[Neuroradiological and pathohistological markers of the main epileptogenic substrates in children. Other cerebral disorders]. / Neiroradiologicheskie i patogistologicheskie markery osnovnykh epileptogennykh substratov u detei. Drugie tserebral'nye narusheniya.

High-resolution MRI is an important tool in the diagnosis of structural epilepsy |in determining the seizure initiation zones, identification of the mechanisms of epileptogenesis in predicting outcomes and preventing postoperative complications in patients. In this article we have tried to demonstrate the neuroradiological and pathohistological characteristics of the main epileptogenic substrates in children using modern classification. The second part of the article is devoted to the spectrum of epileptogenic cerebral disorders, in addition to cortical malformations.

[Neuroradiological and pathohistological markers of the main epileptogenic substrates in children.Cortical malformations]. / Neiroradiologicheskie i patogistologicheskie markery osnovnykh epileptogennykh substratov u detei. Kortikal'nye mal'formatsii.

High-resolution MRI is an important tool in the diagnosis of structural epilepsy in determining the seizure initiation zones, identification of the mechanisms of epileptogenesis in predicting outcomes and preventing postoperative complications in patients. In this article we demonstrate the neuroradiological and pathohistological characteristics of the main epileptogenic substrates in children using modern classification. The first part of the article is devoted to cortical malformations as the most common epileptogenic cerebral disorders.

[The presurgical evaluation of patients with drug-resistant epilepsy]. / Prekhirurgicheskoe obsledovanie patsientov s farmakorezistentnoi epilepsiei.

Comprehensive multimodal examination of patients with focal refractory epilepsies is currently a prerequisite for high-quality pre-surgical diagnostics, which aims not only to expand the indications for radical treatment of epilepsy, but also to avoid the appearance of severe postoperative deficits. High-resolution MRI plays a key role in preoperative assessment. In this review, we illustrate the modern aspects of a pre-surgical diagnostical complex in examinations of patients with focal drug-resistant epilepsy, including the possibilities of neuroimaging.

[Modern diagnostic of agenesis of the corpus callosum in children]. / Sovremennaia diagnostika agenezii mozolistogo tela u detei.

Observations of the authors regarding main MRI symptoms of agenesis of the corpus callosum (ACC) and literature review on the structure of the corpus callosum in normalcy and pathology are presented. The authors emphasize that some cases of isolated ACC has been found during routine prenatal ultrasound examination. In this regard, prenatal MRI is more effective. In 74% patients with ACC, MRI results are consistent with the results of ultrasound and CT. MRI has advantages in the differentiation of inherited corpus callosum malformation as well as concomitant CNS abnormalities.

[MRI-characteristics of epileptogenic supratentorial brain tumors in children].

OBJECTIVE: To analyze MR-images in patients with symptomatic epilepsy associated with the brain tumor. MATERIAL AND METHODS: MRI results of 52 patients with symptomatic epilepsy operated for tumors of supratentorial localization were analyzed. The most epileptogenic tumors with atypical MRI signs and subtle clinical presentation were identified. All patients with tumors were operated using different methods of surgical intervention. RESULTS: Dysembryoplastic neuroepithelial tumors (DNET), diffuse astrocytomas (DA) and gangliogliomas (GG) were the most frequent epileptogenic tumors. In all the cases of DNET and in 4 patients with GG, epileptic seizures were the first, and in 4 of 5 cases of DIO were the only clinical sign of tumor presence. In DNET, DA and GG, there was an iso- or hypointensive signal on T1 WI and a signal varying in intensity from moderate to hyperintense in T2 and FLAIR WI, while in cases with DNET and GG, no mass effect and perifocal edema was practically seen. The so-called «spume-like¼ (multicystic) structure was most clearly observed in FLAIR WI. No significant changes in the dimensions of the DNET and GG were identified. The combination of DNET with focal cortical dysplasia was noted in one case. In DA, it was difficult to distinguish the perifocal edema from tumorous tissue and normal brain tissues, and the growth potential of malformation was slow. CONCLUSION: Epileptogenic tumors can imitate the x-ray characteristics of each other, and mimicry to gangliogliomas, oligodendrogliomas and astrocytomas Gr I, II, and others. They are the most frequent causes of symptomatic focal epilepsy. The presence of these malformations is necessary to exclude first of all in all cases of pharmacoresistant epilepsy.

[West syndrome: clinico-electro-anatomical characteristics and a differential therapeutical approach].

One hundred and thirty children with West syndrome, aged 1.5 months-2 years, were studied. The symptomatic form of West syndrome was diagnosed in 95.4% of cases. The prenatal etiological factors were observed in 57% of patients. Different variants of hypsarrhythmia at EEG were revealed in 87%. The percentage of cases with typical and modified hypsarrhythmia was 13.3% and 86.7%, respectively. The choice of treatment was based on the revealed disturbances on EEG and MRI that was useful for increasing the effectiveness of treatment of West syndrome resulting not only in the reduction of seizures and improvement of EEG but also in the stabilization of intellectual disintegration and recovery of functions. The basic drugs in the treatment were valproates used both as mono- and polytherapy.

[Clinical polymorphism of malignant epilepsy of infancy with migrating multifocal seizures (8 cases)].

Malignant migrating partial seizures in infancy are rare epilepsy syndrome that begins in the first 6 months of life and characterized by multiple continuous electroencephalographic and electroclinical focal ictal patterns which involved different independent areas of both hemispheres with arrest of psychomotor development. The present detailed review is based on the personal observation of 8 patients newly diagnosed at the Russian Children Clinical hospital, Moscow, Russia. At least three ictal patterns recorded from different independent areas of both hemispheres were fixed by video-EEG-monitoring in all patients. The high polymorphism and very frequent seizures (not less than five types at every child) were observed. The cases were pharmacoresistant, with the absence of reaction to antiepileptic therapy and progressive deterioration in 4 (50%) patients. Decreasing of seizure frequency by 50% was achieved in 3 (37.5%) patients treated with the combination of valproates, benzodiazepines and barbiturates and by 75% in 1 (12.5%) patient case treated with valproates, benzodiazepines and levetyracetam (keppra). The authors proposed a definition of this epileptic syndrome as: "malignant epilepsy of infancy with migrating multifocal seizures".

[Magnetic resonance characteristics of minor focal cortical dysplasia in children]. / Magnitno-rezonansnaia kharakteristika malykh fokal'nykh korkovykh displazii u detei.

The paper presents data on rare "obscure" forms of cortical dysplasias that play, nevertheless, an important role in the genesis of epilepsy in children. Pseudoschizencephalic phenomena of cortical organization (the straightened sulcus) and two dismigration defects (annular convolution and local simplifications of the pattern of sulci) are characterized. General information on the essence of this problem in Russian and foreign publications is presented.

[Neurovisualization in diagnosis of mesial temporal sclerosis in children]. / Znachenie neurovizualizatsii v diagnostike mezial'nogo temporal'nogo skleroza u detei.

We present specific magnetic resonance characteristics of mesial temporal sclerosis (MTS) represented by hypoxic-ischemic, dysplastic and mixed clinical variants. Temporal size decrease, irregular grey-white differentiation and ipsilateral dilatation of inferior horn of lateral ventricle were identified as specific MTS markers.

[3D FSPGR (fast spoiled gradient echo) magnetic resonance imaging in the diagnosis of focal cortical dysplasia in children]. / Ispol'zovanie rezhima 3D FSPGR v magnitno-rezonansnoi diagnostike kortikal'nykh displazii u detei.

Small dysplastic lesions of the cerebral cortex are often missed by conventional MRI methods. The identification of subtle structural abnormalities by traditional multiplanar rectilinear slices is often limited by the complex convolutional pattern of the brain. We used a method of FSPGR (fast spoiled gradient-echo) of three-dimensional MRI data that improves the anatomical display of the sulcal structure of the hemispheric convexities. It also reduces the asymmetric sampling of gray-white matter that may lead to false-positive results. We present 5 from 12 patients with dysplastic cortical lesions in whom conventional two-dimensional and three-dimensional MRI with multiplanar reformatting was initially considered normal. Subsequent studies using 3D FSPGR identified various types of focal cortical dysplasia in all. These results indicate that an increase in the detection of subtle focal dysplastic lesions may be accomplished when one improves the anatomical display of the brain sulcal structure by performing 3D FSPGR.

[Unilateral hemimegalencephaly and hemiatrophy of brain: principles of computer tomographic differentiation]. / Unilateral'naia gemimegaléntsefaliia i gemiatrofiia mozga: printsipy komp'iuterno-tomograficheskoi differentsiatsii.

Unilateral hemimegalencephaly (UHE) and hemiatrophy (HA) of brain are two pathological states of brain completely different in their nature. Nevertheless, neuroimaging examinations revealed pronounced asymmetry of hemispheres in both cases. This dictates a nesessity of both elaboration and wide usage of definife objective criteria for differentiation of the alterations above by means of either computer tomography or magneto-resonance tomography. Differential diagnostic criteria for UHE and HA are proposed.