Infant Motor Development Recovery after Surgery of Post Traumatic Epilepsy (PTE) - Meaningful Change of Fractional Anisotropy (FA) of MRI Diffusion Tensor Imaging (DTI) in a Case of Growing Skull Fracture

Epileptic seizure in pediatric patients affects neurodevelopment, and surgical treatment of intractable epilepsy improved comorbidities, but the mechanism is not fully uncovered yet. By measurement of MRI-DTI Fractional Anisotropy (FA) of posterior limb of internal capsule (PIC) of infants, we presented its change by seizure propagation and control in a case of an infant post traumatic epilepsy (PTE) caused by growing skull fracture. Her motor developmental delay and hemiparesis with non-convulsive status epilepticus (NCSE) started 2 months after injury, recovered after surgical repair and seizure control. FA of PIC was lower than normal (0.29 ipsilateral, 0.37 contralateral) had increased to normal range in one week after surgical treatment and seizure control (0.62, 0.66). Comparing with normal time course of FA of motor tract of infant, this dynamic change of FA indicated the effect of seizure control after surgical treatment. As measurement of other brain lesion also showed increased FA in both ipsilateral and contralateral deep white matter, indicated the effect of NCSE for wide network of brain, and influenced infant neuronal development. These result indicated one mechanism why NCSE affected motor developmental delay and surgical intervention for regional infant intractable epilepsy prevented further developmental delay. By handy method of measuring FA of motor tract, we had one possibility to predict motor tract injury in infancy. We also reviewed and discussed about the mechanism of FA increase and decrease in early infancy and how PTE caused FA change.