FULL TEXT

The Correlations of the age of onset, MRI

and examination of EEG LTM in epileptic
patients

Yudanto Suryo Nugroho* Aris Catur Bintoro**

*Neurology Resident in Medical Faculty of Diponegoro

University/RSUP Dr Kariadi Semarang

**Lecturer of Neurology Department in Faculty of Medicine,

Diponegoro University Semarang

Medical Faculty of Diponegoro University, Semarang –

Indonesia, 2018
12th ASEAN & OCEANIA EPILEPSY CONGRESS
Bali, Indonesia, June 28th - July 1st 2018
 Chapter I
Introduction
Mesial temporal sclerosis (scarring in the inner
portions of the temporal lobe) may be caused by oxygen
starvation to the brain, head trauma, or brain infection, but can
also occur without an apparent cause.
Over time, neurons die and scar tissue tends to form
within the hippocampus and amygdala (areas in the temporal
lobe responsible for emotions and short-term memory).
Mesial temporal sclerosis (also known as
hippocampal sclerosis) can cause a form of temporal lobe
epilepsy with partial (focus) seizures that can spread or
secondarily generalize and affect other areas of the brain.
Treatments for temporal lobe epilepsy caused by
mesial temporal sclerosis can include anticonvulsant
medications and surgery.
The overall purpose of this study is to find correlation
between age of onset, MRI and seizure focal point of patients
with longstanding epilepsy who have not been properly
investigated and the patients with refractory seizures undergo
both magnetic resonance imaging (MRI) and EEG Long term.
 Chapter II
Theory
Nearly 0.6% of Canadians have a seizure disorder.
More than 21% of patients with epilepsy experience complex
partial seizures, one-half of which are refractory to
anticonvulsant therapy. Intractable complex partial seizures
are common in temporal lobe epilepsy, which is often
associated with sclerosis of the structures of the medial
temporal lobes, particularly the hippocampus. This
abnormality is one of the most prevalent epileptogenic foci in
localization-related epilepsy.
The etiology of mesial temporal sclerosis is unclear.
Studies suggest an increased incidence among family
members and an association with precipitating insults during
the first four to five years of life. For example, the risk of
mesial temporal sclerosis developing from childhood complex
febrile seizures is 3%. The precipitating event is typically
followed by a latent period before the patient presents with
epilepsy. Seizures may then undergo remission until the
patient’s late adolescence.
Patients classically present with complex partial
seizures lasting one to two minutes. Preceding auras generally
involve epigastric “rising” sensations, fear, anxiety and
autonomic symptoms. Arrest (freezing), altered consciousness
and automatisms are typical, sometimes accompanied by
dystonic posturing or motor symptoms. Secondary
generalization is rare; however, disturbances of mood,
cognition, language and memory may occur postictally.
 Diagnostic findings in mesial temporal sclerosis
include interictal anterior temporal spikes on
electroencephalography and hippocampal atrophy with
increased T2-weighted signal on magnetic resonance imaging.
Although mesial temporal sclerosis is generally unilateral,
bilateral involvement is occasionally seen.
Symptoms
Mesial temporal sclerosis usually results in partial
(focal) epilepsy, in which seizures are confined to one area of
the brain. The condition can cause a variety of symptoms,
such as strange sensations, changes in behavior or emotions,
muscle spasms or convulsions. A focal seizure may spread to
become a generalized seizure, which involves the entire brain
and may cause a sudden loss of awareness or consciousness.
Causes and Risk Factors
Brain damage from traumatic injury, infection, a brain
tumor, stroke or uncontrolled seizures is thought to cause the
scar tissue to form, particularly in the hippocampus. The
region begins to atrophy; neurons die, and more scar tissue
forms. This damage is thought to be a significant cause of
temporal lobe epilepsy. In fact, 70 percent of temporal lobe
epilepsy patients have some degree of mesial temporal
sclerosis. It also appears that additional seizures can aggravate
existing mesial temporal sclerosis.
Tests and Diagnosis
The changes associated with mesial temporal sclerosis are
usually identifiable on a magnetic resonance imaging (MRI)
scan. This scan uses magnets, radio waves and a computer to
form pictures of the body’s structures.
 Chapter III
Methods
Cross sectional study of forty-eight epileptic patient
of all etiologies who undergoes both MRI and EEG Long-
term done in Kariadi General Hospital from January 2017 to
December 2017. The data analyzed with Chi Square Test to
show the correlation of each variable with seizure focal point.
 Chapter IV
Result
The MRI result of the epileptic patient were 18.8% Right
Mesial Temporal Sclerosis; 16.7% were Left Mesial Temporal
Sclerosis; 8.3% were Bilateral Mesial Temporal Sclerosis, and
56.3% were not Mesial Temporal Sclerosis. The age of onset
seizure of the epileptic patient were 8.3% <1years old; 14.6%
were 1-5 years old; 27.1% were 6-10 years old; 33.3% were
11-15 years old; 6.3% were 16-20 years old; 4.2% were 21-25
years old; 2.1% were 26-30 years old and 4.2% were >30
years old. The EEG seizure focal point of the epileptic patient
were 22.9% right temporal; 25.0% were left temporal and
52.1% were not temporal. Both Age of onset (p=0,754) and
MRI (p=0,667) had statistically non-significant relationship
with EEG Long-term seizure focal point; significance value
p<0.05.

Frequency Table

Usia (tahun)

Cumulative
Frequency Percent Valid Percent Percent
Valid 1 - 10 6 12.5 12.5 12.5
11 - 20 22 45.8 45.8 58.3
21 - 30 14 29.2 29.2 87.5
31 - 40 5 10.4 10.4 97.9
41 - 50 1 2.1 2.1 100.0
Total 48 100.0 100.0
 Onset (tahun)

Cumulative
Frequency Percent Valid Percent Percent
Valid <1 4 8.3 8.3 8.3
1-5 7 14.6 14.6 22.9
6 - 10 13 27.1 27.1 50.0
11 - 15 16 33.3 33.3 83.3
16 - 20 3 6.3 6.3 89.6
21 - 25 2 4.2 4.2 93.8
26 - 30 1 2.1 2.1 95.8
> 30 2 4.2 4.2 100.0
Total 48 100.0 100.0

MRI

Cumulative
Frequency Percent Valid Percent Percent
Valid non MTS 27 56.3 56.3 56.3
MTS kanan 9 18.8 18.8 75.0
MTS kiri 8 16.7 16.7 91.7
MTS bilateral 4 8.3 8.3 100.0
Total 48 100.0 100.0

EEG

Cumulative
Frequency Percent Valid Percent Percent
Valid non temporal 25 52.1 52.1 52.1
temporal kanan 11 22.9 22.9 75.0
temporal kiri 12 25.0 25.0 100.0
Total 48 100.0 100.0
Crosstabs
Crosstab

EEG
temporal
non temporal kanan temporal kiri Total
Usia 1 - 10 Count 4 1 1 6
(tahun) Expected Count 3.1 1.4 1.5 6.0
% within Usia (tahun) 66.7% 16.7% 16.7% 100.0%
11 - 20 Count 10 6 6 22
Expected Count 11.5 5.0 5.5 22.0
% within Usia (tahun) 45.5% 27.3% 27.3% 100.0%
21 - 30 Count 10 2 2 14
Expected Count 7.3 3.2 3.5 14.0
% within Usia (tahun) 71.4% 14.3% 14.3% 100.0%
31 - 40 Count 1 2 2 5
Expected Count 2.6 1.1 1.3 5.0
% within Usia (tahun) 20.0% 40.0% 40.0% 100.0%
41 - 50 Count 0 0 1 1
Expected Count .5 .2 .3 1.0
% within Usia (tahun) .0% .0% 100.0% 100.0%
Total Count 25 11 12 48
Expected Count 25.0 11.0 12.0 48.0
% within Usia (tahun) 52.1% 22.9% 25.0% 100.0%

Chi-Square Tests

Asymp. Sig.
Value df (2-sided)
Pearson Chi-Square 8.106a 8 .423
Likelihood Ratio 8.091 8 .425
Linear-by-Linear
1.141 1 .286
Association
N of Valid Cases 48
a. 11 cells (73.3%) have expected count less than 5. The
minimum expected count is .23.
Onset (tahun) * EEG
Crosstab

EEG
temporal
non temporal kanan temporal kiri Total
Onset <1 Count 3 0 1 4
(tahun) Expected Count 2.1 .9 1.0 4.0
% within Onset (tahun) 75.0% .0% 25.0% 100.0%
1-5 Count 5 2 0 7
Expected Count 3.6 1.6 1.8 7.0
% within Onset (tahun) 71.4% 28.6% .0% 100.0%
6 - 10 Count 8 2 3 13
Expected Count 6.8 3.0 3.3 13.0
% within Onset (tahun) 61.5% 15.4% 23.1% 100.0%
11 - 15 Count 6 5 5 16
Expected Count 8.3 3.7 4.0 16.0
% within Onset (tahun) 37.5% 31.3% 31.3% 100.0%
16 - 20 Count 1 1 1 3
Expected Count 1.6 .7 .8 3.0
% within Onset (tahun) 33.3% 33.3% 33.3% 100.0%
21 - 25 Count 1 0 1 2
Expected Count 1.0 .5 .5 2.0
% within Onset (tahun) 50.0% .0% 50.0% 100.0%
26 - 30 Count 1 0 0 1
Expected Count .5 .2 .3 1.0
% within Onset (tahun) 100.0% .0% .0% 100.0%
> 30 Count 0 1 1 2
Expected Count 1.0 .5 .5 2.0
% within Onset (tahun) .0% 50.0% 50.0% 100.0%
Total Count 25 11 12 48
Expected Count 25.0 11.0 12.0 48.0
% within Onset (tahun) 52.1% 22.9% 25.0% 100.0%

Chi-Square Tests

Asymp. Sig.
Value df (2-sided)
Pearson Chi-Square 10.113a 14 .754
Likelihood Ratio 14.202 14 .435
Linear-by-Linear
3.118 1 .077
Association
N of Valid Cases 48
a. 22 cells (91.7%) have expected count less than 5. The
minimum expected count is .23.
MRI * EEG
Crosstab

EEG
temporal
non temporal kanan temporal kiri Total
MRI non MTS Count 15 4 8 27
Expected Count 14.1 6.2 6.8 27.0
% within MRI 55.6% 14.8% 29.6% 100.0%
MTS kanan Count 5 3 1 9
Expected Count 4.7 2.1 2.3 9.0
% within MRI 55.6% 33.3% 11.1% 100.0%
MTS kiri Count 4 2 2 8
Expected Count 4.2 1.8 2.0 8.0
% within MRI 50.0% 25.0% 25.0% 100.0%
MTS bilateral Count 1 2 1 4
Expected Count 2.1 .9 1.0 4.0
% within MRI 25.0% 50.0% 25.0% 100.0%
Total Count 25 11 12 48
Expected Count 25.0 11.0 12.0 48.0
% within MRI 52.1% 22.9% 25.0% 100.0%

Chi-Square Tests

Asymp. Sig.
Value df (2-sided)
Pearson Chi-Square 4.074a 6 .667
Likelihood Ratio 4.110 6 .662
Linear-by-Linear
.118 1 .731
Association
N of Valid Cases 48
a. 9 cells (75.0%) have expected count less than 5. The
minimum expected count is .92.
Tabel Deskriptif Data

Variabel Frekuensi %
Usia (tahun)
1 – 10 6 12,5
11 – 20 22 45,8
21 – 30 14 29,2
31 – 40 5 10,4
41 – 50 1 2,1
Onset (tahun)
<1 4 8,3
1–5 7 14,6
6 – 10 13 27,1
11 – 15 16 33,3
16 – 20 3 6,3
21 – 25 2 4,2
26 – 30 1 2,1
> 30 2 4,2
MRI
Non MTS 27 56,3
MTS kanan 9 18,8
MTS kiri 8 16,7
MTS bilateral 4 8,3
EEG
Non temporal 25 52,1
Temporal kanan 11 22,9
Temporal kiri 12 25,0
Tabel hubungan terhadap EEG

EEG
Non Temporal Temporal
Variabel p
temporal kanan kiri
N % n % n %
Usia (tahun)
16, 0,423
1 – 10 4 66,7 1 16,7 1 ‡
7
27,
11 – 20 10 45,5 6 27,3 6
3
14,
21 – 30 10 71,4 2 14,3 2
3
40,
31 – 40 1 20,0 2 40,0 2
0
41 – 50 0 0 0 0 1 100
Onset
(tahun)
25, 0,754
<1 3 75,0 0 0 1 ‡
0
1–5 5 71,4 2 28,6 0 0
23,
6 – 10 8 61,5 2 15,4 3
1
31,
11 – 15 6 37,5 5 31,3 5
3
33,
16 – 20 1 33,3 1 33,3 1
3
21 – 25 1 50 0 0 1 50
26 – 30 1 100 0 0 0 0
> 30 0 0 1 50 1 50
MRI
Non 29, 0,667
15 55,6 4 14,8 8 ‡
MTS 6
MTS 5 55,6 3 33,3 1 11,1
kanan
MTS kiri 4 50 2 25 2 25
MTS
1 25 2 50 1 25
bilateral
Keterangan : ‡ Uji chi square

Chapter V
Conclusion
Seizure focal point showed in EEG Long-term
emerged in seizure does not appear significantly related in
either age of onset seizure and MRI to provoke seizure.
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