Neuroimaging of Epilepsy

Abstract

PURPOSE OF REVIEW:This article focuses on the evaluation of children and adults who present with new-onset seizures, with an emphasis on differential diagnosis, classification, evaluation, and management. RECENT FINDINGS:New-onset seizures are a common presentation in neurologic practice, affecting approximately 8% to 10% of the population. Accurate diagnosis relies on a careful history to exclude nonepileptic paroxysmal events. A new classification system was accepted in 2017 by the International League Against Epilepsy, which evaluates seizure type(s), epilepsy type, epilepsy syndrome, etiology, and comorbidities. Accurate classification informs the choice of investigations, treatment, and prognosis. Guidelines for neuroimaging and laboratory and genetic testing are summarized. SUMMARY:Accurate diagnosis and classification of first seizures and new-onset epilepsy are key to choosing optimal therapy to maximize seizure control and minimize comorbidities. KEY POINTS• Epilepsy is defined as any of the following: (1) at least two unprovoked (or reflex) seizures occurring more than 24 hours apart, (2) one unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years, or (3) diagnosis of an epilepsy syndrome.• A careful history taken from both the patient as well as any witnesses to the event(s) is the most critical aspect in distinguishing a seizure from a nonepileptic paroxysmal event.• It is the first convulsive seizure that typically brings the patient to medical attention. Many people presenting with a "first seizure" have a history of prior seizures, which may not have been recognized, and thus have epilepsy.

Protein MRI Contrast Agents as an Effective Approach for Precision Molecular Imaging

“…In addition, it allows us to capture dynamic signal changes. Magnetic resonance imaging has emerged to be a primary imaging modality for both clinical and preclinical applications including but not limited to cardiac imaging for heart diseases; 1 neuroimaging for Parkinson disease 2 and epilepsy 3 ; and cancer imaging for primary and metastatic cancers, 4 including brain tumors 5 and hepatocellular carcinoma (HCC) 6 . This wide array of applications is largely due to the discovery and development of MRI contrast agents (CAs) 7 …”