Age-specific MRI patterns in pediatric epilepsy: insights from a sudanese cohort and implications for low-resources settings.
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OBJECTIVE: Epilepsy is a global health problem affecting the quality of life of many children. Neuroimaging, particularly Magnetic Resonance Imaging (MRI), plays a crucial role in precisely identifying epileptogenic foci that are potentially amenable to surgical resection for a possible cure. This study aims to evaluate the diagnostic yield of MRI in a Sudanese pediatric epilepsy cohort and to identify age-specific neuroimaging patterns to optimize resource allocation in low-income settings. METHODS: A descriptive cross-sectional study enrolled 100 pediatric patients (≤ 17 years) diagnosed with epilepsy from June 2023 to June 2024. Data on age, gender, and MRI findings were collected and analyzed using SPSS v26.0. Chi-square tests assessed univariate associations, and multivariate logistic regression evaluated the combined impact of age and gender on abnormal MRI findings, with significance set at P < 0.05. RESULTS: Of 100 patients (55% male, 45% female), 87% were aged 1-12 years. MRI abnormalities were detected in 31%, with mesial temporal sclerosis (35.4%) most frequent, followed by brain atrophy and periventricular leukomalacia (16% each). Age was significantly associated with abnormalities (P = 0.002), with higher odds in < 1-year-olds (OR = 9.35, 95% CI: 1.67-52.41, P = 0.011) and 13-17-year-olds (OR = 14.20, 95% CI: 1.47-137.32, P = 0.021) compared to 1-6-year-olds. Specific findings varied by age: periventricular leukomalacia in < 1-year-olds, atrophy in 1-6 years, mesial temporal sclerosis in 7-12 years, and tumors in 13-17 years (P < 0.002). Gender showed no significant effect (OR = 0.74, 95% CI: 0.32-1.71, P = 0.480). CONCLUSION: Approximately one-third of children with epilepsy showed MRI abnormalities, most commonly mesial temporal sclerosis. Abnormal MRI results were notably linked to patient age, particularly those under one year old and between 13 and 17 years old. Age-specific MRI protocols could enhance diagnostic efficiency in low-resources settings. These findings support for prioritized neuroimaging in infants and adolescents, informing public health strategies to address Sudan's epilepsy burden. CLINICAL TRIAL NUMBER: Not applicable.