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Related Experiment Videos

Clinical correlations: MRI and EEG

D R Fish1, S S Spencer

  • 1National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.

Magnetic Resonance Imaging
|January 1, 1995
PubMed
Summary
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Structural abnormalities like hippocampal atrophy can indicate epilepsy, but electroencephalography (EEG) is crucial for pinpointing seizure origins, especially in complex cases with dual pathology. Accurate localization via EEG ensures effective surgical treatment for epilepsy.

Area of Science:

  • Neurology
  • Neuroscience
  • Epileptology

Background:

  • Epileptogenesis is associated with structural abnormalities such as hippocampal sclerosis, cortical dysgenesis, and dual pathology.
  • Magnetic Resonance Imaging (MRI) increasingly defines these abnormalities, facilitating electroencephalography (EEG) correlative analyses.
  • Hippocampal atrophy (HA) and medial temporal T2 signal increases are sensitive and specific indicators of mesial temporal sclerosis.

Purpose of the Study:

  • To investigate the concordance between MRI-defined structural abnormalities and EEG localization of seizure onset in epilepsy patients.
  • To highlight the importance of EEG in identifying the true epileptogenic zone, particularly in cases of dual pathology or discordant findings.

Main Methods:

  • Analysis of ictal scalp and intracranial EEG data in patients with temporal lobe epilepsy and hippocampal atrophy.

Related Experiment Videos

  • Correlation of EEG findings with MRI-defined structural abnormalities, including isolated HA and dual pathology.
  • Evaluation of surgical outcomes based on the removal of the EEG-identified seizure onset area versus the MRI-defined lesion.

    • Main Results:

    • In patients with unilateral HA, scalp EEG localized to the atrophic temporal lobe in a subset, but intracranial EEG revealed cases where the seizure focus was elsewhere.
    • A subgroup of patients with unilateral HA showed EEG localization distinct from the atrophy, and surgical removal of the EEG focus led to seizure control.
    • Dual pathology, including HA with foreign tissue lesions or cortical dysgenesis, often requires EEG for accurate localization of the epileptogenic zone, as MRI alone can be misleading.

    Conclusions:

    • While MRI identifies structural correlates of epilepsy, EEG is paramount for accurate localization of the seizure onset zone, especially in complex cases with dual pathology.
    • Failure to consider EEG findings when they discord with MRI can lead to suboptimal surgical outcomes.
    • Further investigation into dual pathology, potentially missed by MRI, is essential for optimizing epilepsy surgery.