Advances in neuroimaging in patients with epilepsy

Abstract

<jats:p>Intractable seizures can have a devastating effect on the development of a child. In children with intractable epilepsy that is refractory to medication, surgical treatment may be needed. Magnetic resonance imaging is an essential neuroimaging tool to assist in the identification of an epileptogenic substrate. The interpretation of MR images should be done in the context of clinical knowledge of the seizure symptomatology and electroencephalographic findings. Quantitative processing of structural MR data and advanced MR imaging such as diffusion tensor imaging and MR spectroscopy have the potential to identify subtle lesions that may otherwise have been missed. In addition to lesion localization, identification of eloquent cortex and white matter tracts are also an essential component of epilepsy surgery workup. Functional MR imaging maps the sensorimotor cortex and also lateralizes language. Diffusion tensor imaging tractography can be used to map the corticospinal tracts and the optic radiations. In addition to MR imaging, magnetoencephalography and nuclear medicine studies such as PET and SPECT scanning may be used to lateralize seizure focus when clinical, electrophysiological, and structural MR imaging findings are discordant.</jats:p>

Surgical approaches to epilepsy

“…It has been used for motor mapping, language mapping (Figure 4), mapping of the somatosensory cortex and memory function. Functional MRI has been shown to have a greater than 90% concordance when compared with the Wada test for language lateralization, with the majority of remaining patients demonstrating language codominance [21]. It is rapidly becoming the investigation of choice for identifying language dominance.…”

Mogućnosti detekcije i karakterizacije epileptogenih lezija primjenom magnetne rezonance jačine 1,5T i 3,0T

“…Senzitivnost MR kod detekcije abnormalnosti endokranijuma pacijenata oboljelih od epilepsije zavisi od vrste patološkog supstrata, vrste MR protokola koji se primjenjivao i iskustva radiologa koji je analizirao pregled [23]. Kod interpretacije MR slika potrebno je voditi i imati uvid u kliničku sliku i EEG nalaz pacijenta.…”

Recent advances in imaging epilepsy

“…This combination of MR sequences has been shown to identify a lesion in approximately 13–18% of all patients with epilepsy, but this is increased to 82–86% in patients with refractory epilepsy 4–6. This sensitivity may be even greater in the paediatric population and may be increased further with the use of stronger magnets and specialised MR techniques 4 7 8…”