Brain magnetic resonance imaging findings in children with seizures at Moi Teaching and Referral Hospital, Eldoret, Kenya.

Abstract

Background: Seizures are sudden uncontrolled electrical disturbances in the brain that cause changes in behavior, movement, or levels of consciousness. They are the most common pediatric neurological disorder. The high prevalence of seizure disorders in Sub-Saharan Africa is attributed to preventable risk factors including poor perinatal care and endemic infections. Diagnosis of seizures is highly dependent on clinical evaluation and electrical physiology. However, the two have limitations in identification of structural brain disorders that might underlie seizures. Radiological investigations play a key role in identification of such lesions but their use is limited by several factors including concern for radiation and cost. Early imaging investigation will increase diagnostic certainty and prevent brain damage, especially from lesions that would benefit from treatment. The aim of this study was to determine whether there were structural brain abnormalities in children with seizures sent for brain magnetic resonance imaging (MRI) at Moi Teaching and Referral Hospital (MTRH). Objective: To describe the age distribution and clinical features of children with seizures imaged at MTRH. To determine the proportion of children with seizures with abnormal brain MRI findings at MTRH. To describe the observed brain MRI abnormalities in children with seizures at MTRH. Methods: A descriptive cross-sectional study was conducted for a period of one year. It was conducted on 77 patients aged below 18 years, with seizures, and sent for brain MRI. Demographic data and clinical features were obtained using a questionnaire. The patients then underwent brain MRI on a 0.36 Tesla scanner. Information on demographic data, clinical features and brain MRI findings was then analyzed. Mean and median were used to summarize continuous data. Categorical variables were summarized using frequencies, percentages, charts and tables. Association between variables was determined using Chi-square test and a P value of <0.05 was considered statistically significant. Multivariate logistic regression with odds ratio was used to determine factors that predict brain MRI findings. Results: Age range was 1 month to 17 years. Patients aged five years and below accounted for 51.9% of cases. Females were 59.7%. Generalized onset seizures were noted in 69.6% of study participants. Fever was present in 31.2% of cases. There were underlying conditions in 53.2% of cases with birth asphyxia being the most common underlying condition at 18.2%. Most patients (71.4%) had normal brain MRI findings. Global brain atrophy was the most common pathology among children with abnormal brain MRI findings, accounting for 45.5% of cases. Other pathologies included tumors and cystic encephalomalacia. Bivariate analysis showed a statistically significant association between age, underlying condition, seizure type and brain MRI findings with P values of 0.043, 0.001 and 0.014 respectively. Multivariate logistic regression showed that underlying condition was a strong predictor of MRI findings with an adjusted odds ratio of 3.21 and a confidence interval of (1.77, 6.88) meaning that the presence of underlying condition was 3 times more likely to affect MRI findings. Conclusions: Majority of the children studied were aged 5 years and below. The most common seizure type was generalized onset. Abnormal findings were more likely to be found among children aged five years and below, with focal onset seizures, with underlying clinical conditions, and without associated fever. Global brain atrophy was the most common pathology in children with abnormal brain MRI findings. Recommendations: Brain MRI is recommended for children with seizures who are under five years, with focal onset seizures, without associated fever and with underlying conditions as they are likely to have structural brain abnormalities.