Skip to main content
NCBI home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2001 Nov;71(5):638–642. doi: 10.1136/jnnp.71.5.638

A magnetic resonance study of complicated early childhood convulsion

R Grunewald 1, T Farrow 1, P Vaughan 1, C Rittey 1, J Mundy 1
PMCID: PMC1737589  PMID: 11606676

Abstract

OBJECTIVES—The relation between complicated early childhood convulsion (ECC) and adult epilepsy is unclear, although a history of complicated ECC is obtainable in half of adults with epilepsy associated with hippocampal sclerosis. It is not known if the ECC is a marker of pre-existing brain damage or is itself harmful to the developing brain. The objective of the study was to assess the extent of structural brain abnormality present soon after a first complicated early childhood convulsion with a view to obtaining data which might contribute to an understanding of whether such abnormalities were likely to be pre-existing or caused by the convulsion.
METHODS—Children under the age of 5 years were recruited into the study after their first complicated febrile or non-febrile ECC. None had previously experienced an epileptic seizure. All underwent MRI of the brain within 14 days. Hippocampal volumes and T2 relaxation times were measured. The results were compared with a neurological control group of children without gross structural abnormalities of the neocortex undergoing MRI of the brain for reasons other than epilepsy.
RESULTS—Eighteen patients and 10 control subjects were recruited into the study. One patient was subsequently excluded because of EEG and clinical evidence of benign childhood epilepsy. Nine patients had volumetric evidence of significant hippocampal volume asymmetry (3 SD from the mean of the control group), although in only three of these was the asymmetry apparent on visual inspection of the MRI. Three patients had extrahippocampal neuropathology. None of the control subjects had significant hippocampal volume asymmetry (p<0.001). T2 relaxometry showed no evidence that postictal hippocampal oedema contributed to the asymmetry.
CONCLUSIONS—There is a high prevalence of structural brain abnormalities in children within 2 weeks of the first complicated early childhood convulsion, including significant hippocampal asymmetry unrelated to oedema. This does not exclude a damaging effect of complicated ECC on the brain, but suggests that in at least some patients the complicated ECC is the result of pre-existing brain abnormalities.



Full Text

The Full Text of this article is available as a PDF (131.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Awaya Y., Iwamoto H., Fukuyama Y. A long-term follow-up study of first episodes of idiopathic status convulsivus in childhood: in relation to subsequent epilepsy (second report). Jpn J Psychiatry Neurol. 1992 Jun;46(2):303–306. doi: 10.1111/j.1440-1819.1992.tb00863.x. [DOI] [PubMed] [Google Scholar]
  2. Barnes D., McDonald W. I., Tofts P. S., Johnson G., Landon D. N. Magnetic resonance imaging of experimental cerebral oedema. J Neurol Neurosurg Psychiatry. 1986 Dec;49(12):1341–1347. doi: 10.1136/jnnp.49.12.1341. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bland J. M., Altman D. G. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986 Feb 8;1(8476):307–310. [PubMed] [Google Scholar]
  4. Dam A. M. Epilepsy and neuron loss in the hippocampus. Epilepsia. 1980 Dec;21(6):617–629. doi: 10.1111/j.1528-1157.1980.tb04315.x. [DOI] [PubMed] [Google Scholar]
  5. DeGiorgio C. M., Tomiyasu U., Gott P. S., Treiman D. M. Hippocampal pyramidal cell loss in human status epilepticus. Epilepsia. 1992 Jan-Feb;33(1):23–27. doi: 10.1111/j.1528-1157.1992.tb02278.x. [DOI] [PubMed] [Google Scholar]
  6. Fernández G., Effenberger O., Vinz B., Steinlein O., Elger C. E., Döhring W., Heinze H. J. Hippocampal malformation as a cause of familial febrile convulsions and subsequent hippocampal sclerosis. Neurology. 1998 Apr;50(4):909–917. doi: 10.1212/wnl.50.4.909. [DOI] [PubMed] [Google Scholar]
  7. Grünewald R. A., Jackson G. D., Connelly A., Duncan J. S. MR detection of hippocampal disease in epilepsy: factors influencing T2 relaxation time. AJNR Am J Neuroradiol. 1994 Jun;15(6):1149–1156. [PMC free article] [PubMed] [Google Scholar]
  8. Jackson G. D., Connelly A., Duncan J. S., Grünewald R. A., Gadian D. G. Detection of hippocampal pathology in intractable partial epilepsy: increased sensitivity with quantitative magnetic resonance T2 relaxometry. Neurology. 1993 Sep;43(9):1793–1799. doi: 10.1212/wnl.43.9.1793. [DOI] [PubMed] [Google Scholar]
  9. Kuks J. B., Cook M. J., Fish D. R., Stevens J. M., Shorvon S. D. Hippocampal sclerosis in epilepsy and childhood febrile seizures. Lancet. 1993 Dec 4;342(8884):1391–1394. doi: 10.1016/0140-6736(93)92754-h. [DOI] [PubMed] [Google Scholar]
  10. Meldrum B. S., Brierley J. B. Prolonged epileptic seizures in primates. Ischemic cell change and its relation to ictal physiological events. Arch Neurol. 1973 Jan;28(1):10–17. doi: 10.1001/archneur.1973.00490190028002. [DOI] [PubMed] [Google Scholar]
  11. Sagar H. J., Oxbury J. M. Hippocampal neuron loss in temporal lobe epilepsy: correlation with early childhood convulsions. Ann Neurol. 1987 Sep;22(3):334–340. doi: 10.1002/ana.410220309. [DOI] [PubMed] [Google Scholar]
  12. VanLandingham K. E., Heinz E. R., Cavazos J. E., Lewis D. V. Magnetic resonance imaging evidence of hippocampal injury after prolonged focal febrile convulsions. Ann Neurol. 1998 Apr;43(4):413–426. doi: 10.1002/ana.410430403. [DOI] [PubMed] [Google Scholar]
  13. Verity C. M., Golding J. Risk of epilepsy after febrile convulsions: a national cohort study. BMJ. 1991 Nov 30;303(6814):1373–1376. doi: 10.1136/bmj.303.6814.1373. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Wallace S. J. Spontaneous fits after convulsions with fever. Arch Dis Child. 1977 Mar;52(3):192–196. doi: 10.1136/adc.52.3.192. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES