Role of MRI in patient selection for surgical treatment of intractable epilepsy in infancy

Daghistani, Razan; Widjaja, Elysa

doi:10.1016/j.braindev.2013.03.009

Cited by 18 publications

(14 citation statements)

References 33 publications

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“…1 Absence of a structural lesion on MRI still represents a challenge for surgical management, as it entails a poorer prognosis in both children and adults. [2][3][4][5] Although epileptogenic lesions, mainly focal cortical dysplasia (FCD), have been demonstrated in 30-50% of histopathology specimens of MRI-negative patients, [6][7][8][9][10][11][12] 16-43% of patients referred for presurgical assessment have negative brain MRI.…”

Section: Gre and Flair Imagesmentioning

confidence: 99%

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7TMRIin focal epilepsy with unrevealing conventional field strength imaging

Ciantis

Barba

Tassi³

et al. 2016

Epilepsia

137

127

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SUMMARYObjective: To assess the diagnostic yield of 7T magnetic resonance imaging (MRI) in detecting and characterizing structural lesions in patients with intractable focal epilepsy and unrevealing conventional (1.5 or 3T) MRI. Methods: We conducted an observational clinical imaging study on 21 patients (17 adults and 4 children) with intractable focal epilepsy, exhibiting clinical and electroencephalographic features consistent with a single seizure-onset zone (SOZ) and unrevealing conventional MRI. Patients were enrolled at two tertiary epilepsy surgery centers and imaged at 7T, including whole brain (three-dimensional [3D] T 1 -weighted [T1W] fast-spoiled gradient echo (FSPGR), 3D susceptibility-weighted angiography [SWAN], 3D fluid-attenuated inversion recovery [FLAIR]) and targeted imaging (2D T 2 *-weighted dual-echo gradient-recalled echo [GRE] and 2D gray-white matter tissue border enhancement [TBE] fast spin echo inversion recovery [FSE-IR]). MRI studies at 1.5 or 3T deemed unrevealing at the referral center were reviewed by three experts in epilepsy imaging. Reviewers were provided information regarding the suspected localization of the SOZ. The same team subsequently reviewed 7T images. Agreement in imaging interpretation was reached through consensus-based discussions based on visual identification of structural abnormalities and their likely correlation with clinical and electrographic data. Results: 7T MRI revealed structural lesions in 6 (29%) of 21 patients. The diagnostic gain in detection was obtained using GRE and FLAIR images. Four of the six patients with abnormal 7T underwent epilepsy surgery. Histopathology revealed focal cortical dysplasia (FCD) in all. In the remaining 15 patients (71%), 7T MRI remained unrevealing; 4 of the patients underwent epilepsy surgery and histopathologic evaluation revealed gliosis. Significance: 7T MRI improves detection of epileptogenic FCD that is not visible at conventional field strengths. A dedicated protocol including whole brain FLAIR and GRE images at 7T targeted at the suspected SOZ increases the diagnostic yield.

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Section: Gre and Flair Imagesmentioning

confidence: 99%

“…Histopathology revealed FCD type IIa in two patients (2 and 6), FCD IIb in one (7), FCD IIIa in one (8), and gliosis in four (1,(3)(4)(5).…”

Section: Histopathologymentioning

confidence: 99%

7TMRIin focal epilepsy with unrevealing conventional field strength imaging

Ciantis

Barba

Tassi³

et al. 2016

Epilepsia

137

127

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“…The success of epilepsy surgery is in part dependent on identification of a lesion on MRI. 3 Overall, ictal SPECT has the highest diagnostic sensitivity for both temporal and extratemporal lobe epilepsy, and PET is known to have high sensitivity for the evaluation of extratemporal lobe epilepsy. 4 Also 18 F-FDG PET has a promising role in preoperative epilepsy surgery evaluation for patients with temporal lobe epilepsy.…”

Section: Figurementioning

confidence: 99%

Mammillary Body

Jha

Agarwal²,

Sahoo³

et al. 2016

Clinical Nuclear Medicine

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“…18) Other lesions show lower T2 and higher T1 signals, which are thought to be sec ondary to early myelination and subsequently disappear as mye lination progresses. 19,20) In cases of negative MRI findings during infancy, repeating imaging is recommended at 6month intervals or after 24 months when more mature myelination can reveal otherwise unsuspected cortical dysplasia. 14,19) Similarly, lesions such as cortical tubers in tuberous sclerosis and SturgeWeber syndrome may be more evident on followup imaging.…”

Section: Structural Neuroimaging In Epilepsymentioning

confidence: 99%

Advanced neuroimaging techniques for evaluating pediatric epilepsy

Lee

2020

Clin Exp Pediatr

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Accurate localization of the seizure onset zone is important for better seizure outcomes and preventing deficits following epilepsy surgery. Recent advances in neuroimaging techniques have increased our understanding of the underlying etiology and improved our ability to noninvasively identify the seizure onset zone. Using epilepsy-specific magnetic resonance imaging (MRI) protocols, structural MRI allows better detection of the seizure onset zone, particularly when it is interpreted by experienced neuroradiologists. Ultra-high-field imaging and postprocessing analysis with automated machine learning algorithms can detect subtle structural abnormalities in MRI-negative patients. Tractography derived from diffusion tensor imaging can delineate white matter connections associated with epilepsy or eloquent function, thus, preventing deficits after epilepsy surgery. Arterial spin-labeling perfusion MRI, simultaneous electroencephalography (EEG)-functional MRI (fMRI), and magnetoencephalography (MEG) are noinvasive imaging modalities that can be used to localize the epileptogenic foci and assist in planning epilepsy surgery with positron emission tomography, ictal single-photon emission computed tomography, and intracranial EEG monitoring. MEG and fMRI can localize and lateralize the area of the cortex that is essential for language, motor, and memory function and identify its relationship with planned surgical resection sites to reduce the risk of neurological impairments. These advanced structural and functional imaging modalities can be combined with postprocessing methods to better understand the epileptic network and obtain valuable clinical information for predicting long-term outcomes in pediatric epilepsy.

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Role of MRI in patient selection for surgical treatment of intractable epilepsy in infancy

Cited by 18 publications

References 33 publications

7TMRIin focal epilepsy with unrevealing conventional field strength imaging

7TMRIin focal epilepsy with unrevealing conventional field strength imaging

Mammillary Body

Advanced neuroimaging techniques for evaluating pediatric epilepsy

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