Original Research
Yield of Brain MRI in Clinically Diagnosed Epilepsy in the Kingdom of Bhutan: A Prospective Study
Authors:
Veronica Bruno ,
Department of Neurology, Massachusetts General Hospital, Boston, MA
About Veronica
MD, MPH
Joshua P. Klein,
Harvard Medical School, Boston, MA; Department of Neurology, Brigham & Women’s Hospital, Boston, MA; Department of Radiology, Brigham & Women’s Hospital, Boston, MA
About Joshua P.
MD, PhD
Dechen Nidup,
Department of Radiology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan, BT
About Dechen
MD
Damber K. Nirola,
Department of Radiology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan, BT
About Damber K.
MD
Lhab Tshering,
Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan, BT
About Lhab
BA
Sonam Deki,
Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan, BT
About Sonam
BComm
Sarah J. Clark,
Department of Neurology, Massachusetts General Hospital, Boston, MA
About Sarah J.
BSc
Kristin A. Linn,
University of Pennsylvania, Philadelphia, PA
About Kristin A.
PhD
Russell T. Shinohara,
University of Pennsylvania, Philadelphia, PA
About Russell T.
PhD
Chencho Dorji,
Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan, BT
About Chencho
MD
Dili Ram Pokhrel,
Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
Ugyen Dema,
Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan, BT
About Ugyen
MD
Farrah J. Mateen,
Department of Neurology, Massachusetts General Hospital, Boston, MA
About Farrah J.
MD, PhD
for the Bhutan Epilepsy Project
Abstract
Background
People with epilepsy (PWE) in low- and middle-income countries may not access the health resources that are considered optimal for epilepsy diagnosis. The diagnostic yield of magnetic resonance imaging (MRI) has not been well studied in these settings.
Objectives
To report the diagnostic yield of brain MRI and identify clinical associations of abnormal MRI findings among PWE in a neurocysticercosis-endemic, resource-limited setting and to identify the proportion and putative structural brain causes of drug-resistant epilepsy.
Methods
PWE were prospectively enrolled at the Jigme Dorji Wangchuck National Referral Hospital in Bhutan (2014-2015). Each participant completed clinical questionnaires and a 1.5-Tesla brain MRI. Each MRI was reviewed by at least 1 radiologist and neurologist in Bhutan and the United States. A working definition of drug-resistant epilepsy for resource-limited settings was given as (a) seizures for >1 year, (b) at least 1 seizure in the prior year, and (c) presently taking 2 or more antiepileptic drugs (AEDs). Logistic regression models were constructed to test the cross-sectional association of an abnormal brain MRI with clinical variables.
Findings
A total of 217 participants (125 [57%] female; 54 [25%] < 18 years old; 199 [92%] taking AEDs; 154 [71%] with a seizure in the prior year) were enrolled. There was a high prevalence of abnormal brain MRIs (176/217, 81%). Mesial temporal sclerosis was the most common finding (n = 115, 53%, including 24 children), exceeding the number of PWE with neurocysticercosis (n = 26, 12%, including 1 child) and congenital/perinatal abnormalities (n = 29, 14%, including 14 children). The number of AEDs (odds ratio = .59, P = .03) and duration of epilepsy (odds ratio = 1.11, P = .02) were significantly associated with an abnormal MRI. Seizure in the prior month was associated with the presence of mesial temporal sclerosis (odds ratio = .47, P = .01). A total of 25 (12%) participants met our definition of drug-resistant epilepsy, with mesial temporal sclerosis (n = 10), congenital malformations (n = 5), and neurocysticercosis (n = 4) being the more common findings.
Conclusions
The prevalence of abnormalities on brain MRI for PWE in resource-limited settings is high as a result of a diffuse range of etiologies, most commonly mesial temporal sclerosis. Drug-resistant epilepsy accounted for 12% of the referral population in a conservative estimation.
How to Cite:
Bruno, V., Klein, J.P., Nidup, D., Nirola, D.K., Tshering, L., Deki, S., Clark, S.J., Linn, K.A., Shinohara, R.T., Dorji, C., Pokhrel, D.R., Dema, U., Mateen, F.J. and Bhutan Epilepsy Project, . for . the ., 2017. Yield of Brain MRI in Clinically Diagnosed Epilepsy in the Kingdom of Bhutan: A Prospective Study. Annals of Global Health, 83(3-4), pp.415–422. DOI: http://doi.org/10.1016/j.aogh.2017.02.001
Published on
07 Apr 2017.
Peer Reviewed
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