MRI in cerebral developmental malformations and epilepsy

doi:10.1016/0730-725X(95)02024-N

Magnetic Resonance Imaging

Volume 13, Issue 8, 1995, Pages 1137-1145

https://doi.org/10.1016/0730-725X(95)02024-N Get rights and content

Abstract

Cerebral developmental malformations are increasingly recognized as a major cause of developmental delay and epilepsy. The incidence of these developmental malformations in patients with epilepsy is not known, but epilepsy surgery data suggest that this pathology is commonly seen in children who undergo epilepsy surgery for intractable epilepsy. These malformations can be diagnosed by a combination of clinical, neurophysiological, and imaging techniques. However, imaging techniques such as MRI have been able to provide in vivo recognition of many of these malformations and have contributed to the recognition of specific syndromes. These malformations can be classified on an anatomical basis either into diffuse, unilateral, or generalized. However, a combination of imaging data in conjunction with genetics and embryology may be more appropriate in the future. Further technical developments promise to increase the sensitivity of MRI in detecting these malformations and may help to delineate the possible biology of these disorders.

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Cited by (32)

Automated patient-specific classification of long-term Electroencephalography
2014, Journal of Biomedical Informatics
Citation Excerpt :
Seizures are not a disease themselves; rather a transient symptom of synchronous neuronal activity in the brain [1]. In contrast to methods such as Magnetic Resonance Imaging [2] and three-dimensional accelerometer [2], using Electroencephalography (EEG) is a more common method for long-term epileptic patient monitoring. EEG is a multi-channel recording of the electrical activity generated by neurons in the brain.
This paper presents a novel systematic approach for patient-specific classification of long-term Electroencephalography (EEG). The goal is to extract the seizure sections with a high accuracy to ease the Neurologist’s burden of inspecting such long-term EEG data. We aim to achieve this using the minimum feedback from the Neurologist. To accomplish this, we use the majority of the state-of-the-art features proposed in this domain for evolving a collective network of binary classifiers (CNBC) using multi-dimensional particle swarm optimization (MD PSO). Multiple CNBCs are then used to form a CNBC ensemble (CNBC-E), which aggregates epileptic seizure frames from the classification map of each CNBC in order to maximize the sensitivity rate. Finally, a morphological filter forms the final epileptic segments while filtering out the outliers in the form of classification noise. The proposed system is fully generic, which does not require any a priori information about the patient such as the list of relevant EEG channels. The results of the classification experiments, which are performed over the benchmark CHB-MIT scalp long-term EEG database show that the proposed system can achieve all the aforementioned objectives and exhibits a significantly superior performance compared to several other state-of-the-art methods. Using a limited training dataset that is formed by less than 2 min of seizure and 24 min of non-seizure data on the average taken from the early 25% section of the EEG record of each patient, the proposed system establishes an average sensitivity rate above 89% along with an average specificity rate above 93% over the test set.
Epilepsy and focal lesions in children. Surgical management
2008, Neurochirurgie
Epilepsy surgery has gained a large role in the treatment of intractable seizures in the last few decades because of the development of operative techniques and better identification of the cerebral anomalies using electrophysiological recordings and neuroimaging.
A series of 419 children, aged from five months to 15 years, with epilepsy (medically refractory in 85.5% of them) associated with focal cortical lesions, who underwent surgery between 1986 and 2006 was analyzed to identify the factors that correlated with outcome. Mean follow-up was 5.2 years. According to Engel's classification; 75.8% of the children were seizure-free.
When the lesion was well defined, correlations between clinical data, radiological features and electrophysiological features, suggesting a zone of seizure onset around (or even in) the lesion, was the best guarantee of achieving good seizure control by lesionectomy.
Nevertheless, seizure outcome was also determined by other factors: the duration of the epilepsy and the surgery. Persistence of seizures was found to be significantly associated with the preoperative duration of epilepsy, the completeness of the lesional resection and de novo brain damage induced by the surgical procedure itself.
Early surgery must be considered in children because of the benefits of seizure control on the developing brain and the risk of secondary epileptogenesis.
Durant ces dernières années, la chirurgie de l’épilepsie connaît un grand essor. Cela tient à une meilleure connaissance de l’épilepsie, aux progrès de l’imagerie, des méthodes d’enregistrement, des techniques chirurgicales. À quels enfants s’adresse la chirurgie de l’épilepsie ? Quand ? Et avec quelles procédures préchirurgicales ?
Nous rapportons une série de 419 enfants âgés de cinq mois à 15 ans présentant une épilepsie réfractaire dans 85 % des cas, pour lesquels une lésionnectomie a été proposée entre les années 1986 et 2006, afin d’identifier les facteurs associés à un résultat favorable. Avec un recul postopératoire de 5,2 ans, 75,8 % des enfants de cette série sont complètement libres de crises (classe Ia de Engel). En cas de lésion bien définie, la mise en évidence d’une parfaite corrélation entre les données sémiologiques, neuropsychologiques, EEG et l’imagerie, suggérant un point de départ des crises au contact (ou même dans) la lésion est la meilleure garantie d’obtenir un bon contrôle des crises par une lésionnectomie.
Cependant, les résultats sur les crises sont également déterminés par d’autres facteurs : la longueur de l’histoire de l’épilepsie et la chirurgie. La persistance de crises est significativement associée à la durée préopératoire de l’épilepsie, au caractère incomplet de l’exérèse lésionnelle et à la présence de novo d’une lésion cérébrale induite par le geste chirurgical en soi. Une chirurgie précoce doit être considérée chez les enfants en raison des bénéfices attendus par le contrôle des crises sur le cerveau en développement et du risque d’épileptogénèse secondaire.
Treatment considerations: Role of surgery
2002, Epilepsy and Behavior
Patients with developmental disabilities, including retardation and global developmental delay, are not ideal candidates for epilepsy surgery. Because they have an increased likelihood of diffuse brain dysfunction and multifocal or generalized epileptogenic zones, there is an increased chance that a focal cortical resection will not confer a major improvement in their seizure frequency and severity. There is also increased concern that cortical resection will lead to increase in the patient’s disability. However, by applying the basic principles of epilepsy surgery selection (i.e., convergence of multiple lines of localizing evidence) to this population, patients with a reasonable likelihood of good seizure control can be identified. Various means of localizing seizure onset are reviewed, including history and examination, electroencephalography, magnetic resonance imaging, position emission tomography, single-photon-emission tomography, and magnetoencephalography.
Epilepsy surgery in children with developmental disabilities
2000, Seminars in Pediatric Neurology
Surgery for treatment of medically uncontrolled epilepsy in children is now widely accepted with reported outcomes similar to those in adults. Epilepsy is reported in 8.8% to 32% of children with mental retardation (MR) and in up to half of children with severe retardation. There has been concern that patients with low IQ will experience unsatisfactory outcomes from epilepsy surgery and not achieve good seizure control. It is appropriate to reassess the prior bias against resective epilepsy surgery in children with MR in view of the changing criteria for potential candidacy for epilepsy surgery in infants and young children. There are three prerequisites for epilepsy surgery: (1) the epilepsy must be medically intractable; (2) the surgery must be feasible, that is, the epileptogenic zone can identified and safely resected; and (3) there is high likelihood of a satisfactory outcome as regards both the epilepsy and the patient's functional status. Patients with MR may have diffuse cerebral dysfunction and diffuse or multifocal epileptogenic regions. Appropriate patient selection is made possible through use of current technology that allows identification of lesions or areas of cerebral dysgenesis, aiding in identification of localized areas of epileptogenesis. Results from various series of patients with MR who have undergone resective surgery for epilepsy have shown that with careful presurgical evaluations, outcomes are similar between patients with normal IQ scores and those with low scores. Surgical protocols specifically for patients with MR and intractable epilepsy are required, including careful definition of desired outcomes.
Neuroimaging in the evaluation of children and adolescents with intractable epilepsy: I. Magnetic resonance imaging and the substrates of epilepsy
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Recent advances in neuroimaging, particularly the magnetic resonance imaging (MRI) scan, have greatly enhanced our ability to visualize intraparenchymal anatomy. With the linkage between intracranial pathology and epilepsy now clearly established, the MRI data provides detailed information for the clinician treating patients with epilepsy. This article supplies the reader with an overview of the new techniques in MRI brain imaging that allow us to identify intracranial abnormalities, and a survey of some of the MRI-identified substrates of epilepsy.
Neurodevelopmental disorders: 2023 update
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Original contributionMRI in cerebral developmental malformations and epilepsy

Abstract

Brain Dev.

Lancet

Nonlissencephalic cortical dysplasias: Correlation of imaging findings with clinical defecits

Am. J. Neuroradiol.

Formation, maturation, and disorders of brain neocortex

Am. J. Neuroradiol.

Disorders of neuronal migration

Can. J. Neurol. Sci.

Epilepsy and focal gyral anomalies detected by MRI: Electroclinico-morphological correlations and follow-up

Dev. Med. Child Neurol.

Structural imaging

Neuronal migration disorders: A contribution to modern neuro-imaging to the etiologic diagnosis of epilepsy

Can. J. Neurol. Sci.

Focal dysplasia of the cerebral cortex in epilepsy

J. Neurol. Neurosurg. Psychiatry

Cortical dysplasia in TLE: MRI correlations

Ann. Neurol.

Magnetic resonance imaging in childhood intractable partial epilepsies: Pathologic correlations

Neurology

Les malformations du systeme nerveux

Syndromes with lissencephaly. I: Miller-Dieker and Norman-Roberts syndromes and isolated lissencephaly

Am. J. Med. Genet.

MR of neuronal migration anomalies

Am. J. Neuroradiol.

Pachygyria

J. Pathol. Bact.

Original contribution
MRI in cerebral developmental malformations and epilepsy