COMMENTARY

Neuroimaging and Epilepsy: State of the Art

Andrew N. Wilner, MD

Disclosures

August 01, 2013

In This Article

Clinical Implications

From years ago in my own practice, I remember one man in his late 20s who had daily seizures despite optimal medical management. Seizures typically began with him raising his left arm, twisting his head to the opposite side, and letting out an "epileptic cry," followed by a tonic/clonic convulsion. Despite the clinical suggestion of a seizure focus in the right frontal lobe, his brain CT was unremarkable. As such, we did not consider seizure surgery.

However, when he finally had an MRI, a small area of abnormal signal was apparent in the right frontal lobe. At his craniotomy, I saw a thickened area of discolored cortex, about 1 cm square. The neurosurgeon removed it without difficulty, as it separated easily from the surrounding normal cortex. Postoperatively, with the dysplastic tissue removed, my patient became seizure-free.

Improving Lives With Neuroimaging

Advances in anatomical and functional neuroimaging have significantly improved the ability to diagnose the etiology of epilepsy and direct surgical therapy. Although EEG remains an important physiologic test, MRI has become an essential part of the evaluation of nearly all patients with epilepsy. Future technological refinements in neuroimaging will aid in the localization of seizure onset, diagnosis of etiopathology, and improvement in the lives of people with epilepsy.

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