Abstracts

Few studies have systematically examined structural brain abnormalities in children at the onset of their seizures. Previously reported large prospective studies of Shinnar (1996) and Berg (2000) have differed in demographics, age distribution, number of seizures, and imaging. The purpose of this study is to extend previous investigations, by limiting analysis to MRI, the current [ldquo]gold standard[rdquo], narrowing the imaging window closer to seizure onset, and applying a more comprehensive standardized scoring system., Children aged 6-14 years were prospectively recruited as part of a longitudinal study examining cognitive and behavioral adaptation to seizures. Recruitment was performed through two large community-based academic medical centers. Of 350 children enrolled, 282 (81%) had an MRI within 6 months of the first recognized seizure (FRS). Most imaging studies were performed with a standardized, dedicated seizure protocol. A standard scoring system was adapted from one previously developed at CCHMC. Abnormal features were classified by pathological category and location., At least one MRI abnormality was identified in 97 (34%) of children with FRS. Two or more abnormalities were identified in 38 (13%). Most common abnormalities were ventricular enlargement (45%), leukomalacia/gliosis (20%), various other white matter lesions (23%), gray matter lesions such as heterotopias and cortical dysplasias (10%), volume loss (10%), and encephalomalacia (5%). Abnormalities defined as [ldquo]significant[rdquo], or potentially related to seizures, occurred in 39 (14%). Further analysis by location of abnormality, presence of other structural abnormalities, and seizure syndrome, was also performed and will be discussed., This study, utilizing newer MR imaging, and a standardized scoring system for analysis, demonstrates a higher rate of abnormal findings than previous investigations. Neverthless, the rate of [ldquo]significant[rdquo] findings may not differ greatly from that previously reported., (Supported by PHS R01 NS22416 (NINDS) to J.K. Austin.)