COMMENTARY

Neuroimaging and Epilepsy: State of the Art

Andrew N. Wilner, MD

Disclosures

August 01, 2013

In This Article

Special Neuroimaging Issue

A recent article in the journal Seminars of Neurology[1] reviewed the progress in neuroimaging for epilepsy. The same issue also examined neuroimaging of the afferent visual system, pituitary and parasellar region, cranial nerves, and skull base; neurodegenerative dementias; traumatic brain injury; vascular imaging of the head and neck; transcranial Doppler ultrasonography, positron emission tomography (PET), neurospectroscopy, cerebral perfusion imaging, and functional magnetic resonance imaging (fMRI); and imaging findings in cancer therapy-associated neurotoxicity. The full-text article is available online.

History of Neuroimaging

Epilepsy is a disorder of recurrent seizures with myriad etiologies, ranging from genetic causes to hippocampal sclerosis to traumatic brain injury. Electroencephalography (EEG), which reveals the electrical activity of the brain, has been available since Hans Berger's experiments in the 1920s. However, at that time, only primitive methods for visualizing intracranial structures were available, such as pneumoventriculography and pneumoencephalography.

Pneumoencephalography was a painful procedure that required a lumbar puncture and an injection into the cerebrospinal fluid space, followed by radiography. Cerebral arteriography was another invasive imaging technology introduced in the 1920s. Radioisotope studies also have a long history and have evolved into PET and single photon emission computed tomography (SPECT) scans.

Neuroimaging of the brain that provides a detailed anatomical view and deeper insights into diverse pathologies would not arrive until much later. It was not until the introduction of cranial CT in the 1970s that physicians could routinely correlate seizures, EEG, and underlying brain pathology. A fascinating documentary that tells the story of Godfrey Hounsfield's invention of the CT and its implications for medical care may be watched here. In the 1980s, MRI became available, which revealed even greater neuroanatomical detail than CT.

Brain CT still has applications for people with seizures, particularly in head trauma to assess for skull fractures and hemorrhage or to rapidly evaluate patients with a first seizure. With the advent of CT, there was little further need for invasive pneumoventriculography or pneumoencephalography. Cerebral arteriography has been largely replaced by noninvasive imaging modalities, although specific clinical circumstances still require cerebral angiography.

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