The structural consequences of newly diagnosed seizures

Authors

  • Rebecca S. N. Liu BSc, MRCP,

    1. Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London
    2. National Society for Epilepsy, Buckinghamshire, United Kingdom
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  • Louis Lemieux PhD,

    1. Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London
    2. National Society for Epilepsy, Buckinghamshire, United Kingdom
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  • Gail S. Bell MRCGP,

    1. National Society for Epilepsy, Buckinghamshire, United Kingdom
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  • Sanjay M. Sisodiya PhD, MRCP,

    1. Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London
    2. National Society for Epilepsy, Buckinghamshire, United Kingdom
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  • Philippa A. Bartlett DCR,

    1. Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London
    2. National Society for Epilepsy, Buckinghamshire, United Kingdom
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  • Simon D. Shorvon MD, FRCP,

    1. Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London
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  • Josemir W. A. S. Sander PhD, MRCP,

    1. Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London
    2. National Society for Epilepsy, Buckinghamshire, United Kingdom
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  • John S. Duncan DM, FRCP

    Corresponding author
    1. Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London
    2. National Society for Epilepsy, Buckinghamshire, United Kingdom
    • National Society for Epilepsy, Chalfont St. Peter, Gerrards Cross Bucks, Buckinghamshire SL9 0RJ, United Kingdom
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Abstract

Intractable epilepsy may be associated with widespread structural cerebral damage. We determined whether structural damage occurs to the hippocampus, cerebellum and neocortex in the first few years following a diagnosis of seizures. Sixty-eight patients over the age of 14 years with newly diagnosed seizures and 90 matched controls underwent serial magnetic resonance imaging (MRI) brain scans 3.5 years apart. Using quantitative analysis of serial scans, we determined changes in hippocampal volume, hippocampal T2 relaxometry and total and regional brain volumes. Thirty-four (50%) patients had recurrent unprovoked seizures between baseline and follow-up scans. One patient with pre-existing hippocampal sclerosis (HS) did not develop progressive hippocampal damage. Group analyses found no difference in change in cerebral measures between patients and controls or between patients with and without recurrent seizures. Significant quantitative changes in individuals were largely attributable to pre-existing cerebral lesions or alcohol abuse. Subtle changes detected in individuals over 3.5 years but were not related to a history of overt seizures. Our results show patients with newly diagnosed seizures are not generally at increased risk of seizure-induced structural cerebral damage as detected with MRI. Cerebral damage may occur before the onset of seizures or develop insidiously over a more prolonged period.

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