Yield of Brain MRI in Clinically Diagnosed Epilepsy in the Kingdom of Bhutan: A Prospective Study
Background: People with <a title="Learn more about Epilepsy" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/epilepsy">epilepsy</a> (PWE) in low- and middle-income countries may not access the health resources that are considered optimal for epilepsy...
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| Autores principales: | , , , , , , , , , , , , , |
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| Formato: | article |
| Lenguaje: | EN |
| Publicado: |
Ubiquity Press
2017
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| Acceso en línea: | https://doaj.org/article/7925b5111b3a450cb23c0685780a1b07 |
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| Sumario: | Background: People with <a title="Learn more about Epilepsy" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/epilepsy">epilepsy</a> (PWE) in low- and middle-income countries may not access the health resources that are considered optimal for epilepsy diagnosis. The diagnostic yield of <a title="Learn more about Magnetic resonance imaging" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/magnetic-resonance-imaging">magnetic resonance imaging</a> (MRI) has not been well studied in these settings. Objectives: To report the diagnostic yield of <a title="Learn more about Magnetic resonance imaging of the brain" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/magnetic-resonance-imaging-of-the-brain">brain MRI</a> and identify clinical associations of abnormal <a title="Learn more about Magnetic resonance imaging" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/magnetic-resonance-imaging">MRI</a> findings among PWE in a neurocysticercosis-endemic, resource-limited setting and to identify the proportion and putative structural brain causes of drug-resistant epilepsy. Methods: PWE were prospectively enrolled at the Jigme Dorji Wangchuck National Referral Hospital in Bhutan (2014-2015). Each participant completed clinical questionnaires and a 1.5-Tesla brain MRI. Each MRI was reviewed by at least 1 radiologist and neurologist in Bhutan and the United States. A working definition of drug-resistant epilepsy for resource-limited settings was given as (a) <a title="Learn more about Epileptic seizure" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/epileptic-seizure">seizures</a> for >1 year, (b) at least 1 seizure in the prior year, and (c) presently taking 2 or more <a title="Learn more about Anticonvulsant" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/anticonvulsant">antiepileptic drugs</a> (AEDs). Logistic regression models were constructed to test the cross-sectional association of an abnormal brain MRI with clinical variables. Findings: A total of 217 participants (125 [57%] female; 54 [25%] < 18 years old; 199 [92%] taking AEDs; 154 [71%] with a seizure in the prior year) were enrolled. There was a high prevalence of abnormal brain MRIs (176/217, 81%). Mesial temporal sclerosis was the most common finding (n = 115, 53%, including 24 children), exceeding the number of PWE with <a title="Learn more about Neurocysticercosis" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/neurocysticercosis">neurocysticercosis</a> (n = 26, 12%, including 1 child) and congenital/perinatal abnormalities (n = 29, 14%, including 14 children). The number of AEDs (odds ratio = .59, 'P' = .03) and duration of epilepsy (odds ratio = 1.11, 'P' = .02) were significantly associated with an abnormal MRI. Seizure in the prior month was associated with the presence of mesial temporal sclerosis (odds ratio = .47, 'P' = .01). A total of 25 (12%) participants met our definition of drug-resistant epilepsy, with mesial temporal sclerosis (n = 10), congenital malformations (n = 5), and neurocysticercosis (n = 4) being the more common findings. Conclusions: The prevalence of abnormalities on brain MRI for PWE in resource-limited settings is high as a result of a diffuse range of <a title="Learn more about Etiology (medicine)" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/etiology-medicine">etiologies</a>, most commonly mesial temporal sclerosis. Drug-resistant epilepsy accounted for 12% of the referral population in a conservative estimation. |
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