Current Role of MRI in Detecting Epileptogenic lesion of Refractory Epilepsy with Positive EEG in Paediatric Period

Mousa, Walid; Amin, Ahmed; Said, Nahla; El-Toukhy, Huda; Soltan, Belal

doi:10.21608/ejhm.2025.420596.1838

Current Role of MRI in Detecting Epileptogenic lesion of Refractory Epilepsy with Positive EEG in Paediatric Period

Document Type : Original Article

Authors

¹ Assistant Professor of radiodiagnosis, interventional radiology and medical imaging Faculty of medicine -Menoufia University

² Professor of radiodiagnosis, interventional radiology and medical imaging Faculty of medicine -Menoufia University

³ Egyptian ministry of health, Resident physician at Tala Central Hospital

⁴ Lecturer of radiodiagnosis, interventional radiology and medical imaging Faculty of medicine –Menoufia University

10.21608/ejhm.2025.420596.1838

Abstract

Background: Epilepsy affects about 1% of children, with 10–30% developing refractory epilepsy unresponsive to antiepileptic drugs (AEDs). Accurate localization of epileptogenic lesions is critical for management, and magnetic resonance imaging (MRI) is the gold standard due to superior resolution and absence of radiation.

Aim: This study aimed to evaluate the role of MRI in detecting epileptogenic foci in pediatric patients with refractory epilepsy and positive electroencephalography (EEG).

Methods: This cross-sectional observational study was conducted from July 2023 to May 2025 at Menoufia University Hospitals and affiliated centers. Sixty children aged 3–17 years with clinically and EEG-confirmed refractory epilepsy underwent standardized brain MRI. Imaging findings were correlated with demographic data, seizure type, EEG results, and AED use.

Results: MRI abnormalities were detected in 48/60 patients (80%). Common findings included encephalomalacia/gliosis (23.3%), demyelination (20.0%), cortical dysplasia (10.0%), and brain atrophy (10.0%). Lesions predominantly involved the white matter and frontal–parietal regions. A strong correlation was observed between EEG positivity and MRI abnormalities (p=0.000) with all EEG-positive patients showing structural lesions. Additionally, all patients receiving three or more AEDs had MRI-detectable abnormalities compared to 45.5% of those on two drugs (p=0.005).

Conclusion: MRI demonstrated high diagnostic yield in pediatric refractory epilepsy, showing strong agreement with EEG and AED resistance. It played a vital role in identifying epileptogenic lesions, supporting individualized treatment strategies, and guiding surgical decision-making.

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