Imaging Offers Greater Insight into Epilepsy

Advances in MRI have enabled better understanding for diagnosing epilepsy, while multimodality techniques allow for better information for surgery and post-surgery follow up, according to experts presenting at ECR 2011.

The cause of epilepsy, a chronic nuerological disorder, is a mystery, but over the last 30 years, MRI advances have helped physicians determine a large number of underlying causes, particularly for intractable epilepsy, experts said.

“If there is a field where imaging has had an impact, it is certainly in patients with intractable epilepsy,” said Beatriz Gómez-Ansón, head of the neuroradiology unit at Hospital Sant Pau in Barcelona, who chaired a refresher course at the congress this week.

Intractable epilepsy, which affects 5 percent of epilepsy patients, is only treatable with surgery. Through imaging, physicians have determined that intractable epilepsy is mainly caused by non-neoplastic conditions, such as hippocampus sclerosis, or abnormalities of cortical development, either congenital or related to an infancy condition, according to a release about the session.

Imaging also now helps with treatment planning. For example, MRI usually provides enough information to show where a tumor is located. But when MRI fails to reveal focal, structural pathology as the putative aetiology for the seizures, other modalities may be considered, researchers said.

“Ictal SPECT may help to identify focal areas of hyperperfusion – ictal zones – while functional MRI is used to determine language laterality (dominant hemisphere) and localize eloquent cortical structures to aid the planning of the surgical approach,” Doctor Lars Stenberg, radiologist at Lund University Hospital, said in the release.