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Magnetic Resonance Imaging Findings in Childhood Epilepsy at a Tertiary Hospital in Kenya

Background: Neuroimaging is important for determining etiology and guiding care in early childhood epilepsy. However, access to appropriate imaging in sub-Saharan Africa is modest, and as a consequence, etiological descriptions of childhood epilepsy in the region have been limited. We sought to desc...

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Autores principales: Samia, Pauline, Odero, Nicholas, Njoroge, Maureen, Ochieng, Shem, Mavuti, Jacqueline, Waa, Sheila, Gwer, Samson
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7906981/
https://www.ncbi.nlm.nih.gov/pubmed/33643201
http://dx.doi.org/10.3389/fneur.2021.623960
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author Samia, Pauline
Odero, Nicholas
Njoroge, Maureen
Ochieng, Shem
Mavuti, Jacqueline
Waa, Sheila
Gwer, Samson
author_facet Samia, Pauline
Odero, Nicholas
Njoroge, Maureen
Ochieng, Shem
Mavuti, Jacqueline
Waa, Sheila
Gwer, Samson
author_sort Samia, Pauline
collection PubMed
description Background: Neuroimaging is important for determining etiology and guiding care in early childhood epilepsy. However, access to appropriate imaging in sub-Saharan Africa is modest, and as a consequence, etiological descriptions of childhood epilepsy in the region have been limited. We sought to describe MRI findings in children with epilepsy presenting to a tertiary hospital in Nairobi, Kenya, over a 6-year period of routine care. Materials and Methods: We undertook a retrospective review of MRI findings of children aged between 0 and 18 years with a diagnosis of epilepsy presenting to the pediatric neurology department of Aga Khan University Hospital in Nairobi, Kenya, between January 2014 and July 2020. Over this period, the hospital had 1.5T MRI machines (GE1.5T Signa Excite and GE 1.5T Signa Explorer) and a 3T MRI machine (Philips 3T Ingenia). MRI images were independently reviewed by two study radiologists, and the findings were summarized and categorized into a study database. Related clinical and electroencephalographic (EEG) details were extracted from patient records. Categorical data analysis methods were applied to investigate for relationships between clinically relevant neuroimaging findings and key clinical and EEG observations. Results: Over the study period, 288 children with a confirmed diagnosis of epilepsy had an MRI. They were of median age of 6 [interquartile range (IQR) 2–11] years. Ninety-five (33%) children had abnormal findings on imaging. The most common findings were encephalomalacia related to chronic infarcts (n = 18: 6.3%), cerebral atrophy (n = 11: 3.8%), disorders of neuronal migration (n = 11: 3.8%), periventricular leukomalacia (n = 9: 3.1%), and hippocampal sclerosis (n = 8: 2.8%). Findings related to infectious etiology were only observed in four children. Clinical comorbidity and inter-ictal epileptiform activity on EEG were independently associated with abnormal findings on imaging. Conclusion: Up to a third of the children who underwent an MRI had a positive yield for abnormal findings. Imaging findings related to infectious etiologies were little observed in our cohort, in contradistinction to etiology studies in similar settings. At the time of the study, comorbidity and inter-ictal epileptiform activity on EEG were associated with abnormal findings on imaging and should be considered in informing prioritization for imaging in childhood epilepsy in this setting.
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spelling pubmed-79069812021-02-27 Magnetic Resonance Imaging Findings in Childhood Epilepsy at a Tertiary Hospital in Kenya Samia, Pauline Odero, Nicholas Njoroge, Maureen Ochieng, Shem Mavuti, Jacqueline Waa, Sheila Gwer, Samson Front Neurol Neurology Background: Neuroimaging is important for determining etiology and guiding care in early childhood epilepsy. However, access to appropriate imaging in sub-Saharan Africa is modest, and as a consequence, etiological descriptions of childhood epilepsy in the region have been limited. We sought to describe MRI findings in children with epilepsy presenting to a tertiary hospital in Nairobi, Kenya, over a 6-year period of routine care. Materials and Methods: We undertook a retrospective review of MRI findings of children aged between 0 and 18 years with a diagnosis of epilepsy presenting to the pediatric neurology department of Aga Khan University Hospital in Nairobi, Kenya, between January 2014 and July 2020. Over this period, the hospital had 1.5T MRI machines (GE1.5T Signa Excite and GE 1.5T Signa Explorer) and a 3T MRI machine (Philips 3T Ingenia). MRI images were independently reviewed by two study radiologists, and the findings were summarized and categorized into a study database. Related clinical and electroencephalographic (EEG) details were extracted from patient records. Categorical data analysis methods were applied to investigate for relationships between clinically relevant neuroimaging findings and key clinical and EEG observations. Results: Over the study period, 288 children with a confirmed diagnosis of epilepsy had an MRI. They were of median age of 6 [interquartile range (IQR) 2–11] years. Ninety-five (33%) children had abnormal findings on imaging. The most common findings were encephalomalacia related to chronic infarcts (n = 18: 6.3%), cerebral atrophy (n = 11: 3.8%), disorders of neuronal migration (n = 11: 3.8%), periventricular leukomalacia (n = 9: 3.1%), and hippocampal sclerosis (n = 8: 2.8%). Findings related to infectious etiology were only observed in four children. Clinical comorbidity and inter-ictal epileptiform activity on EEG were independently associated with abnormal findings on imaging. Conclusion: Up to a third of the children who underwent an MRI had a positive yield for abnormal findings. Imaging findings related to infectious etiologies were little observed in our cohort, in contradistinction to etiology studies in similar settings. At the time of the study, comorbidity and inter-ictal epileptiform activity on EEG were associated with abnormal findings on imaging and should be considered in informing prioritization for imaging in childhood epilepsy in this setting. Frontiers Media S.A. 2021-02-12 /pmc/articles/PMC7906981/ /pubmed/33643201 http://dx.doi.org/10.3389/fneur.2021.623960 Text en Copyright © 2021 Samia, Odero, Njoroge, Ochieng, Mavuti, Waa and Gwer. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Samia, Pauline
Odero, Nicholas
Njoroge, Maureen
Ochieng, Shem
Mavuti, Jacqueline
Waa, Sheila
Gwer, Samson
Magnetic Resonance Imaging Findings in Childhood Epilepsy at a Tertiary Hospital in Kenya
title Magnetic Resonance Imaging Findings in Childhood Epilepsy at a Tertiary Hospital in Kenya
title_full Magnetic Resonance Imaging Findings in Childhood Epilepsy at a Tertiary Hospital in Kenya
title_fullStr Magnetic Resonance Imaging Findings in Childhood Epilepsy at a Tertiary Hospital in Kenya
title_full_unstemmed Magnetic Resonance Imaging Findings in Childhood Epilepsy at a Tertiary Hospital in Kenya
title_short Magnetic Resonance Imaging Findings in Childhood Epilepsy at a Tertiary Hospital in Kenya
title_sort magnetic resonance imaging findings in childhood epilepsy at a tertiary hospital in kenya
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7906981/
https://www.ncbi.nlm.nih.gov/pubmed/33643201
http://dx.doi.org/10.3389/fneur.2021.623960
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