JRM
Journal of Radiology in Medicine

Journal of Radiology in Medicine is an international journal that published original research and articles in all areas of radiology. Its publishes original research articles, review articles, case reports, editorial commentaries, letters to the editor, educational articles, and conference/meeting announcements.

eISSN: 3023-6487
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Online Manuscript System

Index
Original Article
Magnetic resonance imaging (MRI) based cerebellum and brain volume measurement using Cavalier principle in epilepsy patients on long-term phenytoin and carbamazepine therapy
Abstract
Aims: This study aims to evaluate cerebellar atrophy findings in epilepsy patients using long-term antiepileptic drugs by calculating cerebellum/brain volume ratios with the Cavalieri principle and comparing this method with other volumetric measurement techniques.
Methods: A total of 30 patients diagnosed with epilepsy and receiving long-term phenytoin or carbamazepine treatment between January 2004 and May 2005, along with a control group of 15 individuals, were included in the study. Magnetic resonance imaging (MRI) was performed using a 0.2 Tesla open MRI system. Brain volumes and cerebellum/brain volume ratios were calculated using the point-counting method based on the Cavalieri principle.
Results: No statistically significant difference was found between the calculated volume values of the phenytoin, carbamazepine, and control groups (p>0.05). However, in one patient using phenytoin, the cerebellum volume was found to be significantly low, consistent with cerebellar atrophy.
Conclusion: Larger studies are needed to determine whether long-term use of phenytoin and carbamazepine leads to cerebellar atrophy. The point-counting method based on the Cavalieri principle may offer a practical and applicable alternative for routine clinical use.

Keywords : Cerebellar atrophy, epilepsy, phenytoin, stereology, Cavalieri principle

Download Article


1. De Marco FA, Ghizoni E, Kobayashi E, Li LM, Cendes F. Cerebellar volume and long-term use of phenytoin. Seizure. 2003;12(5):312-315. doi:10.1016/s1059-1311(02)00267-4
2. Lindvall O, Nilsson B. Cerebellar atrophy following phenytoin intoxication. Ann Neurol. 1984;16(2):258-260. doi:10.1002/ana.410160218
3. Luft AR, Skalej M, Schulz JB, et al. Patterns of age-related shrinkage in cerebellum and brainstem observed in vivo using three-dimensional MRI volumetry. Cereb Cortex. 1999;9(7):712-721. doi:10.1093/cercor/9. 7.712
4. Hayakawa K, Kumagai H, Suzuki Y, et al. MR imaging of chronic alcoholism. Acta Radiol. 1992;33(3):201-206.
5. Savoiardo M, Bracchi M, Passerini A, et al. Computed tomography of olivopontocerebellar degeneration. AJNR Am J Neuroradiol. 1983;4(3): 509-512.
6. Ramos A, Quintana F, Diez C, et al. CT findings in spinocerebellar degeneration. AJNR Am J Neuroradiol. 1987;8(4):635-640.
7. Tedeschi G, Bertolino A, Massaquoi SG, et al. Proton magnetic resonance spectroscopic imaging in patients with cerebellar degeneration. Ann Neurol. 1996;39(1):71-78. doi:10.1002/ana.410390111
8. Specht U, May TW, Rohde M, et al. Cerebellar atrophy decreases the threshold of carbamazepine toxicity in patients with chronic focal epilepsy. Arch Neurol. 1997;54(4):427-431. doi:10.1001/archneur.1997. 00550160063017
9. Specht U, May T, Schulz R, et al. Cerebellar atrophy and prognosis after temporal lobe resection. J Neurol Neurosurg Psychiatry. 1997;62(5):501-506. doi:10.1136/jnnp.62.5.501
10. Ney GC, Lantos G, Barr WB, Schaul N. Cerebellar atrophy in patients with long-term phenytoin exposure and epilepsy. Arch Neurol. 1995; 52(3):232. doi:10.1001/archneur.1994.00540200043014
11. Guerrero AL, Paniagua JA, Diaz Cascajo P, et al. Temporal cerebellar atrophy following phenytoin therapy. Neurologia. 1997;12(6):259-261.
12. Savic I, Thorell JO. Localized cerebellar reductions in benzodiazepine density in human partial epilepsy. Arch Neurol. 1996;53(7):656-662. doi:10.1001/archneur.1996.00550070094016
13. Luef G, Burtscher J, Kremser C, et al. Magnetic resonance volumetry of the cerebellum in epileptic patients after phenytoin overdosages. Eur Neurol. 1996;36(5):273-277. doi:10.1159/000117271
14. Luef G, Chemelli A, Birbamer G, et al. Phenytoin overdosage and cerebellar atrophy in epileptic patients: clinical and MRI findings. Eur Neurol. 1994;34(2):79-81. doi:10.1159/000119516
15. Ferner RE. Phenytoin and damage to the cerebellum. Expert Opin Drug Saf. 2022;21(7):801-804. doi:10.1080/14740338.2022.2058487
16. Elder C. The cerebellum in epilepsy. Epilepsia. 2025;66(1):34-45. doi:10. 1111/epi.18316
17. Mito R, Cole JH, Genc S, Jackson GD, Zalesky A. Towards precision MRI biomarkers in epilepsy with normative modelling.Brain. 2025; 148(7):2247-2261. doi:10.1093/brain/awaf090
18. Wang G, Liu X, Zhang M, et al. Structural and functional changes of the cerebellum in temporal lobe epilepsy.Front Neurol. 2023;14:1213224. doi:10.3389/fneur.2023.1213224
19. Ibdali M, Hadjivassiliou M, Grünewald RA, Shanmugarajah PD. Cerebellar degeneration in epilepsy: a systematic review.Int J Environ Res Public Health. 2021;18(2):473. doi:10.3390/ijerph18020473
Article available in :
Volume 2, Issue 4, 2025
Page : 71-75
https://doi.org/10.51271/JRM-0038
Article Information
Received : 30 Tem 2025
Accepted : 06 Eki 2025
Published : 15 Eki 2025
Corresponding Author :

Mustafa Yalçın: Department of Radiology, Antalya Training and Researh Hospital, Antalya, Turkiye

[email protected]
Citation : Oyar O, Yalçın M. Magnetic resonance imaging (MRI) based cerebellum and brain volume measurement using cavalier principle in epilepsy patients on long-term phenytoin and carbamazepine therapy. J Radiol Med. 2025;2(4):71-75.

Read: 4
Download : 658
Cited: 0
_Footer