The role of MRI in the assessment of different causes of epilepsy

Background and aim
Seizures are one of the most common medical problems affecting children, and epilepsy is the most common chronic neurological condition in children. The aim of this study was to highlight the different causes of epilepsy and to demonstrate and emphasize the usefulness of MRI epilepsy protocol on high-field magnet 3 T as imaging modality in the evaluation of pediatric epilepsy and its value in detecting subtle abnormalities that were commonly missed by previous nondedicated studies.


Patients and methods
This prospective study was conducted upon 40 pediatric patients diagnosed with epilepsy referred to a private center for MRI evaluation done on high-field magnet 3 T MRI, including the following sequences: three-dimensional T1 coronal (1 mm thick partition) with multi-planar reformat (MPR) on axial and sagittal, three-dimensional sagittal fluid attenuated inversion recovery (FLAIR) (1 or 1.5 mm thick, partition) with MPR on coronal and axial planes, high-resolution two-dimensional coronal T2‐weighted MRI, two-dimensional axial T2 (3 mm thickness), susceptibility weighted image (SWI) sequences (1.5 mm thick partition), and diffusion weighted image (DWI), as well as optional sequences, such as T1 MRI with gadolinium to look for contrast enhancement in the time interval between April 2018 and May 2020.


Results
The most common cause of epilepsy in our patients was malformation of the cortical development, accounting for 35% (14 patients), followed by neurocutaneous disorder and mesial temporal lobe lesions, each accounting for 25% (10 patients), followed by miscellaneous causes including brain tumors and vascular malformation [arterio-venous fistula (AVF), developmental venous anomaly (DVA), and cavernoma], accounting for 15% (six patients).


Conclusion
The dedicated MRI epilepsy protocol is a valuable tool in detection and illustration of the MR spectrum of different structural lesions causing pediatric seizures, describing the main MRI features of these disorders.