Seizure recurrence in children with focal seizures and single small enhancing computed tomographic lesions: Prognostic factors on long-term follow-up

Single small enhancing computed tomographic (CT) lesions are common in chil dren with focal seizures. There is a paucity of information regarding their long-term outcome and prognostic factors for seizure recurrence. The objec tive of this work was to study the frequency of seizure recurrence in child ren with single small enhancing computed tomographic lesions and to identif y prognostic factors, if any, for seizure recurrence. A prospective long-te rm follow-up was conducted at the Advanced Pediatric Center, Postgraduate I nstitute of Medical Education and Research, an urban tertiary care teaching hospital. Sixty-three children between 2 and 12 years of age with focal se izures for less than 3 months and single small enhancing computed tomograph ic lesions were enrolled in a randomized, double-blind, placebo-controlled trial of albendazole therapy and followed up for 4 years. On long-term foll owup, the albendazole and placebo groups were left with 29 and 28 children, respectively. After several months of seizure-free period, antiepileptic d rug was tapered off. Children with relapse underwent magnetic resonance ima ging examination. All children were followed up for at least 18 months afte r stopping of the antiepileptic drug. Seizure recurrence was seen in three children each in both groups, after a mean interval of 6.4 weeks after stop ping the antiepileptic drug. Magnetic resonance imaging revealed persistent chronic granuloma in 2 and calcified granuloma in 4 children. Residual les ions were significantly correlated with seizure recurrence. In children who se lesions completely disappeared, no seizure recurrence was seen even duri ng shorter periods of antiepileptic drug treatment. Seizure recurrence was seen in a small number of children with focal seizures and single small enh ancing computed tomographic lesions. It appears to be related to either a p ersistent or a calcified lesion.