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Improving the detection of focal brain abnormality in children with intractable focal epilepsy

Riney, C.J.; (2008) Improving the detection of focal brain abnormality in children with intractable focal epilepsy. Doctoral thesis, UCL (University College London).

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Abstract

Children with intractable focal epilepsy pose a difficult management problem. For those who have a visible structural brain lesion on magnetic resonance imaging (MRI), epilepsy surgery may be a possible treatment option. Hippocampal sclerosis, one of the commonest structural pathologies that can underlie intractable temporal lobe epilepsy, is one such structural lesion that is usually clearly defined on MRI and outcome following surgical resection is good. However, in those with no visible MRI abnormality, the option of surgery becomes much more difficult to consider. Subtle areas of developmental pathology such as focal cortical dysplasia (FCD) or areas of gliosis can exist in these patients that are difficult to detect with current high resolution MRI. In the first part of this thesis, the results of a study of voxel based morphometric (VBM) analysis of structural imaging (in particular fluid-attenuated inversion-recovery (FLAIR) imaging) of children with intractable focal epilepsy are presented. VBM of FLAIR imaging allowed detection of known visible FCD and in addition detected abnormality in a proportion of children with intractable focal seizures who had normal MRI. In the second part of this thesis, the role of both visual and VBM assessment of diffusion tensor imaging is explored. Diffusion tensor imaging is not demonstrated to have a useful role in presurgical evaluation of children with intractable focal epilepsy. In the final part of this thesis, the development of hippocampal sclerosis as a dual pathology in the context of extrahippocampal lesional epilepsy is explored. In this patient group, it is most likely that hippocampal sclerosis is acquired as a result of extra-hippocampal seizures and that children who are young at the time of their first seizure have a lower chance of acquiring hippocampal sclerosis.

Type:Thesis (Doctoral)
Title:Improving the detection of focal brain abnormality in children with intractable focal epilepsy
Language:English
Additional information:Authorisation for digitisation not received
UCL classification:UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Child Health > Department of Neurosciences and Mental Health > ICH - Neurosciences Unit

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