Neuroimaging and the Epilepsy Journey

Area of Science:

• Neurology
• Neurosurgery
• Medical Imaging

Background:

• Epilepsy affects millions globally, with a significant portion experiencing drug-resistant seizures.
• Current epilepsy care pathways increasingly rely on advanced diagnostics to optimize treatment strategies.
• Identifying the epileptogenic zone is crucial for effective surgical intervention in refractory epilepsy.

Purpose of the Study:

• To review the role of neuroimaging in guiding treatment decisions for drug-resistant epilepsy.
• To detail various noninvasive and invasive diagnostic modalities used in presurgical evaluation.
• To illustrate the integration of these techniques for precise localization and surgical targeting.

Main Methods:

• Review of noninvasive neuroimaging: structural CT and MR imaging, PET, ictal/interictal SPECT, and magnetoencephalography.
• Description of invasive diagnostic approaches: video-scalp EEG monitoring and invasive EEG monitoring.
• Integration of multimodal data for epileptogenic zone localization.
• Case study demonstrating presurgical evaluation and stereoelectroencephalography-guided resection.

Main Results:

• Neuroimaging modalities effectively support treatment decisions in drug-resistant epilepsy.
• Multimodal diagnostic approaches enable accurate localization of the epileptogenic zone.
• These techniques guide targeted surgical interventions such as resection, laser ablation, and neuromodulation.
• Stereoelectroencephalography-guided resection proved effective in the illustrative case study.

Conclusions:

• Neuroimaging is integral to modern epilepsy care, particularly for drug-resistant cases.
• A multimodal diagnostic strategy is essential for precise epileptogenic zone localization.
• Advanced imaging and invasive monitoring facilitate successful surgical outcomes in epilepsy management.