Low-Field Magnetic Resonance Imaging Findings in Children with Seizures in Ibadan, Nigeria

  • JA Akinmoladun
  • GI Ogbole University College Hospital/University of Ibadan, Ibadan Nigeria
  • ID Famosaya University College Hospital, Ibadan Nigeria
  • RU Joel
Keywords: Adolescents, Brain tumours, Children, Magnetic Resonance Imaging, Seizures

Abstract

Background: Seizure is the most common neurological disorder in children and an important cause of paediatric hospital admission with the highest prevalence in the under-five age group. Magnetic Resonance Imaging (MRI) is the neuro-imaging technique of choice in the initial evaluation of children with epilepsy. High-field MRI is the ideal imaging modality for evaluating seizures but this is not readily available in developing countries.

Objective: To analyse the spectrum of MRI findings in children presenting with seizures using a low-field (0.36T) MRI.

Methods: Children aged ≤18years with seizures, with cranial MRI at the University College Hospital (UCH), Nigeria between January 2013 and June 2015 were retrospectively reviewed.

Results: There were a total of 134 patients with 53% as adolescents and most of them (85; 63.4%) had abnormal cranial MRI findings. More male children had abnormal findings (52; 61.2%) and most abnormal findings (42; 49.4%) were reported among adolescents. The most frequent abnormality was hydrocephalus (23.5%) from various causes followed by cerebral tumours (14.1%) and ischaemic cerebral infarcts (11.8%). In the adolescents, intracranial tumours (21.4%) were the most frequent abnormal findings, while hydrocephalus was commoner in children aged less than 10 years, accounting for 33.3% and 36.0% among the 1-5 years and 6-11 years age groups respectively.

Conclusion: Low-field MRI, which is more readily available, can provide substantial preliminary findings to aid the management of children with epilepsies. Improved access to high-field MRI through cost reduction and early MR imaging evaluation in the course of illness are desirable.

References

Ba-diop A, Marin B, Druet-Cabanac M, Ngoungou EB, Newton CR, Preux P-M. Epidemiology, causes, and treatment of epilepsy in sub-Saharan Africa. Lancet Neurol 2017; 13: 1029–1044. doi:10.1016/S1474-4422(14)70114-0.

Boling W, Means M, Fletcher A. Quality of Life and stigma in epilepsy, perspectives from selected regions of Asia and Sub-Saharan Africa. Brain Sci 2018; 8: 54-92. doi:10.3390/brainsci8040059.

Mwipopo EE, Akhatar S, Fan P, Zhao D. Profile and clinical characterization of seizures in hospitalized children. Pan Afr Med J 2016; 24: 313-341. https://doi.org/10.1186/1471-2431-13-43.

Chaudhary N, Gupta MM, Shrestha S, Pathak S, Kurmi OP, Bhatia BD, et al. Clinicodemographic profile of children with seizures in a Tertiary Care Hospital: A Cross-sectional observational study. Neurol Res Int 2017; 2017: 1–6. doi:10.1155/2017/1524548.

Aaberg KM, Gunnes N, Bakken IJ, Søraas CL, Berntsen A, Magnus P, et al. Incidence and prevalence of childhood epilepsy: A nationwide cohort study. Artic Pediatr 2017; 139: e20163908. https://doi.org/10.1542/peds.2016-3908.

Mungdala-odeara V, White S, Otieno GO, Njuguna T, Mturi N ET. Prevalence, incidence and risk factors of epilepsy in older children in rural Kenya. Sci Direct 2008; 17: 396–404. http://doi.org/10.1016/j.seizure.2007.11.028.

Prabhu S, Mahomed N. Imaging of intractable paediatric epilepsy. S Afr J Rad. 2015; 19: 1-10. https://doi.org/10.4102/sajr.v19i2.936.

Mustafa C, Ekrem KNC. Clinical importance of neuroimaging in epilepsy. J Neurosci Rural Pract 2013; 4: 11–12. doi:10.4102/sajr.v19i2.936.

Ogbole GI, Adeyomoye AO, Badu-Peprah A, Mensah Y, Nzeh DA. Survey of magnetic resonance imaging availability in West Africa. Pan Afr Med J 2018; 30: 240. doi:10.11604/pamj.2018.30.240.14000.

Ndubuisi CA, Mezue WC, Ohaegbulam SC, Chikani MC, Ekuma M, Onyia E. Neuroimaging findings in pediatric patients with seizure from an institution in Enugu. Niger J Clin Pract 2016; 19: 121–127. doi:10.4103/1119-3077.173712.

Sahdev R, Rao A, Sinha S. Neuroimaging in pediatric seizures. l Int J Res Med Sci 2017; 5: 295–299. https://dx.doi.org/10.18203/2320-6012.ijrms20164566.

Amirsalari S, Saburi A, Hadi R, Mirmohammad SM. Magnetic Resonance Imaging (MRI) findings in epileptic children and its relation with clinical and demographic findings. Acta Med Iran 2012; 50: 37-42. https://doi.org/10.1038/pr.2011.371.

Anand A, Disawal A, Bathwal P, Bakde A. Magnetic Resonance Imaging Brain in the evaluation of pediatric epilepsy. Int J Sci Stud 2017; 5: 8-14. doi:10.17354/ijss/2017/547.

Kim JD, Park DW, Eun TK, Chung DH, Hwang TK. Brain MRI Findings of Complex Partial Seizure in Children. J Korean Radiol Soc 1992; 28: 631-638.

Kalnin AJ, Fastenau PS, deGrauw TJ, Musick BS, Perkins SM, Johnson CS, et al. MR Imaging findings in children with first recognized seizure. Pediatr Neurol 2008; 39: 404–414. doi:10.1016/j.pediatrneurol.2008.08.008.

Chaurasia R, Singh S, Mahur S, Sachan P. Imaging in Pediatric Epilepsy: Spectrum of Abnormalities detected on MRI. J Evolution Med Dent Sci 2013; 2: 3377-3388. doi:

14260/jemds/707.

Fitsiori A, Garibotto V. Hiremath SB, Vargas MI. Morphological and advanced imaging of epilepsy: Beyond the Basics. Children 2019; 6: 43-66. doi:10.3390/children6030043.

Skjei KL., Dlugos DJ. The evaluation of treatment-resistant epilepsy. Semin Pediatr Neurol 2011; 18: 150–170. doi:10.1016/j.spen.2011.06.002.

Wang ZI, Alexopoulos AV, Jones SE, JaisaniZ, Najm IM, Prayson RA. The pathology of magnetic resonance imaging-negative epilepsy. Mod Pathol 2013; 26: 1051–1058. doi:10.1038/modpathol.2013.52.

Bien CG, Szinay M, Wagner J, Clusmann H, Becker AJ, Urbach H. Characteristics and surgical outcomes of patients with refractory magnetic resonance imaging-negative epilepsies. Arch Neurol 2009; 66: 1491–1499. doi:10.1001/archneurol.2009.283.

Phal PM, Usmanov A, Nesbit GM, Anderson JC, Spencer D, Wang P, et al. Qualitative comparison of 3-T and 1.5-TMRI in the evaluation of epilepsy. Am J Roentgenol 2008; 191: 890–895. doi:10.2214/AJR.07.3933.

Mellerio C, Labeyrie MA, Chassoux F, Roca P, Alami O, Plat M, et al. 3T MRI improves the detection of transmantle sign in type 2 focal cortical dysplasia. Epilepsia 2014; 55: 117–122. doi: 10.1111/epi.12464.

Zijlmans M, De Kort GA, Witkamp TD, Huiskamp GM, Seppenwoolde JH, van Huffelen AC, et al. 3T versus 1.5T phased-array MRI in the presurgical work-up of patients with partial epilepsy of uncertain focus. J Magn Reson Imaging 2009; 30: 256–262. doi:10.1002/jmri.21811.

Ahluwalia VV, Sharma N, Chauhan A, Narayan S, Saharan PS, Agarwal D. MRI imaging in afebrile pediatric epilepsy: experience sharing. Int J Contemp Pediatr 2017; 4: 300-305. https://dx.doi.org/10.18203/2349-3291.ijcp20164626.

Lagunju IO, Oyinlade AO, Atalabi OM, Ogbole G, Tedimola O, Famosaya ID, et al. Electroencephalography as a tool for evidence-based diagnosis and improved outcomes in children with epilepsy in a resource-poor setting. Pan Afr Med J 2015; 22: 328. doi:10.11604/pamj.2015.22.328.7065.

Chen G., Lei D, Ren J, Zuo P, Suo X, Wang D, et al. Patterns of postictal cerebral perfusion in idiopathic generalized epilepsy: a multi-delay multi-parametric arterial spin labelling perfusion MRI study. Sci Rep 2016; 6: 28867. https://doi.org/10.1038/srep28867.

Shang K, Wang J, Fan X, Cui B, Ma J, Yang H, et al. Clinical value of Hybrid TOF-PET/MR Imaging-Based Multiparametric Imaging in localizing seizure focus in patients with MRI-Negative Temporal Lobe Epilepsy. Am J Neuroradiol 2018; 39; 1791-1798. doi:10.3174/ajnr.A5814.

Berg AT, Shinnar S, Levy SR, Testa FM. Newly diagnosed epilepsy in children: presentation at

diagnosis. Epilepsia 1999; 40: 445–452. https://doi.org/10.1111/j.1528-1157.1999.tb00739.

Wellmer J, Quesada, CM., Rothe, L, Elger, CE., Bien CG, Urbach H. Proposal for a magnetic resonance imaging protocol for the detection of epileptogenic lesions at early outpatient stages. Epilepsia 2013; 54: 1977–1987. doi: 10.1111/epi.12375.

Osuntokun BO, Adeuja AOG, Nottidge VA, Bademosi O, Olumide A, Ige O, et al. Prevalence of the epilepsies in Nigerian Africans: a community-based study. Epilepsia 1987; 28: 272-279. doi:10.1111/j.1528-1157.1987.tb04218.x

Owolabi LF, Ogunniyi A. Etiology and electroclinical pattern of late-onset epilepsy in Ibadan, Southwestern Nigeria. Afr J Neurol Sci 2015; 34: 25-33.

Published
2020-11-24
Section
Original Research