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MR imaging in patients with intractable complex partial epileptic seizures.
B S Brooks1, D W King, T el Gammal
1Department of Radiology, University of Alabama, Birmingham 35233.
AJR. American Journal of Roentgenology
|March 1, 1990
Summary
Magnetic resonance imaging (MRI) aids in diagnosing epilepsy causes. MRI accurately detects structural lesions but is less effective for mesial temporal gliosis in patients with complex partial seizures.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Intractable complex partial seizures often require surgical intervention for epilepsy treatment.
- Accurate preoperative diagnosis is crucial for successful surgical outcomes in epilepsy patients.
- Identifying the underlying cause, whether structural lesions or mesial temporal gliosis, guides treatment decisions.
Purpose of the Study:
- To evaluate the diagnostic accuracy of magnetic resonance (MR) imaging and CT scanning in patients with intractable complex partial seizures undergoing epilepsy surgery.
- To determine the utility of MR imaging in identifying specific pathologies like tumors, vascular malformations, and mesial temporal gliosis.
- To assess the impact of MR imaging on preoperative planning and the need for invasive electroencephalogram (EEG) monitoring.
Main Methods:
- Detailed neurologic studies, high-field-strength MR imaging, and CT scanning were performed preoperatively in 53 patients.
- Patients had intractable complex partial seizures and underwent surgical treatment for epilepsy.
- Pathologic findings were correlated with imaging results to assess diagnostic accuracy.
Main Results:
- Macroscopic structural lesions (tumoral or vascular) were identified in 28% of patients; tumors were benign or low-grade.
- MR imaging accurately diagnosed structural lesions, including occult tumors and cryptic vascular malformations.
- In mesial temporal gliosis cases, MR showed a dilated anterior temporal horn correlating with the seizure focus in some patients, but T2 signal abnormalities were found in only 8%.
Conclusions:
- MR imaging is highly valuable for preoperative diagnosis of structural lesions in epilepsy surgery, potentially obviating invasive EEG monitoring.
- Its utility is limited in identifying epileptogenic abnormalities associated with mesial temporal gliosis.
- Overall, MR provided useful information in 28% of patients with refractory complex partial epilepsy, primarily those with structural lesions.