Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Pediatric Radiology
Published in: Pediatric Radiology 10/2016

01-09-2016 | Original Article

Prospective detection of cortical dysplasia on clinical MRI in pediatric intractable epilepsy

Authors: Rupa Radhakrishnan, James L. Leach, Francesco T. Mangano, Michael J. Gelfand, Leonid Rozhkov, Lili Miles, Hansel M. Greiner

Published in: Pediatric Radiology | Issue 10/2016

Login to get access

Abstract

Background

Cortical dysplasia is the most common cause of pediatric refractory epilepsy. MRI detection of epileptogenic lesion is associated with good postsurgical outcome. Additional electrophysiological information is suggested to be helpful in localization of cortical dysplasia. Educational measures were taken to increase the awareness of cortical dysplasia at our institution in the context of a recent International League Against Epilepsy (ILAE 2011) classification of cortical dysplasia.

Objective

To determine changes in the rate of prospective identification of cortical dysplasia on an initial radiology report and also evaluate the benefit of MRI review as part of a multidisciplinary epilepsy conference in identifying previously overlooked MRI findings.

Materials and methods

We retrospectively evaluated surgically treated children with refractory epilepsy from 2007 to 2014 with cortical dysplasia on histopathology. We analyzed the initial radiology report, preoperative MRI interpretation at multidisciplinary epilepsy conference and subsequent retrospective MRI review with knowledge of the resection site. We recorded additional electrophysiological data and the presence of lobar concordance with the MRI findings.

Results

Of 78 children (44 MRI lesional) evaluated, 18 had initially overlooked MRI findings. Comparing 2007–2010 to 2011–2014, there was improvement in the rate of overlooked findings on the initial radiology report (54% vs. 13% of lesional cases, respectively; P = 0.008). The majority (72%) were identified at a multidisciplinary conference with lobar concordance of findings with at least one additional electrophysiological investigation in 89%.

Conclusion

Awareness of current classification schemes of cortical dysplasia and image review in the context of a multidisciplinary conference can lead to improved MRI detection of cortical dysplasia in children.
Literature
1.
Harvey AS, Cross JH, Shinnar S et al (2008) Defining the spectrum of international practice in pediatric epilepsy surgery patients. Epilepsia 49:146–155CrossRefPubMed
2.
Rowland NC, Englot DJ, Cage TA et al (2012) A meta-analysis of predictors of seizure freedom in the surgical management of focal cortical dysplasia. J Neurosurg 116:1035–1041CrossRefPubMed
3.
Leach JL, Miles L, Henkel DM et al (2014) Magnetic resonance imaging abnormalities in the resection region correlate with histopathological type, gliosis extent, and postoperative outcome in pediatric cortical dysplasia. J Neurosurg Pediatr 14:68–80CrossRefPubMed
4.
Fauser S, Essang C, Altenmuller DM et al (2015) Long-term seizure outcome in 211 patients with focal cortical dysplasia. Epilepsia 56:66–76CrossRef
5.
Muhlebner A, Coras R, Kobow K et al (2012) Neuropathologic measurements in focal cortical dysplasias: validation of the ILAE 2011 classification system and diagnostic implications for MRI. Acta Neuropathol 123:259–272CrossRefPubMed
6.
Chen HH, Chen C, Hung SC et al (2014) Cognitive and epilepsy outcomes after epilepsy surgery caused by focal cortical dysplasia in children: early intervention maybe better. Childs Nerv Syst 30:1885–1895CrossRefPubMed
7.
Oluigbo CO, Wang J, Whitehead MT et al (2015) The influence of lesion volume, perilesion resection volume, and completeness of resection on seizure outcome after resective epilepsy surgery for cortical dysplasia in children. J Neurosurg Pediatr 15:644–650CrossRefPubMed
8.
Leach JL, Greiner HM, Miles L et al (2014) Imaging spectrum of cortical dysplasia in children. Semin Roentgenol 49:99–111CrossRefPubMed
9.
Mellerio C, Labeyrie MA, Chassoux F et al (2012) Optimizing MR imaging detection of type 2 focal cortical dysplasia: best criteria for clinical practice. AJNR Am J Neuroradiol 33:1932–1938CrossRefPubMed
10.
Colombo N, Tassi L, Galli C et al (2003) Focal cortical dysplasias: MR imaging, histopathologic, and clinical correlations in surgically treated patients with epilepsy. AJNR Am J Neuroradiol 24:724–733PubMed
11.
Salamon N, Kung J, Shaw SJ et al (2008) FDG-PET/MRI coregistration improves detection of cortical dysplasia in patients with epilepsy. Neurology 71:1594–1601CrossRefPubMedPubMedCentral
12.
Itabashi H, Jin K, Iwasaki M et al (2014) Electro- and magneto-encephalographic spike source localization of small focal cortical dysplasia in the dorsal peri-rolandic region. Clin Neurophysiol 125:2358–2363CrossRefPubMed
13.
Funke ME, Moore K, Orrison WW Jr et al (2011) The role of magnetoencephalography in “nonlesional” epilepsy. Epilepsia 52:10–14CrossRefPubMed
14.
Palmini A, Najm I, Avanzini G et al (2004) Terminology and classification of the cortical dysplasias. Neurology 62:S2–S8CrossRefPubMed
15.
Blumcke I, Thom M, Aronica E et al (2011) The clinicopathologic spectrum of focal cortical dysplasias: a consensus classification proposed by an ad hoc Task Force of the ILAE Diagnostic Methods Commission. Epilepsia 52:158–174CrossRefPubMed
16.
Miles L, Greiner HM, Miles MV et al (2013) Interaction between akt1-positive neurons and age at surgery is associated with surgical outcome in children with isolated focal cortical dysplasia. J Neuropathol Exp Neurol 72:884–891CrossRefPubMed
17.
18.
Knake S, Triantafyllou C, Wald LL et al (2005) 3T phased array MRI improves the presurgical evaluation in focal epilepsies: a prospective study. Neurology 65:1026–1031CrossRefPubMed
19.
20.
21.
Johnson AM, Sugo E, Barreto D et al (2014) Clinicopathological associations in temporal lobe epilepsy patients utilising the current ILAE focal cortical dysplasia classification. Epilepsy Res 108:1345–1351CrossRefPubMed
22.
Garbelli R, Milesi G, Medici V et al (2012) Blurring in patients with temporal lobe epilepsy: clinical, high-field imaging and ultrastructural study. Brain 135:2337–2349CrossRefPubMed
23.
Lee JJ, Kang WJ, Lee DS et al (2005) Diagnostic performance of 18F-FDG PET and ictal 99mTc-HMPAO SPET in pediatric temporal lobe epilepsy: quantitative analysis by statistical parametric mapping, statistical probabilistic anatomical map, and subtraction ictal SPET. Seizure 14:213–220CrossRefPubMed
24.
Lee SK, Lee SY, Kim KK et al (2005) Surgical outcome and prognostic factors of cryptogenic neocortical epilepsy. Ann Neurol 58:525–532CrossRefPubMed
25.
Kim YK, Lee DS, Lee SK et al (2002) (18)F-FDG PET in localization of frontal lobe epilepsy: comparison of visual and SPM analysis. J Nucl Med 43:1167–1174PubMed
26.
Muzik O, Chugani DC, Juhasz C et al (2000) Statistical parametric mapping: assessment of application in children. Neuroimage 12:538–549CrossRefPubMed
27.
Tan KM, Britton JW, Buchhalter JR et al (2008) Influence of subtraction ictal SPECT on surgical management in focal epilepsy of indeterminate localization: a prospective study. Epilepsy Res 82:190–193CrossRefPubMed
28.
Matsuda H, Matsuda K, Nakamura F et al (2009) Contribution of subtraction ictal SPECT coregistered to MRI to epilepsy surgery: a multicenter study. Ann Nucl Med 23:283–291CrossRefPubMed
29.
30.
Kim JT, Bai SJ, Choi KO et al (2009) Comparison of various imaging modalities in localization of epileptogenic lesion using epilepsy surgery outcome in pediatric patients. Seizure 18:504–510CrossRefPubMed
31.
Willmann O, Wennberg R, May T et al (2007) The contribution of 18F-FDG PET in preoperative epilepsy surgery evaluation for patients with temporal lobe epilepsy A meta-analysis. Seizure 16:509–520CrossRefPubMed
32.
Kurian M, Spinelli L, Delavelle J et al (2007) Multimodality imaging for focus localization in pediatric pharmacoresistant epilepsy. Epileptic Disord 9:20–31PubMed
33.
Pail M, Marecek R, Hermanova M et al (2012) The role of voxel-based morphometry in the detection of cortical dysplasia within the temporal pole in patients with intractable mesial temporal lobe epilepsy. Epilepsia 53:1004–1012CrossRefPubMed
34.
Wilke M, Rose DF, Holland SK et al (2014) Multidimensional morphometric 3D MRI analyses for detecting brain abnormalities in children: impact of control population. Hum Brain Mapp 35:3199–3215CrossRefPubMed
35.
Widjaja E, Blaser S, Miller E et al (2007) Evaluation of subcortical white matter and deep white matter tracts in malformations of cortical development. Epilepsia 48:1460–1469CrossRefPubMed
36.
Bernasconi A, Bernasconi N, Bernhardt BC et al (2011) Advances in MRI for ‘cryptogenic’ epilepsies. Nat Rev Neurol 7:99–108CrossRefPubMed
37.
38.
Regis J, Tamura M, Park MC et al (2011) Subclinical abnormal gyration pattern, a potential anatomic marker of epileptogenic zone in patients with magnetic resonance imaging-negative frontal lobe epilepsy. Neurosurgery 69:80–93
39.
Mellerio C, Roca P, Chassoux F et al (2015) The power button sign: a newly described central sulcal pattern on surface rendering MR images of type 2 focal cortical dysplasia. Radiology 274:500–507CrossRefPubMed
40.
Madan N, Grant PE (2009) New directions in clinical imaging of cortical dysplasias. Epilepsia 50:9–18CrossRefPubMed
41.
42.
Ahmed B, Brodley CE, Blackmon KE et al (2015) Cortical feature analysis and machine learning improves detection of “MRI-negative” focal cortical dysplasia. Epilepsy Behav 48:21–28CrossRefPubMedPubMedCentral
Metadata
Title
Prospective detection of cortical dysplasia on clinical MRI in pediatric intractable epilepsy
Authors
Rupa Radhakrishnan
James L. Leach
Francesco T. Mangano
Michael J. Gelfand
Leonid Rozhkov
Lili Miles
Hansel M. Greiner
Publication date
01-09-2016
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Radiology / Issue 10/2016
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-016-3623-x

Other articles of this Issue 10/2016

Pediatric Radiology 10/2016 Go to the issue

Original Article

Pulmonary arterial hypertension in children: diagnosis using ratio of main pulmonary artery to ascending aorta diameter as determined by multi-detector computed tomography

Pictorial Essay

Radiographic assessment of congenital malformations of the upper extremity

Original Article

Peritonitis following percutaneous gastrostomy tube insertions in children

Original Article

Comparison of complications between pediatric peripherally inserted central catheter placement techniques

Original Article

Anomalous origin of the left coronary artery from the pulmonary artery in children: diagnostic use of multidetector computed tomography

Original Article

Posterior urethral valves: are neonatal imaging findings predictive of renal function during early childhood?