Predictive Factors for Abnormal Brain CT-Scan in Childhood Epilepsy at Yaoundé (Cameroon)

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 ac-cessible 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 va-riables 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 col-lected were clinical, type of seizure, Electroencephalogram and head CT-scans results. Indepen-dent predictive factors for CT abnormalities were sought by logistic regression. A p value < 0.05 was considered. Results: 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 mi-crocephaly, 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 epi-* Corresponding author. B. Moifo et al. 32 lepsy. Conclusion: Almost two-thirds of head CT-scan performed in epileptic children are abnor-mal 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 inci-dence of epilepsy in children.