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MR imaging in epilepsy that is refractory to medical therapy
1Department of Radiology, Istanbul Sisli Etfal Hospital, Istanbul, Turkey. scakirer@yahoo.com
Abstract:
The aim of this study was the assessment of detection rate on MRI and description of MRI findings in patients with medically intractable epilepsy. Seventy-three patients with medically intractable epilepsy between the ages of 0 and 68 years old were evaluated by MRI, on three planes with spin-echo T1, fast spin-echo T2, and fluid-attenuated inversion recovery sequences, and, if necessary, with contrast-enhanced SE T1 sequences. Cerebral infarct regions with atrophy and gliosis in 8 patients, cerebral tumors in 5 patients, hippocampal sclerosis in 16 patients, radial microbrain in 1 patient, cortical dysplasia in 3 patients, pachygyria in 2 patients, subcortical heterotopia in 2 patients, schizencephaly in 3 patients, cerebral hemiatrophy in 2 patients, tuberous sclerosis in 1 patient, herpes encephalitis in 2 patients, Rasmussen's encephalitis in 1 patient, vascular malformations in 5 patients, and no abnormality in 22 patients were detected. Magnetic resonance imaging has a high success rate in detecting structural brain abnormalities, of both temporal and extratemporal locations, associated with medically intractable epilepsy syndromes. So MRI plays a primary role in planning of the treatment, primarily surgical therapy, by detecting structural epileptogenic lesions.
Insights
Magnetic resonance imaging (MRI) effectively detects structural brain abnormalities in patients with medically intractable epilepsy. This aids in planning surgical treatments by identifying the epileptogenic lesions causing seizures.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Medically intractable epilepsy often requires identifying underlying structural brain abnormalities.
- Magnetic resonance imaging (MRI) is a key diagnostic tool in neurological assessments.
Purpose of the Study:
- To assess the detection rate of MRI in identifying structural brain abnormalities in patients with medically intractable epilepsy.
- To describe the specific MRI findings associated with intractable epilepsy.
Main Methods:
- Seventy-three patients with medically intractable epilepsy underwent MRI scans.
- Multi-planar imaging with T1, fast spin-echo T2, and fluid-attenuated inversion recovery sequences was utilized.
- Contrast-enhanced sequences were employed when necessary.
Main Results:
- MRI detected various structural abnormalities including hippocampal sclerosis (16 patients), infarcts with gliosis (8 patients), tumors (5 patients), and vascular malformations (5 patients).
- No abnormality was found in 22 patients.
- MRI demonstrated a high success rate in detecting both temporal and extratemporal epileptogenic lesions.
Conclusions:
- Magnetic resonance imaging is highly effective in detecting structural brain lesions in medically intractable epilepsy.
- MRI plays a crucial role in guiding treatment decisions, particularly surgical interventions, by pinpointing the source of seizures.