MRI imaging in afebrile pediatric epilepsy: experience sharing

In this article, we emphasize the usefulness and cost-effectiveness of non-contrast MRI as the primary imaging modality in the evaluation of non-febrile pediatric seizure, illustrate the MR spectrum of different structural lesions causing pediatric seizures, and finally describing the main MR imaging features of these disorders. Among 366 cases of pediatric epilepsy studied over a period of fifteen years the commonly detected structural malformations are mesial temporal sclerosis unilateral and bilateral, heterotopias, cortical dysplasia, neurocutaneous syndromes and few neoplasms. MRI showed hippocampal atrophy and increased signal intensity of the hippocampus on T2-weighted images in mesial temporal sclerosis, cortical thickness and sulcation are decreased in microcephaly, enlarged dysplastic cortex in hemimegalencephaly, and focal cortical dysplasia shows ipsilateral focal cortical thickening with radial hyperintense bands. MRI detects smooth brain in classic lissencephaly, the ectopic position of gray matter in heterotopias, and the nodular cortex with cobblestone cortex in congenital muscular dystrophy. MRI can detect polymicrogyria and the related syndromes, as well as schizencephaly types. In conclusion, MR imaging is essential to demonstrate the morphology, distribution, and extent of different disorders causing seizures in children as well as the associated anomalies and related syndromes to guide patient for further surgical treatment and counseling.