Yield Of Magnetic Resonance Imaging With Spectroscopy In Children With New Onset Afebrile Seizure Between One Month To Twenty-Four Months Of Age

Abstract

Background & objectives A seizure is “an abnormal high burst of synchronized neu¬ronal activity affecting neuronal networks resulting in clini¬cal manifestations that are sudden, brief, and usually transient”. Magnetic Resonance Imaging (MRI) is the present choice of imaging in patients who present with seizures. MRI identifies structural lesions that require prompt response from the treating physicians such as high-grade gliomas, arteriovenous malformations, infections and malformations of cortical development. Proton (1H) magnetic resonance spectroscopy (MRS) is an MR modality that measures CNS metabolites.MRS can be used with MRI in the assessment of children with seizures. MRI is commonly regarded as a tool for the assessment of new onset seizures. There is a need to study the role of neuroimaging in the new onset seizures in the age group of 1-24 months as it gives a higher positive study as compared to the older children age group and also affects the treatment protocol and leads to better outcome. American academy of neurology recommends non urgent neuroimaging like magnetic resonance imaging in a new onset seizure in the age group of 1-24 months. The objectives of this study are to establish to study the presenting features of first-onset afebrile seizures in children (age 1–24 months) and the yield of neuroimaging, to collect indications which are necessary to make recommendations for the use of routine MRI in children (age 1- 24 months) with first onset afebrile seizures and to detect structural anomalies in the brain that may be related to the cause of seizures with supplementation of MR spectroscopy. Materials and methods One year hospital based observational study was done in Department of Radio-diagnosis at the KLE’S Dr. Prabhakar Kore hospital & MRC, Belagavi. 31 patents were included in the study. These patients are subjected to Magnetic resonance imaging with proton spectroscopy to detect the underlying pathological and structural anomalies causing first onset seizures. Distribution according to Age and sex, on the basis of duration of seizures, on MR diagnosis, percentage of abnormal MR diagnosis and abnormalities in various age groups were calculated. Results Maximum number of patients (41.94 %) were in the group of 0-6 months of age. Ratio of Male: female was almost equal (51.61: 48.39 %). Out of 31, 16 were male and 15 were female. Most of the children presented with seizures of 2-minute duration. In 12 out of 31 children (38.70 %), the study was normal and 19 (61.29 %) patients showed magnetic resonance imaging abnormalities. In 19 abnormal patients, 11 were male (57.90%) and 8 were female (42.10 %). In 4 children (12.90 %) structural malformations was noted. 4 children showed imaging abnormalities which were due to inborn metabolic errors. Imaging abnormalities were noted maximum in the children between 0-6 months of age. Interpretation and conclusion Precise diagnosis of the cause of seizure is vital for finding an effective treatment. MRI has been shown to be highly sensitive and specific in recognizing the underlying pathology in seizures. With its high spatial resolution, excellent inherent soft tissue contrast, multiplanar imaging capability and lack of ionizing radiation, MR imaging has emerged as a resourceful tool in the evaluation of patients with seizures. Routine use of magnetic resonance imaging after first onset seizures helps to identify the underlying pathophysiological causes and its severity and thus helping in further medical and surgical management. As per our study, use of MRI with spectroscopy resulted in early detection of the structural malformations, inborn metabolic errors, infectious causes and also other various causes resulting in prompt definitive treatment. These results suggest that Use of MRI with spectroscopy can be used as a routine screening tool for assessment of the new onset seizures in the neonatal life. Studies with a larger sample size with immediate and long-term follow-up is required to include routine MRI screening as a modality after new onset seizure. Future studies could compare the use of MRI and EEG for better diagnosis of the pathophysiology thus resulting in prompt accurate treatment protocol.