Aims: The aims of this study were to identify the diagnostic efficacy of dedicated epilepsy protocol in detecting possible structural abnormalities that underlie seizure disorders, and compare the diagnostic yields of MRI and electroencephalogram individually and in combination. Study Design: This was a cross-sectional analytic study. Place and Duration of Study: Medical Imaging and Diagnostic Radiology Department at Tishreen University Hospital, Lattakia, Syria; between July 2019 and July 2020. Methodology: Our study included 100 cases (58 females, 41 males, age range 13-77 years) who presented with seizure over 18 months. Patients underwent complete neurological examination, EEG, and MRI with a standard and dedicated epilepsy protocol. Results: We found epileptogenic lesions in MRI in 55.5%. MRI detected epileptogenic lesions in 74.5% patients who had focal onset seizures. Mesial temporal lobe sclerosis was the most common epileptogenic lesion (45.5%). The diagnostic efficacy of MRI had increased with dedicated epilepsy protocol compared to standard protocol. Abnormal MRI and EEG were compatible in 21%. Conclusion: Dedicated epilepsy protocol increased the diagnostic efficacy of brain MRI in detecting a structural epileptogenic lesion, with 100% of mesial temporal sclerosis, the most common lesion in our study, was detected only in dedicated epilepsy protocol and missed in standard protocol.

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