of lower nose, (subalar width = 0%) or mouth (0%) were not contained in the FOV of 2D images, but contained in 3D images (100%). Both 2D and 3D images did not allow assessment of lower face or the mandible as such landmarks were not contained in the FOV.We conclude thatBrain MRIs performed to evaluate cerebral pathology can be executed to assess facial measurements, provided the FOV of the scan is adjusted to include all significant landmarks.

La evaluación prequirúrgica de la morfometría facial con frecuencia se justifica para niños con dismorfismo facial. Aunque muchos métodos se utilizaron anteriormente para tales fines, los datos son escasos sobre el uso de imágenes cerebrales por resonancia magnética (MRI) para tales fines. El propósito de este estudio fue evaluar la viabilidad de utilizar resonancias magnéticas cerebrales realizadas en el protocolo de imágenes de epilepsia para evaluar la morfometría facial.Medidas de la cara, la órbita, la boca y la nariz de niños de 1 a 7 años se obtuvieron mediante imágenes de resonancia magnética cerebral T1 sagital, axial T2 y tridimensional (3D) del cerebro (n = 20). Se obtuvieron las medidas faciales, y fue calculada la variabilidad inter e intraobservador.La edad de los niños estudiados fue de 4 ± 2 años, de los cuales el 40% (n = 8) hombre y el 60% (n = 12) mujer. La obtención de medidas faciales fue confiable con altos acuerdos intraobservador (α = 0,757 a 0,999) e interobservador (α = 0,823 a 0,997). Los puntos de referencia del cráneo, la cara superior y la nariz superior se pudieron identificar (100%) tanto en imágenes bidimensionales (2D) como en 3D cuando dichos puntos de referencia estaban contenidos en el campo de visión de la imagen (FOV). Los puntos de referencia de la parte inferior de la nariz (ancho subalar = 0%) o la boca (0%) no estaban contenidos en el campo de visión de las imágenes 2D, sino que estaban contenidos en las imágenes 3D (100%). Tanto las imágenes 2D como las 3D no permitieron la evaluación de la parte inferior de la cara o la mandíbula, ya que tales puntos de referencia no estaban contenidos en el campo de visión.Concluimos que las resonancias magnéticas cerebrales realizadas para evaluar la patología cerebral se pueden usar para evaluar las medidas faciales, siempre que el campo de visión de la exploración se ajuste para incluir todos los puntos de referencia importantes.

Hipermetabolismo temporal izquierdo en síndrome de Landau-Kleffner demostrado con PET F18-FDG: reporte de un caso con remisión metabólico-clínica postratamiento / Left temporal hypermetabolism detected in Landau-Kleffner syndrome with F18-FDG PET/CT: report of a case with metabolic and clinical remission after treatment

Brain F18-FDG Positron Emission Tomography (PET) has been used for studying focal epilepsy, with high sensitivity in detection of epileptogenic foci, even with normal magnetic resonance imaging (MRI). Some cases of Landau-Kleffner Syndrome (LKS) have shown PET abnormalities, mostly showing uni- or bilateral temporoparietal hypometabolism, although a heterogeneous group of alterations have been described. We report a case of LKS with a left hypermetabolic temporo-occipital area that responded to treatment, with clinical improvement and remission of PET hypermetabolic focus.

La positron emission tomography (PET) cerebral con F18-FDG ha sido utilizado para estudiar epilepsias focales con alta sensibilidad en la detección del área epileptógena, aun con resonancia magnética (RM) normal. La PET ha mostrado positividad en algunos casos de síndrome de Landau-Kleffner (SLK), la mayoría de las veces evidenciando hipometabolismo temporoparietal uni o bilateral, aunque un grupo heterogéneo de alteraciones asociadas ha sido descrito. Presentamos un caso de SLK con un área hipermetabólica temporooccipital izquierda, que respondió al tratamiento, con mejoría clínica y regresión del foco hipercaptante a la PET.

Localization Value of Magnetoencephalography Interictal Spikes in Adult Nonlesional Neocortical Epilepsy

Few studies have included magnetoencephalography (MEG) when assessing the diagnostic value of presurgical modalities in a nonlesional epilepsy population. Here, we compare single photon emission computed tomography (SPECT), positron emission tomography (PET), video-EEG (VEEG), and MEG, with intracranial EEG (iEEG) to determine the value of individual modalities to surgical decisions. We analyzed 23 adult epilepsy patients with no abnormal MRI findings who had undergone surgical resection. Localization of individual presurgical tests was determined for hemispheric and lobar locations based on visual analysis. Each localization result was compared with the ictal onset zone (IOZ) defined by using iEEG. The highest to the lowest hemispheric concordance rates were MEG (83%) > ictal VEEG (78%) > PET (70%) > ictal SPECT (57%). The highest to lowest lobar concordance rates were ictal VEEG = MEG (65%) > PET (57%) > ictal SPECT (52%). Statistical analysis showed MEG to have a higher hemispheric concordance than that of ictal SPECT (P = 0.031). We analyzed the effects of MEG clustered-area resection on surgical outcome. Patients who had resection of MEG clusters showed a better surgical outcome than those without such resection (P = 0.038). It is suggested that MEG-based localization had the highest concordance with the iEEG-defined IOZ. Furthermore, MEG cluster resection has prognostic significance in predicting surgical outcome.

Localization Value of Magnetoencephalography Interictal Spikes in Adult Nonlesional Neocortical Epilepsy

Few studies have included magnetoencephalography (MEG) when assessing the diagnostic value of presurgical modalities in a nonlesional epilepsy population. Here, we compare single photon emission computed tomography (SPECT), positron emission tomography (PET), video-EEG (VEEG), and MEG, with intracranial EEG (iEEG) to determine the value of individual modalities to surgical decisions. We analyzed 23 adult epilepsy patients with no abnormal MRI findings who had undergone surgical resection. Localization of individual presurgical tests was determined for hemispheric and lobar locations based on visual analysis. Each localization result was compared with the ictal onset zone (IOZ) defined by using iEEG. The highest to the lowest hemispheric concordance rates were MEG (83%) > ictal VEEG (78%) > PET (70%) > ictal SPECT (57%). The highest to lowest lobar concordance rates were ictal VEEG = MEG (65%) > PET (57%) > ictal SPECT (52%). Statistical analysis showed MEG to have a higher hemispheric concordance than that of ictal SPECT (P = 0.031). We analyzed the effects of MEG clustered-area resection on surgical outcome. Patients who had resection of MEG clusters showed a better surgical outcome than those without such resection (P = 0.038). It is suggested that MEG-based localization had the highest concordance with the iEEG-defined IOZ. Furthermore, MEG cluster resection has prognostic significance in predicting surgical outcome.

Evaluation of EEG in Child Guidance Clinic.

Background: Electroencephalographic (EEG) abnormalities occur in patients with various idiopathic psychiatric disorders. Among the psychiatric patients, children have shown more EEG abnormalities as compared to the adult cases. The present study therefore examined the pattern of EEG abnormalities in children’s attending child guidance clinic of psychiatry department. Method: Electrodes were positioned according to the 10 – 20 system, using a common reference electrode. EEG recordings from 138 hospitalized psychiatric patients were graded blind to diagnosis and treatment for type of EEG abnormalities. Types of clinical diagnosis were evaluated for association with pattern EEG abnormalities. Results: EEG abnormalities occurred in 53.62% (N = 74) subjects, whereas 46.38% (N = 64) showed no abnormality in EEG record. Generalized abnormalities was observed in 37.84% (N = 28) subjects. EEG abnormality in clinically diagnosed epilepsy were commonest 64.62% (N = 42), followed by dissociative (conversion) vs. epilepsy 62.5% (N = 5), pervasive developmental disorder (PDD) 56.67% (N = 17), and mental retardation with epilepsy 28.57% (N = 10). Conclusions: EEG abnormality risk varied widely among children’s with different diagnoses referred/attending Child Guidance Clinic of psychiatry department. Risk was particularly high in clinically diagnosed epilepsy.

Utilidad del PET--FDG en patología neuropediatrica / Usefulness of PET--FDG in neuropediatric pathology

Due to the recent incorporation of positron technology (PET) it appears interesting to review the present indications of fluor-deoxyglucose (FDG) in neuropediatric pathology. The main indication is in the evaluation of refractory epilepsy mainly in cases with negative magnetic resonance or discordance with electroencephalography Some uses in tumors are also discussed, such as tumor characterization and differentiation between radionecrosis and recurrence. The experience between years 2003 and 2007 at the Santiago Military Hospital, using FDG in 66 children and adolescents cases with diverse neurological indications was reviewed.

La incorporación relativamente reciente en nuestro medio de la tecnología de positrones (PET) nos motivó a revisar el uso actual de la flúor-deoxiglucosa (FDG) en neuropediatría. La principal indicación es la evaluación de epilepsia refractaria, especialmente en casos de resonancia magnética negativa o discordancia de ésta con los hallazgos electroencefalográficos. Algunas utilizaciones en tumores también son discutidas, como la caracterización tumoralyla diferenciación entre radionecrosis y recurrencia. Se revisa la casuística del Centro PET del Hospital Militar de Santiago entre los años 2003 y 2007, que comprende 66 casos de niños y adolescentes estudiados con metabolismo glucídico con diversas patologías neurológicas.

Neuropsiquiatra: pet y spect / Neuropsychiatrist: pet and spect

Functional brain imaging with PET and SPECT have a definitive and well established role in the investigation of a variety of conditions such as dementia, epilepsy and drug addiction. With these methods it is possible to detect early rCBF (regional Cerebral Blood Flow) changes seen in dementia (even before clinical symptoms) and differentiate Alzheimer's disease from other dementias by means of the rCBF pattern change. 18-F-FDG PET imaging is a useful tool in partial epilepsy because both rCBF and brain metabolism are compromised at the epileptogenic focus. During the seizure, rCBF dramatically increases locally. Using SPECT it is possible to locate such foci with 97% accuracy. In drug addiction, particularly with cocaine, functional imaging has proven to be very sensitive to detect brain flow and metabolism derangement early in the course of this condition. These findings are important in many ways: prognostic value, they are used as a powerful reinforcement tool and to monitor functional recovery with rehabilitation. There are many other conditions in which functional brain imaging is of importance such as acute stroke treatment assessment, trauma rehabilitation and in psychiatric and abnormal movement diseases specially with the development of receptor imaging.

Existen numerosas indicaciones claramente establecidas para el uso del SPECT y PET en patología neuro-psiquiátrica, particularmente en el estudio de demencias, epilepsia y adicción a drogas. Estos métodos permiten detectar precozmente (aun antes de las manifestaciones clínicas) cambios en la perfusión y metabolismo cerebral en pacientes con demencias. Es posible además diferenciar la enfermedad de Alzheimer de otras causas de demencia, analizando el patrón de la alteración neuro- funcional. En epilepsia parcial, tanto el metabolismo como la perfusión están alterados en el foco epileptogénico, lo que puede ser detectado con F-18FDG PET. Durante la crisis epiléptica, el flujo sanguíneo puede aumentar dramáticamente en el foco epileptogénico, lo que puede ser detectado con SPECT con 97% de certeza. En pacientes drogadictos, especialmente a la cocaína, estos métodos han demostrado ser muy sensibles para la detección precoz de cambios en el flujo y metabolismo cerebral, lo que es clínicamente importante en varios aspectos: 1) Tiene valor pronóstico (neuro-funcional), 2) Se puede usar para aumentar la adherencia a la terapia y 3) Permite evaluar objetivamente la recuperación funcional. Existen muchas otras indicaciones presentes y futuras, por ejemplo: en la monitorización de la revascularización en accidentes vasculares cerebrales agudos, rehabilitación post TEC, estudio de patología psiquiátrica y movimientos anormales especialmente con el desarrollo de radioligandos.

Functional Neuroimaging in Epilepsy: FDG PET and Ictal SPECT

Epileptogenic zones can be localized by F-18 fluorodeoxyglucose positron emission tomography (FDG PET) and ictal single-photon emission computed tomography(SPECT). In medial temporal lobe epilepsy, the diagnostic sensitivity of FDG PET or ictal SPECT is excellent, however, the sensitivity of MRI is so high that the incremental sensitivity by FDG PET or ictal SPECT has yet to be proven. When MRI findings are ambiguous or normal, or discordant with those of ictal EEG, FDG PET and ictal SPECT are helpful for localization without the need for invasive ictal EEG. In neocortical epilepsy, the sensitivities of FDG PET or ictal SPECT are fair. However, because almost a half of the patients are normal on MRI, FDG PET and ictal SPECT are helpful for localization or at least for lateralization in these non-lesional epilepsies in order to guide the subdural insertion of electrodes. Interpretation of FDG PET has been recently advanced by voxel-based analysis and automatic volume of interest analysis based on a population template. Both analytical methods confirmed the performance of previous visual interpretation results. Ictal SPECT was analyzed using subtraction methods(coregistered to MRI) and voxel-based analysis. Rapidity of injection of tracers, HMPAO versus ECD, and repeated ictal SPECT, which remain the technical issues of ictal SPECT, are detailed.

Non-epileptic manifestations in patients with single enhancing computed tomography lesions.

OBJECTIVES AND METHODS: Single enhancing lesions are common computed tomographic (CT) abnormality in patients with epilepsy. In this series we are reporting 13 unusual cases with varied non-epileptic neurological manifestations in patients with ring or disk enhancing CT lesions. RESULTS: Acute, stroke like non-vascular focal neurological deficits (hemiparesis in four patients, and crural monoparesis, Broca's aphasia, homonymous hemianopia, hemichorea in one patient each) were frequent non-epileptic manifestations. Episodic vascular type of headache was seen in three patients, one patient had headache because of raised intracranial pressure. One patient presented with acute confusional state. All these patients were treated symptomatically, and with oral corticosteroids. CT lesions disappeared in 8-12 weeks time in all patients except in one patient with chorea where the lesion calcified. Significant clinical improvements were noted in all the patients. CONCLUSIONS: Several non-epileptic manifestations can also be associated with single enhancing CT lesions, and like epileptic disorders these disorders also have a benign course. Corticosteroids, probably, hasten the clinical improvement and produce early resolution of the CT lesions.

Interictal brain 99m Tc-HMPAO SPECT study in cases of epilepsy with single ring enhancing CT lesion.

BACKGROUND: Contrast enhancing single ring or disc lesion (CESRL), a frequent finding in the CT scan of Indian patients with seizures, has a diverse etiology. Underlying cause in many of these cases remains conjectural. Some of these ring lesions show spontaneous resolution without any specific treatment and in others their temporal profile remains unpredictable. MATERIAL AND METHODS: In a prospective study we studied 17 cases of epilepsy, with the CT scan finding of single contrast enhancing ring lesion. Detailed clinical evaluation and interictal EEG was performed. CT scan and SPECT study was done initially and were then repeated. RESULTS: On the second CT, one lesion disappeared and 2 reduced in size, three showed no change in size. Third CT showed complete disappearance in one case and no change in the second case. Initial SPECT study was abnormal in all 17 cases, showing areas of hypoperfusion corresponding to the anatomical location of ring lesion. On follow up, patients with decreased ring size on CT showed decrease in area of perfusion deficit on the SPECT, but cases in which the lesion disappeared on the CT, the SPECT perfusion abnormality continued to persist, though to a lesser extent. CONCLUSION: Persistence of perfusion defects suggest the presence of altered underlying physiology. Hence, early withdrawal of antiepileptic drugs after disappearance of ring lesion on CT may lead to seizure recurrence. SPECT studies repeated after 3 months may help to prognosticate cases with CESRL and also help in deciding the optimum duration of antiepileptic therapy in individual cases.

Contrast computed tomography in epilepsy with special reference to intracranial ring or disc enhancing lesions.

We report the results of computed tomography (CT) in 170 patients who developed seizures. Localized signs could be demonstrated by neurologic examination in 23.5%. CT findings were normal in 64 patients (37.6%). The commonest abnormality was a focal ring or disc enhancing lesion in 66 patients (62.3%) followed by calcification (18 patients; 16.9%), cerebral atrophy (9; 8.5%), vascular lesions (7; 6.6%), tumours (4; 3.8%) and congenital hydrocephalus (2; 1.9%). The occurrence of abnormal CT was higher (74.3%) in patients with partial seizures.

Plain radiograph skull: is it really needed in epilepsy?

One hundred and three children with seizure disorder were studied. Plain radiograph skull was normal in all the cases. CT scan skull done in 34 patients, showed abnormalities in 24 cases. More than 80% children in partial seizures group had treatable lesions on CT scans, mainly CNS tuberculoma. The need for omitting plain radiograph skull as a routine investigation for epilepsy cases is emphasized.

Brain Computerized Tomographic Findings in Various Epilepic Children

Epilepsy is, in some occassions, manifested as one of the symptoms complex of central nervous system diseases, as well as systemic diseases such as metabolic disorders. In 1976, Bachman reported that 33% of epileptic patients manifested abnormal lesions in their computerized tomographic findings. 1005 epileptic children with various types of seizures have been investigated to detect the possible causes of epilepsies. 32% of the patients had abnormal brain C-T findings, of these patients, infantile spasm was the most frequently manifested abnormal C-T finding, rating 52.9%; simple partial seizure, 37.7%; complex partial seizure, 36.1% and generalized seizure, 27.1%, in order of frequency. Curable lesions, such as tumor, granuloma and arachnoid cyst were detected by brain C-T scan, and a brain tumor was detected in 2% of the patients. The brain C-T scan is one of the most effective diagnostic tools to evaluate the underlying lesions of the central nervous system of epileptic children.

Childhood epilepsy "A correlative study of clinical, electroencephalography and computed tomography"

This work was carried out on 100 epileptic children. Clinical examination and EEG record were done for all patients while CT examination was done for only 42 patients. Correlative study between the above mentioned three methods was done and we found out that; CT yielded the highest incidence of abnormal findings among children presented with neurological deficits and in those with focal persistant EEG changes. It follows, that the three methods are complementery in the diagnostic work up of children with seizure disorders