COMMENTARY

Neuroimaging and Epilepsy: State of the Art

Andrew N. Wilner, MD

Disclosures

August 01, 2013

In This Article

Epilepsy Surgery

Neuroimaging allows precise preoperative definition of potential targets for neurosurgery, which greatly facilitates preoperative planning. For example, hippocampal sclerosis (the underlying lesion in many cases of mesial temporal lobe epilepsy) can now be reliably detected on MRI. Typical imaging features are hippocampal atrophy and increased hippocampal signal on T2-weighted MRI. Because the presence of hippocampal sclerosis predicts a good surgical outcome, neurologists can confidently recommend temporal lobe surgery for patients with medically refractory seizures caused by hippocampal sclerosis.

Another pathologic cause of epilepsy that has yielded much information to improved neuroimaging are malformations of cortical development. These congenital abnormalities include focal cortical dysplasia, hemimegalencephaly, heterotopias, lissencephaly, polymicrogyria and schizencephaly. The ability of MRI to identify these malformations has significantly stimulated research in these conditions and facilitated surgical intervention.

Functional Tests

Functional tests, such as fMRI, MRS, PET, and SPECT, can help define areas of malfunctioning brain, which may reflect the site of a seizure focus. MEG provides complementary information to EEG and may also help pinpoint an epileptic brain region that may potentially be removed.

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