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:	Veronica Bruno, Joshua P. Klein, Dechen Nidup, Damber K. Nirola, Lhab Tshering, Sonam Deki, Sarah J. Clark, Kristin A. Linn, Russell T. Shinohara, Chencho Dorji, Dili Ram Pokhrel, Ugyen Dema, Farrah J. Mateen, for the Bhutan Epilepsy Project
Formato:	article
Lenguaje:	EN
Publicado:	Ubiquity Press 2017
Materias:	diagnosis drug resistant epilepsy epilepsy MRI Asia Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/7925b5111b3a450cb23c0685780a1b07
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id	oai:doaj.org-article:7925b5111b3a450cb23c0685780a1b07
record_format	dspace
institution	DOAJ
collection	DOAJ
language	EN
topic	diagnosis drug resistant epilepsy epilepsy MRI Asia Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
spellingShingle	diagnosis drug resistant epilepsy epilepsy MRI Asia Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270 Veronica Bruno Joshua P. Klein Dechen Nidup Damber K. Nirola Lhab Tshering Sonam Deki Sarah J. Clark Kristin A. Linn Russell T. Shinohara Chencho Dorji Dili Ram Pokhrel Ugyen Dema Farrah J. Mateen for the Bhutan Epilepsy Project Yield of Brain MRI in Clinically Diagnosed Epilepsy in the Kingdom of Bhutan: A Prospective Study
description	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.
format	article
author	Veronica Bruno Joshua P. Klein Dechen Nidup Damber K. Nirola Lhab Tshering Sonam Deki Sarah J. Clark Kristin A. Linn Russell T. Shinohara Chencho Dorji Dili Ram Pokhrel Ugyen Dema Farrah J. Mateen for the Bhutan Epilepsy Project
author_facet	Veronica Bruno Joshua P. Klein Dechen Nidup Damber K. Nirola Lhab Tshering Sonam Deki Sarah J. Clark Kristin A. Linn Russell T. Shinohara Chencho Dorji Dili Ram Pokhrel Ugyen Dema Farrah J. Mateen for the Bhutan Epilepsy Project
author_sort	Veronica Bruno
title	Yield of Brain MRI in Clinically Diagnosed Epilepsy in the Kingdom of Bhutan: A Prospective Study
title_short	Yield of Brain MRI in Clinically Diagnosed Epilepsy in the Kingdom of Bhutan: A Prospective Study
title_full	Yield of Brain MRI in Clinically Diagnosed Epilepsy in the Kingdom of Bhutan: A Prospective Study
title_fullStr	Yield of Brain MRI in Clinically Diagnosed Epilepsy in the Kingdom of Bhutan: A Prospective Study
title_full_unstemmed	Yield of Brain MRI in Clinically Diagnosed Epilepsy in the Kingdom of Bhutan: A Prospective Study
title_sort	yield of brain mri in clinically diagnosed epilepsy in the kingdom of bhutan: a prospective study
publisher	Ubiquity Press
publishDate	2017
url	https://doaj.org/article/7925b5111b3a450cb23c0685780a1b07
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spelling	oai:doaj.org-article:7925b5111b3a450cb23c0685780a1b072021-12-02T04:24:27ZYield of Brain MRI in Clinically Diagnosed Epilepsy in the Kingdom of Bhutan: A Prospective Study2214-999610.1016/j.aogh.2017.02.001https://doaj.org/article/7925b5111b3a450cb23c0685780a1b072017-04-01T00:00:00Zhttps://annalsofglobalhealth.org/articles/154https://doaj.org/toc/2214-9996Background: 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.Veronica BrunoJoshua P. KleinDechen NidupDamber K. NirolaLhab TsheringSonam DekiSarah J. ClarkKristin A. LinnRussell T. ShinoharaChencho DorjiDili Ram PokhrelUgyen DemaFarrah J. Mateenfor the Bhutan Epilepsy ProjectUbiquity Pressarticlediagnosisdrug resistant epilepsyepilepsyMRIAsiaInfectious and parasitic diseasesRC109-216Public aspects of medicineRA1-1270ENAnnals of Global Health, Vol 83, Iss 3-4, Pp 415-422 (2017)

Yield of Brain MRI in Clinically Diagnosed Epilepsy in the Kingdom of Bhutan: A Prospective Study

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