Evaluation of Magnetic Resonance (MR) Findings in Patients with Refractory Epilepsy

Objectives: Epilepsy is characterized as a tendency towards recurrent seizures and it is a significant health problem in the world and one of the most common severe neurologic disorders among children. This study aims to evaluate the outcome of magnetic resonance imaging in determining the etiology in patients with refractory epilepsy and to reveal pathologies that may have the potential to be treated with methods, such as epileptic surgery.
Methods: Data were obtained from the patient files of the patients diagnosed with epilepsy and monitored for at least two years between 01.01.2009-12.31.2012 in the Uludag Faculty of Medicine, the Division of the Pediatric Neurology. File records of the patients, age, sex and MRI findings of the patients were recorded.
Results: One hundred twenty were girls (49%) and 125 were male (51%) of the cases. The age range ranged from 1 to 18 years and the median value was 8.3 (1-18) years. One hundred twenty of the 245 patients who met the diagnostic criteria for resistant epilepsy was found as well controlled. In patients with resistant epilepsy, the findings of these two groups of patients were compared concerning MR findings. Among all patients, 154 (62.8%) patients were found to have MR pathology. Of these patients, 83 (53.9%) were in the resistant group and 71 (46.1%) were in the well-controlled group. There was no significant difference in the presence of MR findings between the two groups (p=0.354). The highest incidence (24.8%) of the encephalomalacia in patients in the resistant group may explain the association of perinatal hypoxia with resistance development.
Conclusion: If patients with epilepsy can be predicted early in the disease, which group of the patients will not respond well to medical treatment; unlike other patients, different treatment modalities, such as antiepileptic use, vagal nerve stimulation, ketogenic diet and epilepsy surgery, can be applied to this group of the patients. We think that clinicians can guide the planning of treatment of the MR findings.

Dirençli epilepsili hastalarda manyetik rezonans (MR) bulgularýnýn deðerlendirilmesi

AMAÇ
Epilepsi tekrarlayan nöbet eðilimi ile karakterize tüm dünyada yaygýn olarak görülen önemli bir saðlýk problemi olup ayný zamanda çocuklarda en sýk görülen ciddi nörolojik bozukluklardan biridir. Bu çalýþmanýn amacý dirençli epilepsili hastalarda etyolojiyi belirlemede manyetik rezonans görüntülemenin sonuçlarýný deðerlendirmek ve epileptik cerrahi gibi yöntemlerle tedavi þansý olabilecek patolojileri ortaya koymaktýr.
GEREÇ VE YÖNTEMLER
Uludað Üniversitesi Týp Fakültesi Çocuk Nöroloji Bilim Dalý Polikliniðinde epilepsi tanýsý almýþ, en az iki yýldýr izlemde olan 01.01.2009– 31.12.2012 tarihleri arasýnda takip edilen hastalarýn dosyalarý incelenerek veriler elde edildi. Hastalarýn dosya kayýtlarýndan; hastalarýn yaþý, cinsi ve MR bulgularý kayda alýndý.
BULGULAR
Vakalarýn 120’si kýz (%49), 125’i erkek (%51) çocuktan oluþmaktaydý. Yaþ aralýðý 1 ile 18 yaþ arasýnda deðiþmekte olup median deðer 8,3 (1-18) yaþ olarak bulundu. Dirençli epilepsi taný kriterlerine uyan 245 hastadan 120’si iyi kontrollü grup olarak bulundu. Dirençli epilepsili hastalarda mr bulgularý açýsýndan bu iki grup hastanýn bulgularý karþýlaþtýrýldý. Tüm hastalar arasýnda 154 (%62,8) hastanýn MR sonucunda patoloji olduðu tespit edildi. Bu hastalarýn 83’ü (%53,9) dirençli grupta, 71’i (%46,1) iyi kontrollü grupta yer aldý. Ýki grup arasýnda MR bulgularýnýn varlýðý açýsýndan anlamlý bir fark bulunmadý (p=0,354). Dirençli gruptaki hastalarda en fazla (%24,8) ensefalomalazi görülmesi, perinatal hipoksinin direnç geliþimi ile iliþkisini açýklayabilir.
SONUÇ
Epilepsili hastalarda hangi hasta grubunun týbbi tedaviye iyi yanýt vermeyeceði hastalýðýn erken dönemde tahmin edilebilirse diðer hastalardan farklý olarak bu hasta grubuna erken yeni kuþak antiepileptik kullanýmý, vagal sinir uyarýmý, ketojenik diyet, uygun vakalara epilepsi cerrahisi gibi deðiþik tedavi yöntemleri uygulanabilir. MR bulgularýnýn tedavi planlanmasýnda klinisyenlere yol gösterici olabileceðini düþünüyoruz. (SETB-2018-09-129)