Brain imaging in epilepsy

Brain imaging with MRI identifies structural cerebral pathology that may give rise to seizures. The greatest yield is from MRI at 3T using epilepsy protocols, and reported by expert neuroradiologists who possess the full clinical data. X-ray CT scanning has a role in assessing patients with seizures in the context of an acute neurological illness. Identifying a relevant structural lesion with MRI is fundamental in the consideration of epilepsy surgery; it is crucial to establish if a lesion is relevant to the epilepsy or not. If no lesion is identified, developmental MRI and image processing may identify a subtle abnormality. Positron-emission tomography (PET) and single-photon emission computed tomography (SPECT) may identify focal functional abnormalities that infer the location of an epileptic focus. Functional MRI is useful for localising eloquent cortex, and tractography delineates crucial white matter tracts, so that these may be avoided in epilepsy surgery. Reviewing data in three dimensions aids visualisation of structural relationships and helps surgical planning.