Neuroimaging in epilepsy: the state of the art

Our understanding of epileptogenesis is still limited. Knowledge is increasing with regard to structural and functional changes in chronic stages of epilepsy. At the same time, we have to appreciate that there is a significant lack of such information in new-onset epilepsy. The First Halifax International Epilepsy Conference tried to fill this gap, focusing on the contribution of advanced neuroimaging in early stages of epilepsy. The following article aims to synthesize the themes that emerged from this meeting. Participants agreed that (1) there is a need for a unified theory of epileptogenesis, addressing the interplay of functional and structural brain changes; (2) neuroimaging reveals widespread brain alterations in epilepsy; (3) advances in neuroimaging challenge the concept of "MRI-negative" (magnetic resonance imaging negative) focal epilepsy; (4) methodologic limitations and potential confounders must be considered in the translation of innovative imaging approaches to clinical practice; and (5) there is an urgent need for longitudinal studies that begin early in the disease process.