Quantitative cerebral MRI in epileptic patients

Objectives - To determine cerebral atrophy parameters on MRI images of epileptic patients. Material and methods - Examination of the brain was performed in a 0.5 Tesla magnet in 32 women with epilepsy and 36 female healthy controls. Fifteen patients were classified to have generalised epilepsy and 17 had partial seizure onset. Epileptic patients with structural brain changes were excluded. At midsagittal level the area of corpus callosum, cerebrum and cerebellum were selected as atrophy parameters. At transverse level the ventricle-brain ratio (VBR) as a measure of overall cerebral atrophy, bifrontal ratio (BFR) reflecting atrophy in the area of the frontal horns, bicaudate ratio (BCR) and bioccipital ratio (BOR) were calculated to evaluate atrophy in the region of nucleus caudatus as well as in the occipital area. Results - The mean values of VBR were significantly larger in the two epileptic groups than in controls, p = 0.0003. No significant difference in mean VBR were found between focal and generalised seizure onset epilepsy. Also significant decreased cerebellar area on midsagittal section was detected in epileptic patients with partial onset epilepsy compared with controls, p = 0.037. Atrophy was not associated with type and duration of epilepsy, but VBR and age were positively associated in patients with generalised onset seizures. Conclusion - These findings suggest general brain atrophy to be present in epileptic patients including those with partial epilepsy. Whether atrophy in epileptic patients occurs as a consequence of disease-related factors like hypoxia or treatment with antiepileptic drugs has to be investigated in a prospectively designed study.