TITLE:
Predictive Factors for Abnormal Brain CT-Scan in Childhood Epilepsy at Yaoundé (Cameroon)
AUTHORS:
Boniface Moifo, Séraphin Nguefack, Jean Roger Moulion Tapouh, Evelyn Mah, Elie Mbonda, Joseph Gonsu Fotsin
KEYWORDS:
Epilepsy; Childhood; Electroencephalogram; CT-Scan; Predicting Factor; Microcephaly; Cameroon
JOURNAL NAME:
Open Journal of Medical Imaging,
Vol.4 No.1,
March
7,
2014
ABSTRACT: Purpose: Despite irradiation, CT-scan remains an
important diagnostic tool in epilepsy in poor countries where MRI is neither
available nor affordable. But many causes of epilepsy
are not accessible to CT-scan and this technique remains expensive for many poor
families in countries with limited resources. The aim of this study was to determine
clinical or electroencephalogram variables which could predict brain CT-scan abnormalities
in childhood epilepsy. Methods: It was a cross-sectional study including 151 epileptic
children who underwent head CT-scan from October 2011 to march 2012, in one university-affiliated
hospital in Cameroon (YGOPH). The data collected were clinical, type of seizure, Electroencephalogram and head
CT-scans results. Independent predictive factors for CT abnormalities were sought
by logistic regression. A p value : Of the 151 children, 54.3% (82/151)
were boys (sex ratio: 1.18 M/1F). The median age was 54 months [2 - 190 months]; 74.8% of children were more than 2 years old but at the onset of epilepsy they were 2 years old or less. Birth asphyxia, mental retardation and
neurologic deficit were respectively associated in 62.4%, 54.3% and 51.7% of cases.
Eighty-five had focal epilepsy (56.3%), 61.6% had abnormal head CT-scan, 68.9% had
abnormal EEG, with no significant gender difference. The factors most significantly
associated with abnormal head CT-scan were: child age ≤ 2 years, maternal hypertension/eclampsy, cerebral palsy, and child microcephaly,
with 89% to 92% abnormal CT. The two independent predictors of abnormal
CT were patients’ age ≤ 2 years and microcephaly. The two main CT-scan lesions were
cerebral atrophy (28.5%) and brain infarct (16.6%). None of these abnormalities
was correlated to any type of epilepsy. Conclusion: Almost two-thirds of head CT-scan performed in
epileptic children are abnormal in our setting. Patients of 2 years old or less and those with microcephaly are very
likely to have brain anomalies on CT-scan. The most common brain lesions are atrophy,
cerebral infarction and porencephalic cavities. Action to reduce birth asphyxia
may lead to the reduction of the incidence of epilepsy in children.