6 yr. old son's MRI changes?

Dear Doctor:

My son will be going in for more video EEG monitoring and now is having the Lamictal withdrawn.  In discussing the lack of improvment and worsening of symptoms with his neurologist I addressed my concern about his last MRI.  It showed gliosis and dilated Virchow-Robin spaces whereas the MRI done nine months earlier did not.  His neurologist apparently was not aware that this was not present on the original MRI, as she was not the one who ordered it, but did have the report, and just said they would have to watch it.  Even though it was explained to me that gliosis just means scarring, I am curious to know what could cause it and if it is indeed signficant or if I'm just a senseless worrier.  One of his motor tics has involved pretty severe head nodding.  If he is doing this constantly could it be his brain is getting somewhat moved around?  Over the last year I would say his seizures have not gotten worse, but have changed.  However, his behavior and school performance has become worse.  His short-term memory is worse and his behavior is full of rage where I am the target and he will suddenly strike me and go into this pattern of name calling, spitting, punching, kicking - anything he can do.  I've shared all this with his neurologist and she had already discussed his case with the other doctors in the clinic and they felt a few days in the EMU was in order, plus a visit from the neuropsychologist.  They haven't addressed the Tourettes issue very much and I'm afraid it is more of a problem than the seizures as far as his behavior is concerned.  I do trust his neurologist, but I also respect your input as well.  

Sincerely,

Dee

[CCF Neuro[P] MD, RPS]

Dear Dee:

The increased size of the Virchow-Robin spaces is probably an incidental finding that doesn't mean a worrisome etiology.  These are normal structures that surround blood vessels (I am sure your neurologist explained this to you).  The gliosis is a reaction to an insult, usually ischemic in nature that occurs after the 2-3 trimester.  It can be an hypoxic event occuring at child birth, or a small stroke, or infection etc.  Seizure medications do not work to lessen tic behavior.  If your son also has tourette's and is not on tic medication, his tics will be present.  Epilepsy patients can have behavior problems as can Tourette's patients.  A neuropsych consult is likely a good idea.  I hope I have helped some.

Sincerely,

CCF Neuro MD