Clinico-radiological Profile in Children with Drug Resistant Focal Epilepsy

Abstract

The aim of this study was to identify patients with drug resistant epilepsy who have either persistent clinical focal seizures or persistent focal discharges on electroencephalogram (EEG), and to assess their clinical and neuroimaging findings reviewing available MRI records, and then performing another MRI using the ‘essential 6’ MRI protocol to assess whether the latter technique was more sensitive at picking subtle structural abnormalities related to drug resistant focal epilepsy. This descriptive case series was conducted on 18 children (10 males and 8 females with a mean age of 8.49 years) with drug resistant focal seizures (clinically and/or by EEG). Children were recruited from the Pediatric Neurology Clinic at Ain shams university, Cairo, Egypt including Children with drug resistant epilepsy (who failed adequate trials of 2 tolerated and appropriately chosen antiepileptic drugs) who have either: clinical focal seizures and/or focal seizures with secondary generalization (irrespective of their EEG findings), and patients with persistent focal discharges on EEG (irrespective of their seizure semiology). Patients were consecutively recruited over a period of 18 months. The mean age at onset of epilepsy was 3.24 ± 2.79 years. Two thirds of patients had a normal neurological examination. Out of 6 patients who had an abnormal neurological examination, 3 patients (50%) had spastic Hemiparesis, one patient had spastic diplegia, and two patients had spastic quadriparesis. One patient had microcephaly, whereas all other patients had a within normal occipitofrontal circumference. About two thirds of the cases had normal development, and just under one third were globally delayed. No children had isolated mental delay, yet isolated motor delay was seen in 2 children, which constitutes 11 percent of the cases.