Neuroimaging of early life epilepsy

Jason Coryell, William D. Gaillard, Renée A. Shellhaas, Zachary M. Grinspan, Elaine C Wirrell, Kelly G. Knupp, Courtney J. Wusthoff, Cynthia Keator, Joseph E. Sullivan, Tobias Loddenkemper, Anup Patel, Catherine J. Chu, Shavonne Massey, Edward J. Novotny, Russel P. Saneto, Anne T. Berg

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

OBJECTIVES: We assessed the adherence to neuroimagingguidelines and the diagnostically relevant yield of neuroimaging in newly presenting early life epilepsy (ELE). METHODS: There were 775 children with a new diagnosis of epilepsy (<3 years old at onset) who were recruited through the ELE study at 17 US pediatric epilepsy centers (2012-2015) and managed prospectively for 1 year. The data were analyzed to assess the proportion of children who underwent neuroimaging, the type of neuroimaging, and abnormalities. RESULTS: Of 725 children (93.5%) with neuroimaging, 714 had an MRI (87% with seizure protocols) and 11 had computed tomography or ultrasound only. Etiologically relevant abnormalities were present in 290 individuals (40%) and included: An acquired injury in 97 (13.4%), malformations of cortical development in 56 (7.7%), and other diffuse disorders of brain development in 51 (7.0%). Neuroimaging was abnormal in 160 of 262 (61%) children with abnormal development at diagnosis versus 113 of 463 (24%) children with typical development. Neuroimaging abnormalities were most common in association with focal seizure semiology (40%), spasms (47%), or unclear semiology (42%). In children withoutspasms or focal semiology with typical development, 29 of 185 (16%) had imaging abnormalities. Pathogenic genetic variants were identified in 53 of 121 (44%) children with abnormal neuroimaging in whom genetic testing was performed. CONCLUSIONS: Structural abnormalities occur commonly in ELE, and adherence to neuroimaging guidelines is high at US pediatric epilepsy centers. These data support the universal adoption of imaging guidelines because the yield is substantially high, even in the lowest risk group.

Original languageEnglish (US)
Article numbere20180672
JournalPediatrics
Volume142
Issue number3
DOIs
StatePublished - Sep 1 2018

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Neuroimaging
Epilepsy
Seizures
Guidelines
Pediatrics
Malformations of Cortical Development
Spasm
Genetic Testing
Brain Diseases
Tomography
Wounds and Injuries

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Coryell, J., Gaillard, W. D., Shellhaas, R. A., Grinspan, Z. M., Wirrell, E. C., Knupp, K. G., ... Berg, A. T. (2018). Neuroimaging of early life epilepsy. Pediatrics, 142(3), [e20180672]. https://doi.org/10.1542/peds.2018-0672

Neuroimaging of early life epilepsy. / Coryell, Jason; Gaillard, William D.; Shellhaas, Renée A.; Grinspan, Zachary M.; Wirrell, Elaine C; Knupp, Kelly G.; Wusthoff, Courtney J.; Keator, Cynthia; Sullivan, Joseph E.; Loddenkemper, Tobias; Patel, Anup; Chu, Catherine J.; Massey, Shavonne; Novotny, Edward J.; Saneto, Russel P.; Berg, Anne T.

In: Pediatrics, Vol. 142, No. 3, e20180672, 01.09.2018.

Research output: Contribution to journalArticle

Coryell, J, Gaillard, WD, Shellhaas, RA, Grinspan, ZM, Wirrell, EC, Knupp, KG, Wusthoff, CJ, Keator, C, Sullivan, JE, Loddenkemper, T, Patel, A, Chu, CJ, Massey, S, Novotny, EJ, Saneto, RP & Berg, AT 2018, 'Neuroimaging of early life epilepsy', Pediatrics, vol. 142, no. 3, e20180672. https://doi.org/10.1542/peds.2018-0672
Coryell J, Gaillard WD, Shellhaas RA, Grinspan ZM, Wirrell EC, Knupp KG et al. Neuroimaging of early life epilepsy. Pediatrics. 2018 Sep 1;142(3). e20180672. https://doi.org/10.1542/peds.2018-0672
Coryell, Jason ; Gaillard, William D. ; Shellhaas, Renée A. ; Grinspan, Zachary M. ; Wirrell, Elaine C ; Knupp, Kelly G. ; Wusthoff, Courtney J. ; Keator, Cynthia ; Sullivan, Joseph E. ; Loddenkemper, Tobias ; Patel, Anup ; Chu, Catherine J. ; Massey, Shavonne ; Novotny, Edward J. ; Saneto, Russel P. ; Berg, Anne T. / Neuroimaging of early life epilepsy. In: Pediatrics. 2018 ; Vol. 142, No. 3.
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abstract = "OBJECTIVES: We assessed the adherence to neuroimagingguidelines and the diagnostically relevant yield of neuroimaging in newly presenting early life epilepsy (ELE). METHODS: There were 775 children with a new diagnosis of epilepsy (<3 years old at onset) who were recruited through the ELE study at 17 US pediatric epilepsy centers (2012-2015) and managed prospectively for 1 year. The data were analyzed to assess the proportion of children who underwent neuroimaging, the type of neuroimaging, and abnormalities. RESULTS: Of 725 children (93.5{\%}) with neuroimaging, 714 had an MRI (87{\%} with seizure protocols) and 11 had computed tomography or ultrasound only. Etiologically relevant abnormalities were present in 290 individuals (40{\%}) and included: An acquired injury in 97 (13.4{\%}), malformations of cortical development in 56 (7.7{\%}), and other diffuse disorders of brain development in 51 (7.0{\%}). Neuroimaging was abnormal in 160 of 262 (61{\%}) children with abnormal development at diagnosis versus 113 of 463 (24{\%}) children with typical development. Neuroimaging abnormalities were most common in association with focal seizure semiology (40{\%}), spasms (47{\%}), or unclear semiology (42{\%}). In children withoutspasms or focal semiology with typical development, 29 of 185 (16{\%}) had imaging abnormalities. Pathogenic genetic variants were identified in 53 of 121 (44{\%}) children with abnormal neuroimaging in whom genetic testing was performed. CONCLUSIONS: Structural abnormalities occur commonly in ELE, and adherence to neuroimaging guidelines is high at US pediatric epilepsy centers. These data support the universal adoption of imaging guidelines because the yield is substantially high, even in the lowest risk group.",
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AU - Gaillard, William D.

AU - Shellhaas, Renée A.

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AU - Knupp, Kelly G.

AU - Wusthoff, Courtney J.

AU - Keator, Cynthia

AU - Sullivan, Joseph E.

AU - Loddenkemper, Tobias

AU - Patel, Anup

AU - Chu, Catherine J.

AU - Massey, Shavonne

AU - Novotny, Edward J.

AU - Saneto, Russel P.

AU - Berg, Anne T.

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N2 - OBJECTIVES: We assessed the adherence to neuroimagingguidelines and the diagnostically relevant yield of neuroimaging in newly presenting early life epilepsy (ELE). METHODS: There were 775 children with a new diagnosis of epilepsy (<3 years old at onset) who were recruited through the ELE study at 17 US pediatric epilepsy centers (2012-2015) and managed prospectively for 1 year. The data were analyzed to assess the proportion of children who underwent neuroimaging, the type of neuroimaging, and abnormalities. RESULTS: Of 725 children (93.5%) with neuroimaging, 714 had an MRI (87% with seizure protocols) and 11 had computed tomography or ultrasound only. Etiologically relevant abnormalities were present in 290 individuals (40%) and included: An acquired injury in 97 (13.4%), malformations of cortical development in 56 (7.7%), and other diffuse disorders of brain development in 51 (7.0%). Neuroimaging was abnormal in 160 of 262 (61%) children with abnormal development at diagnosis versus 113 of 463 (24%) children with typical development. Neuroimaging abnormalities were most common in association with focal seizure semiology (40%), spasms (47%), or unclear semiology (42%). In children withoutspasms or focal semiology with typical development, 29 of 185 (16%) had imaging abnormalities. Pathogenic genetic variants were identified in 53 of 121 (44%) children with abnormal neuroimaging in whom genetic testing was performed. CONCLUSIONS: Structural abnormalities occur commonly in ELE, and adherence to neuroimaging guidelines is high at US pediatric epilepsy centers. These data support the universal adoption of imaging guidelines because the yield is substantially high, even in the lowest risk group.

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