Jason Coryell1,2, William D Gaillard3, Renée A Shellhaas4, Zachary M Grinspan5, Elaine C Wirrell6, Kelly G Knupp7, Courtney J Wusthoff8, Cynthia Keator9, Joseph E Sullivan10, Tobias Loddenkemper11, Anup Patel12, Catherine J Chu13, Shavonne Massey14,15, Edward J Novotny16,17,18, Russel P Saneto16, Anne T Berg19. 1. Departments of Pediatrics and. 2. Neurology, Oregon Health and Sciences University, Portland, Oregon. 3. Department of Neurology, Children's National Health System and School of Medicine, The George Washington University, Washington, District of Columbia. 4. Department of Pediatrics, University of Michigan, Ann Arbor, Michigan. 5. Health Information Technology Evaluation Collaborative, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, New York. 6. Department of Neurology, Mayo Clinic, Rochester, Minnesota. 7. Department of Pediatrics and Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado. 8. Division of Child Neurology, Stanford University, Palo Alto, California. 9. Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, Texas. 10. Department of Neurology, University of California, San Francisco, San Francisco, California. 11. Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts. 12. Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio. 13. Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts. 14. Departments of Neurology and. 15. Pediatrics, Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 16. Division of Pediatric Neurology, Departments of Neurology and. 17. Pediatrics, and. 18. Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle Children's Hospital and University of Washington, Seattle, Washington; and. 19. Epilepsy Center, Ann and Robert H. Lurie Children's Hospital of Chicago and Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois atberg@luriechildrens.org.
Abstract
OBJECTIVES: We assessed the adherence to neuroimaging guidelines and the diagnostically relevant yield of neuroimaging in newly presenting early life epilepsy (ELE). METHODS: There were 775 children with a new diagnosis of epilepsy (<3 years old at onset) who were recruited through the ELE study at 17 US pediatric epilepsy centers (2012-2015) and managed prospectively for 1 year. The data were analyzed to assess the proportion of children who underwent neuroimaging, the type of neuroimaging, and abnormalities. RESULTS: Of 725 children (93.5%) with neuroimaging, 714 had an MRI (87% with seizure protocols) and 11 had computed tomography or ultrasound only. Etiologically relevant abnormalities were present in 290 individuals (40%) and included: an acquired injury in 97 (13.4%), malformations of cortical development in 56 (7.7%), and other diffuse disorders of brain development in 51 (7.0%). Neuroimaging was abnormal in 160 of 262 (61%) children with abnormal development at diagnosis versus 113 of 463 (24%) children with typical development. Neuroimaging abnormalities were most common in association with focal seizure semiology (40%), spasms (47%), or unclear semiology (42%). In children without spasms or focal semiology with typical development, 29 of 185 (16%) had imaging abnormalities. Pathogenic genetic variants were identified in 53 of 121 (44%) children with abnormal neuroimaging in whom genetic testing was performed. CONCLUSIONS: Structural abnormalities occur commonly in ELE, and adherence to neuroimaging guidelines is high at US pediatric epilepsy centers. These data support the universal adoption of imaging guidelines because the yield is substantially high, even in the lowest risk group.
OBJECTIVES: We assessed the adherence to neuroimaging guidelines and the diagnostically relevant yield of neuroimaging in newly presenting early life epilepsy (ELE). METHODS: There were 775 children with a new diagnosis of epilepsy (<3 years old at onset) who were recruited through the ELE study at 17 US pediatric epilepsy centers (2012-2015) and managed prospectively for 1 year. The data were analyzed to assess the proportion of children who underwent neuroimaging, the type of neuroimaging, and abnormalities. RESULTS: Of 725 children (93.5%) with neuroimaging, 714 had an MRI (87% with seizure protocols) and 11 had computed tomography or ultrasound only. Etiologically relevant abnormalities were present in 290 individuals (40%) and included: an acquired injury in 97 (13.4%), malformations of cortical development in 56 (7.7%), and other diffuse disorders of brain development in 51 (7.0%). Neuroimaging was abnormal in 160 of 262 (61%) children with abnormal development at diagnosis versus 113 of 463 (24%) children with typical development. Neuroimaging abnormalities were most common in association with focal seizure semiology (40%), spasms (47%), or unclear semiology (42%). In children without spasms or focal semiology with typical development, 29 of 185 (16%) had imaging abnormalities. Pathogenic genetic variants were identified in 53 of 121 (44%) children with abnormal neuroimaging in whom genetic testing was performed. CONCLUSIONS:Structural abnormalities occur commonly in ELE, and adherence to neuroimaging guidelines is high at US pediatric epilepsy centers. These data support the universal adoption of imaging guidelines because the yield is substantially high, even in the lowest risk group.
Authors: Anne T Berg; Courtney Wusthoff; Renée A Shellhaas; Tobias Loddenkemper; Zachary M Grinspan; Russell P Saneto; Kelly G Knupp; Anup Patel; Joseph E Sullivan; Eric H Kossoff; Catherine J Chu; Shavonne Massey; Ignacio Valencia; Cynthia Keator; Elaine C Wirrell; Jason Coryell; John J Millichap; William D Gaillard Journal: Epilepsy Behav Date: 2019-06-07 Impact factor: 2.937
Authors: R Hourani; W Nasreddine; M Dirani; G Hmaimess; S Sabbagh; O El Tourjuman; J Wazne; H Toufaili; N AlArab; M El Dassouki; A Beydoun Journal: AJNR Am J Neuroradiol Date: 2021-07-08 Impact factor: 4.966
Authors: Renske Oegema; Tahsin Stefan Barakat; Martina Wilke; Katrien Stouffs; Dina Amrom; Eleonora Aronica; Nadia Bahi-Buisson; Valerio Conti; Andrew E Fry; Tobias Geis; David Gomez Andres; Elena Parrini; Ivana Pogledic; Edith Said; Doriette Soler; Luis M Valor; Maha S Zaki; Ghayda Mirzaa; William B Dobyns; Orly Reiner; Renzo Guerrini; Daniela T Pilz; Ute Hehr; Richard J Leventer; Anna C Jansen; Grazia M S Mancini; Nataliya Di Donato Journal: Nat Rev Neurol Date: 2020-09-07 Impact factor: 42.937