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Child Neurol > Volume 26(4); 2018 > Article
Journal of the Korean Child Neurology Society 2018;26(4):280-283.
DOI: https://doi.org/10.26815/jkcns.2018.26.4.280    Published online December 31, 2018.
Transient Abnormalities on Magnetic Resonance Imaging after Absence Seizures
Hye Won Yoo1, Lira Yoon1, Hye Young Kim1, Min Jung Kwak1, Kyung Hee Park1, Mi Hye Bae1, Yunjin Lee2, Sang Ook Nam2, Young Mi Kim1
1Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine and Biochemical Research Institute, Busan, Korea
2Department of Pediatrics, Pusan National University Yangsan Hospital, Pusan National University School of Medicine and Biochemical Research Institute, Yangsan, Korea
Correspondence:  Young Mi Kim, Tel: +82-51-240-7298, Fax: +82-51-248-6205, 
Email: pink2129@naver.com
Received: 22 August 2018   • Revised: 5 October 2018   • Accepted: 5 October 2018
Magnetic resonance imaging (MRI) is recommended for patients with epileptic seizures to rule out an underlying focal lesion. However, abnormalities in idiopathic generalized epilepsy, including childhood absence epilepsy, cannot usually be identified using brain imaging modalities such as MRI. Peri-ictal MRI abnormalities have been most commonly reported secondary to status epilepticus and are rarely observed in patients with focal seizures and generalized tonic-clonic seizures. Transient peri-ictal MRI abnormalities in absence epilepsy are extremely rare. A five-year-old girl presented with a three-day history of absence seizures that persisted despite continued treatment with sodium valproate. Electroencephalography showed bursts of generalized 3-Hz spike-and-wave discharges, during and after hyperventilation. Abnormal cortex thickening in the left perisylvian region was detected on T2-weighted brain MRI, and cortical dysplasia or a tumor was suspected. The patient started treatment with lamotrigine and was seizure-free after one month. The abnormal MRI lesion was completely resolved at the two-month follow-up. We report on a patient with childhood absence epilepsy and reversible brain MRI abnormalities in the perisylvian region. To our knowledge, this is the first report of transient MRI abnormalities after absence seizures. Transient peri-ictal MRI abnormalities should be considered for differential diagnosis in patients with absence seizures and a focal abnormality on brain MRI.
Key Words: Epilepsy, Absence epilepsy, Peri-ictal MRI abnormalities, Differential diagnosis


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