Evidence on Use of Neuroimaging for Surgical Treatment of Temporal Lobe Epilepsy

Recommendations for the use of structural magnetic resonance imaging in the care of patients with epilepsy: A consensus report from the International League Against Epilepsy Neuroimaging Task Force

“…1 The rapid pace of technical advances and developments in neuroimaging has not systematically translated into clinical care. Computational approaches and novel quantitative MRI acquisition and postprocessing techniques have emerged to study neuroanatomy, yielding increasingly sophisticated markers of tissue microstructural integrity.…”

“…In particular, this technique has become fundamental in the management of drug-resistant epilepsy, as the identification of a clear-cut lesion on structural MRI is associated with favorable seizure outcome after surgery. 1 The rapid pace of technical advances and developments in neuroimaging has not systematically translated into clinical care. This is due to a number of reasons, including variability in economic resources and technical infrastructures, difficulty of performing prospective randomized controlled trials to assess level of evidence and added value of a given test, and lack of standardized image acquisition protocols and postprocessing methods.…”

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“…4 MRI of the brain has proven its precision as a diagnostic tool for recognition of different structural lesions underlying medically intractable seizures. 5 There is strong evidence that preoperative MRIidentified hippocampal atrophy consistent with HS concordant with the seizure origin in the temporal lobe is a significant factor associated with a favorable outcome. PET studies may be valuable in individuals with unremarkable MRI findings.…”

Esclerosis temporo mesial, evaluación diagnóstica y resultados.

“…Algunas publicaciones, indican la relación de la atrofia del hipocampo con la pérdida de células neuronales y la intensidad de la señal T2 con el recuento de células gliales, respectivamente 4 . A pesar de ello, otros métodos diagnósticos muy usados actualmente como la tomografía por emisión de positrones (PET) realizada en el periodo interictal que puede revelar una región hipometabólica focal concordante con el inicio de las convulsiones o la tomografía computarizada por emisión de fotón único (SPECT) que puede ayudar en el período ictal, con dificultad en nuestro medio para lograr realizarla de manera estandarizada, ésta demuestra un aumento en la captación del marcador en la región temporal medial, el cerebelo, el tálamo, la ínsula y el putamen, esto sugiere que en la ETM se asocia a un cambio específico del estado en las redes metabólicas 5 . Por lo anteriormente dicho la neuroimagen proporciona la posibilidad de mapear estos cambios citoarquitectónicos en pacientes con antecedentes de epilepsia focal, de difícil manejo con fármacos antiepilépticos y, por lo tanto, probables candidatos para tratamiento quirúrgico.…”

“…Some publications indicate the relationship of hippocampal atrophy with the loss of neuronal cells and the intensity of the T2 signal with the glial cell count, respectively 4 . In spite of this, other diagnostic methods are widely used today such as positron emission tomography (PET) performed in the interictal period that may reveal a focal hypometabolic region consistent with the onset of seizures or single photon emission computed tomography (SPECT) that can help in the ictal period, with difficulty in our environment to achieve it in a standardized way, this shows an increase in the uptake of the marker in the medial temporal region, the cerebellum, the thalamus, the insula and the putamen, this suggests that MTS is associated with a specific change of state in metabolic networks 5 . Therefore, neuroimaging provides the possibility of mapping these cytoarchitectonic changes in patients with a history of focal epilepsy, difficult to manage with antiepileptic drugs and, therefore, likely candidates for surgical treatment.…”