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A case of epilepsy in multiple sclerosis: Three-dimensional double inversion recovery sequences revealed cortical
Domenico S Zimatore1, Mirko Trentadue1, Marco Castellaro2
11 Neuroradiology, Department of Diagnostics and Pathology, Azienda Ospedaliera Universitaria Integrata Verona, Italy.
Abstract:
In epileptic patients with multiple sclerosis (MS), cortical lesions have been suggested to cause seizures. In brain magnetic resonance imaging (MRI), double inversion recovery (DIR) sequences are generally used to evaluate MS cortical disease burden. We present the case of a woman, diagnosed with MS, suffering from drug-resistant partial seizures initially attributed to MS. The patient underwent many MRI exams, but only by means of high-resolution three-dimensional DIR sequences was a focal cortical dysplasia discovered. The MRI findings and FDG-PET/CT supported the diagnosis. This case recommends the use of DIR sequences both in patients with suspect epileptogenic lesions not detected with routine MRI protocols and in epileptic patient with MS, before ascribing seizures to MS.
Insights
Double inversion recovery (DIR) MRI sequences are crucial for identifying focal cortical dysplasia in multiple sclerosis (MS) patients with drug-resistant epilepsy. This technique aids in diagnosing the seizure cause, distinguishing it from MS itself.
Area of Science:
- Neuroimaging
- Neurology
- Epileptology
Background:
- Cortical lesions in multiple sclerosis (MS) are implicated as a cause of seizures in affected individuals.
- Standard brain magnetic resonance imaging (MRI) protocols may not always detect subtle cortical lesions contributing to epilepsy.
- Double inversion recovery (DIR) sequences are valuable for assessing cortical disease burden in MS.