Frequency, prognosis and surgical treatment of structural abnormalities seen with magnetic resonance imaging in childhood epilepsy

Brain. 2009 Oct;132(Pt 10):2785-97. doi: 10.1093/brain/awp187. Epub 2009 Jul 28.


The epidemiology of lesions identified by magnetic resonance imaging (MRI), along with the use of pre-surgical evaluations and surgery in childhood-onset epilepsy patients has not previously been described. In a prospectively identified community-based cohort of children enrolled from 1993 to 1997, we examined (i) the frequency of lesions identified by MRI; (ii) clinical factors associated with 'positive' MRI scans; and (iii) the utilization of comprehensive epilepsy evaluations and neurosurgery. Of the original cohort of 613 children, 518 (85%) had usable MRI scans. Eighty-two (16%) had MRI abnormalities potentially relevant to epilepsy ('positive' scans). Idiopathic epilepsy syndromes were identified in 162 (31%) of whom 3% had positive scans. The remainder had non-idiopathic epilepsy syndromes of which 22% had positive MRI findings. Multiple logistic regression analysis identified non-idiopathic epilepsy and abnormal motor-sensory (neurological) examinations as predictors of a positive MRI scan. Of the non-idiopathic patients with normal neurological exams and who were not pharmacoresistant, 10% had positive MRI scans, including four patients with gliomas. Evaluations at comprehensive epilepsy centres occurred in 54 pharmacoresistant cases. To date 5% of the imaged cohort or 8% of non-idiopathic epilepsy patients have undergone surgical procedures (including vagal nerve stimulator implantation) to treat their epilepsy (n = 22) or for tumours (n = 6) without being drug resistant. Applying our findings to the general population of children in the USA, we estimate that there will be 127/1 000 000 new cases per year of pharmacoresistant epilepsy, and 52/1 000 000 childhood-onset epilepsy patients undergoing epilepsy evaluations. In addition, approximately 27/1 000 000 will have an epilepsy-related surgical procedure. These findings support recommendations for the use of MRI in evaluating newly diagnosed paediatric epilepsy patients, especially with non-idiopathic syndromes, and provide estimates on the utilization of comprehensive evaluations and surgery.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Age of Onset
  • Anticonvulsants / therapeutic use
  • Brain / pathology*
  • Brain / surgery*
  • Child
  • Child, Preschool
  • Cognition / physiology
  • Cohort Studies
  • Drug Resistance
  • Epilepsy / epidemiology
  • Epilepsy / pathology*
  • Epilepsy / surgery*
  • Female
  • Functional Laterality / physiology
  • Humans
  • Image Processing, Computer-Assisted
  • Infant
  • Logistic Models
  • Magnetic Resonance Imaging*
  • Male
  • Neurologic Examination
  • Neuropsychological Tests
  • Neurosurgical Procedures*
  • Prognosis
  • Sclerosis
  • Tomography, X-Ray Computed


  • Anticonvulsants