What Does My MRI Scan Report Indicate?

Posted on Wed, 30 Aug 2017

Question: Dear sir / madam,
I have a 2yr 2mnths son. He had his first convulsion for 2-3 seconds for 10-15 times and started crying, when he was one year old and having high fever at night. That time he was given antibiotic and other medicine to reduce the fever. After one year and till
Date whenever he had fever he got same convulsions for same 2-3 seconds. Doctor recommended frisium 1 tab for 2days as and when seizure comes. That time one of doctor suggested for MRI but one doctor said if it is with fever and for a 2-3 seconds then no need to go for MRI. It will disappear after 5-6 years.

But recently in 2 months he got different different type of seizure including and excluding fever. Sometimes he fell down while standing or running, sometimes while watching videos he lowered his head and hit the phone and recently it was quite heavy 2 times when he became stiff and unconscious type for about 10 mins and some fluid came out of his mouth. We admited him in hospital and EEG done (attached report) and MRI also done. He is continuing with BIOVAL syrup 3ml 3times with a gap of 8hrs. Midcip nasal spray is given for emergency when he became stiff like situations.

At present i dont have final report of MRI to attach as it was not signed but verbally asked by different to radiologist and it is found that MRI report is Ok. I will attach the final report probably by Monday. At 2yrs 2mnths age his speaking development is not so at expected level. Just saying one word type papa, mama, kaka like and quite hyperactive means doesn't sit at one place, only here and there running and angry and stubborn nature. But he is active and understands everything what we say basic things.

Thanks. Kindly suggest.

Answered by Dr. Sumanth Amperayani (1 hour later)

Brief Answer:
Initially it was febrile seizure and now complex partial seizures

Detailed Answer:
Hi... I understand your concern.

The initial episode seems to be simple febrile seizure and the doctor was right in not asking for an MRI brain.

Will explain you what a simple febrile seizure is.

Febrile seizures are seizures which occur during high fever in some kids. They usually occur form 6 months to 6 years of age and usually are self limiting after 6 years of age. They usually do not leave any focal neurological deficits also. Rather than the height of the temperature the rapidity of rise of temperature is more important.

In general, antiepileptic therapy, continuous or intermittent, is not recommended for children with 1 or more simple febrile seizures. Parents should be counseled about the relative risks of recurrence of febrile seizures and recurrence of epilepsy, educated on how to handle a seizure acutely, and given emotional support.

If the seizure lasts for longer than 5 min, buccal or intranasal midazolam (Available as Midacip Nasal spray) may be used and is often preferred by parents.

Now coming to the second issue - this seems like a complex partial seizures to me or the other option is a myoclonic epilepsy.

I didnot get any EEG report here to see.

Sodium valproate is a good drug in this scenario but I would prefer to give it in 2 doses and not in 3 doses per day.

Regards - Dr. Sumanth

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumanth Amperayani (16 minutes later)

Thanks. Reports are attached kindly check again. Sir what further treatment required? How long medicine should continue. Where is the best speciality of this treatment is available in XXXXXXX Thanks

Answered by Dr. Sumanth Amperayani (21 minutes later)

Brief Answer:
Suggestions on complex partial seizures

Detailed Answer:
Hi...Greetings from XXXXXXX

1. I would like to continue Valproate at 20mg/kg/day for a total of 2 years and then get an EEG done again. If it is normal, we can gradually taper and stop it...

2. Meanwhile I would like to get an MRI done - please upload the report by Monday.

3. If you can get back to me with your location, then I would suggest you the nearest best center.

Regards - Dr. Sumanth

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumanth Amperayani (2 days later)

Hi sir hope you got eeg report and now mri report. Since last Thursday my son didnt have seizure and continuing valproate medicine. Is there any restrictions required on his eating habbits? Please Suggest after viewing the reports. Thanks

Answered by Dr. Sumanth Amperayani (2 hours later)

Brief Answer:
This is complex partial seizures and no dietery restrictions

Detailed Answer:
Hi...this is complex partial seizures and there is not dietary restrictions. MRI brain is normal and that is good news.

Sodium valproate is a good drug in this scenario but I would prefer to give it in 2 doses and not in 3 doses per day. I would prefer to give it in the dose of 20mg/kg/day for 6 months and review with EEG report.

Regards - Dr. Sumanth

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar