Neuroimaging Profile of drug-resistant Epilepsy to throw light on its resistance

Drug-resistant epilepsy (DRE) is the most common and challenging neurological problem to identify with scope of surgery. There are very few studies in Indian population. A study in Journal of the associations of Physician of India (JAPI) aimed to look at the neuroimaging profile of drug-resistant epilepsy presenting in a tertiary care center in South India.

Patients diagnosed clinically as drug-resistant epilepsy as per International League Against Epilepsy (ILAE) criteria and who underwent magnetic resonance imaging (MRI) over a period of 24 months were included in the study. Their clinical and MRI features were documented and analyzed.

A total of 150 patients diagnosed with drug-resistant epilepsy were included in the study. Clinically, 96 of them presented with generalized tonic-clonic seizures (GTCS), 36 with complex partial seizures (CPS), 14 with simple focal seizures, and two each with atonic seizures and focal seizures with secondary generalization. The results showed that Magnetic resonance imaging was normal in 32%. While In those with abnormal MRI, mesial temporal sclerosis (MTS) was the commonest pathology seen in 41.3%, followed by cortical malformations (6.7%), tumors (2.6%), vascular malformations (2.7%), and other nonspecific lesions (12%).

The researchers therefore concluded that clinical and neuroimaging profile of Drug-resistant epilepsy is more common in younger age (of less than 30 years) usually presented mainly with generalized tonic-clonic seizures or complex partial seizures; mesial temporal sclerosis is the commonest underlying pathology which was bilateral in 8.6%; temporal lobe lesions predominate; and cortical malformation, low-grade tumors, and vascular lesions are other important causes. Hence, a detailed examination is what needs to be done.

Reference: Navab M, Nagarajan K, Nair PP, et al. Neuroimaging Profile of drug-resistant Epilepsy from a Tertiary Care Center in South India. J Assoc Physicians India 2022;70(7):67–71.