Relationship between MRI patterns and refractory epilepsy in children with cerebral palsy: Cross-sectional study from a tertiary center

Objectives: Approximately one third of children with cerebral palsy (CP) have epilepsy. Our aim was to investigate the relationship between the MRI patterns according to MRI classification system (MRICS) which described by Surveillance of Cerebral Palsy in Europe (SCPE) and refractory epilepsy in children with CP.

Methods:

We retrospectively reviewed data on children with CP refer to our clinic in 2012-2015. Refractory epilepsy was defined as failure of seizure control despite at least two appropriate antiepileptic drugs at maximum tolerated doses. MRI patterns were grouped as maldevelopments, predominant white matter injury, predominant gray matter injury, miscellaneous and normal according to MRICS of the SCPE.

Results:

There were 325 children with CP. Fourteen children were excluded because of had brain injury after neonatal period. Of the 311 children, 20 (6.4%) had maldevelopments, 148 (47,6 %) had predominant white matter injury and 74 (23.8%) had predominant gray matter injury. There were 46 (14.8%) patients in miscellaneous group. Brain MRI of 23(7.4%) patients were normal. 30 % of patients with maldevelopment, 12.2 % of patients with predominant white matter injury, 28.4 % of patients with predominant gray matter injury and 45.7 % of the patients in miscellaneous group had refractory epilepsy. None of the patients had refractory epilepsy who had normal brain MRI. The frequency of refractory epilepsy was significantly lower in predominant white matter injury and normal groups compared to the other groups.

Conclusion:

The results from this study may provide information with regard to prognosis of epilepsy in children with CP.
Keywords: cerebral palsy, refractory epilepsy, neuroimaging