@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2016;22(2):165-170

Background
… [1, 2] Brain imaging procedures including CT scan and MRI (Magnetic Resonance Imaging) are very important in diagnosis of etiology, treatment and prognosis prediction of epilepsy in children with epilepsy [3]. … [4, 5]
Previous Studies
In the study of children with epilepsy, MRI is the preferred imaging method [6, 7]. However, in the case of recent head trauma, coagulation disorders or severe headache suspected to intracranial hemorrhage CT scan should be carried out. Also, whenever MRI is not possible, CT scan of the brain can provide useful information about the etiology of seizure [6]. … [8]
Aim(s)
This study aimed to compare the results of CT scan and MRI of the brain without contrast in children with epilepsy.
Research type
This is a descriptive cross-sectional study.
Research society, place and time
Children aged one month to 14 years refereed to pediatric neurology clinic of Yazd University of Medical Sciences from September 2012 who had epilepsy based on clinical judgment of neurosurgeon and for whom both CT scan and MRI without contrast had been conducted in previous investigations by physician to determine the cause of the seizure were studied.
Sampling method and number
The sample size taking into account 95% confidence level, statistical power 80% and type 1 error (alpha) equal to 5% as well as p= 0.5 (probability of abnormalities on imaging) and d=0.08 was estimated 150 people.
Used devices&materials
After interviewing with parents, history taking, doing physical examination, and investigating the findings of children CT scan and MRI, the information about the research variables including age, gender, type of seizure, age of seizure onset, the results of clinical examination, developmental status, EEF result, and the findings on brain CT scan and MRI without contrast was entered the related questionnaire. Obtained data was entered SPSS 15 software, and required indexes and tables were prepared. To determine the correlation between qualitative variables, Chi-square test was used.
Findings by Text
160 children, including 74 girls (46.2%) and 86 boys (53.8%) aged one month to 14 years and with mean age 4.26 ± 2.64 years were studied. Age of seizure onset was 3 days to five years with the mean age 2.61 ± 1.47 years. 117 children (73.1 %) were in normal developmental status and 43 children (26.9%) had developmental delay. Physical examination was normal in 113 children (70.1%) and it was abnormal in in 47 children (29.4%). Seizure type was generalized tonic-clonic in 94 children (58.7%); it was partial or local in 18 children (11.2 %), and myoclonic in 10 children (6.3%). There was no seizure in 10 children (6.3 %), and it was combined type (more than one type of seizure) in 28 children (17.5%). Family history of epilepsy was negative in 113 children (70.6%). Positive in the first-degree family of 30 children (18.7%), positive in the second-degree family of 14 children (8.8%), and positive in the third-degree family of 3 children (1.9%). Electroencephalography was normal in 12 children (7.5 %), non-specific abnormal in 59 children (36.9%), and epileptic abnormal in 89 children (55.6%). The results of brain CT scan without injection of 121 children (75.6%) was normal and those of 39 children (24.4%) were reported as abnormal. The results of brain MRI without contrast was normal in 84 children (52.5 %) and it was abnormal in 76 children (47.5 %). CT scan and MRI were both normal in 82 children (51.3%), and they were both abnormal in 37 children (23.1%). Therefore, it could be concluded that the results of CT scan and MRI was similar in 119 children (73.4%). In two children (1.2%) who had normal MRI, CT scan showed calcification. In 39 children who had normal CT scan, MRI was abnormal and 12 children had periventricular leukomalacia. And, 7 persons had non-calcified hamartoma resulted from skin-nerve diseases. And, 6 persons had neuronal migration disorder. And, 5 children had mesial temporal sclerosis and 4 persons had ectopic grey matter (p=0.001). Abnormal cases in CT scan were mostly observed in the age less than six months and the abnormal cases of MRI were mostly observed in age group 2-14 years. In children with normal development and a normal physical examination, the results of CT scan and MRI were mostly normal, and the abnormal cases of CT scan and MRI were mostly observed in the children with developmental delay and in the children with abnormality in physical examination. In seizure types and the result of CT scan, no statistically significant difference was observed, but MRI abnormality cases were mostly observed in the children with local (partial) seizure. Abnormal CT scan was mostly observed in the children with epilepsy abnormal EEG and the cases of Abnormal MRI was mostly seen in the children with non-specific abnormal EEG (Table 1).
Main comparison to the similar studies
In this study, CT scan was reported as abnormal partial seizure in 7.16% of the children, whereas in a study conducted in India, in which CT scan of 50 children aged one month to 12 years with partial seizure of unknown etiology was checked, CT scan has been abnormal in 68% of them [9]. Medical records of 93 children with seizure without fever have been studied and in 35% of cases brain CT scan has been performed which has been abnormal in 9% of the children [10]. CT scan of 53 out of 124 children with the age less than or equal to 12 years (42.7 %) who had been brought to the emergency room because of the first seizure, has been abnormal and the abnormalities in CT scan has been more in the children with developmental and focal neurological delay [11]. CT scan of 19.7% of children who had not have any problem previously, and who had hospitalized in the pediatric intensive care unit because of the first seizure has been abnormal and the cases of abnormalities in CT scan has been mostly observed in the children with the multiple seizure or in the children younger than 2 years [12]. CT scan has been reported abnormal in 26% of the patients and the frequency of abnormal CT scan in children with developmental delay, local seizure, and the seizure onset in less than one year old has been more [13]. In this study, the cases of abnormal CT scan has been mostly observed in the children with developmental delay and the results are similar to some other studies [13-15]. In the present study, MRI was abnormal in 47.5 % of the children and the MRI abnormal cases were in 2 to 14 years old children, children with developmental delay, and children with abnormal physical examination, local seizure, and non-specific abnormal EEG. 28.5 % of the children aged one to 15 years old with epilepsy, have abnormal MRI and the cases of MRI abnormality are more common in the children with abnormal EEG, family history of epilepsy, developmental delay, abnormal physical examination, and abnormal appearance [16]. MRI abnormal cases have been more observed in children with seizure onset less than three years old, developmental delay, and abnormal physical examination; and the most observed abnormalities are abnormalities of cerebral ischemic lesions and brain abnormalities [7]. Brain MRI in 23.3% of 176 children at one month to 18 years with the first seizure has been abnormal [17]. In the present study, the distribution of abnormal MRI has mostly been in children with local or partial seizure and these results are similar to a research conducted in Rassool-e-Akram hospital in Tehran [15]. … [18, 19] In this study the frequency of MRI abnormality was more in the local seizure and 61.1% of the children with partial seizure and 46.5% of children with generalized seizure (generalized tonic-clonic, absence and myoclonic) had abnormal MRI, whereas in a conducted study in Birjand, 42.6 % of the cases of generalized tonic-clonic, and 76.9% of other types of seizure (partial complex, myoclonic, simple partial and absence) has been abnormal MRI [20]. … [21-26]
Suggestions
Another study should be conducted with the age range 6 months to 2 years with a larger sample size.
Limitations
Of the limitations of this study, wide age range of the patients and the loss of CT scan or MRI of some referring children can be mentioned.
Conclusions
In the study of 2-14 years old children with epilepsy, local seizure and non-specific abnormal EEG, MRI is superior to CT scan; and in less than 6 months children, children with delayed development, abnormal physical examination and abnormal epileptiform EEG , CT scan might be sufficient.
Acknowledgments
Research Deputy of Ali bin Abi Talib School of Medicine of Azad University of Yazd is appreciated.
Conflict of interest
Non-declared
Ethical Permissions
At the beginning of the study, this project was explained to the parents and if they consented, the child was enrolled in the study. Also, Ethics Committee of Ali bin Abi Talib School of Medicine of Azad University of Yazd confirmed the study. Since there was no intervention, there was no moral prohibition.
Funding Sources
To conduct this study, no financial assistance was received from any institution and the cost of the study has been paid by the researchers.

TABLES and CHARTS

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