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Imaging for Adults With Seizures and Epilepsy

Lapalme-Remis, Samuel MDCM, MA, FRCPC; Cascino, Gregory D. MD, FAAN

CONTINUUM: Lifelong Learning in Neurology: October 2016 - Volume 22 - Issue 5, Neuroimaging - p 1451–1479
doi: 10.1212/CON.0000000000000370
Review Articles

ABSTRACT Purpose of Review: This article discusses structural and functional neuroimaging findings in patients with seizures and epilepsy. The indications for neuroimaging in these patients and the potential diagnostic utility of these studies are presented.

Recent Findings: Patients presenting with new seizures typically require urgent imaging to rule out a critical underlying cause. MRI is the structural neuroimaging procedure of choice in individuals with epilepsy. Specific epilepsy protocols should be considered to increase the diagnostic yield of neuroimaging in patients with structural lesions associated with focal or generalized seizures. Common epileptogenic pathologic processes include mesial temporal sclerosis, malformations of cortical development, focal encephalomacia, primary brain tumors, vascular malformations, and neurocysticercosis. Functional neuroimaging studies are usually restricted to the evaluation of patients with drug-resistant focal epilepsy who are being considered for surgical treatment.

Summary: The role of neuroimaging in epilepsy depends on the appropriate clinical indication. In patients without known epilepsy presenting with acute seizures, structural imaging is essential to rule out an underlying etiology (eg, subdural hematoma) that may require a specific therapeutic intervention. In individuals with new or previously uninvestigated epilepsy, MRI serves multiple purposes, including identifying a causative focal lesion and helping to diagnose the epilepsy type. In a significant number of patients with epilepsy, the MRI results are normal or reveal indeterminate findings. For patients with drug-resistant focal epilepsy, functional neuroimaging techniques, such as fludeoxyglucose-positron emission tomography (FDG-PET), ictal single-photon emission computed tomography (SPECT), or functional MRI (fMRI), may assist in surgical planning, especially in patients with MRI-negative epilepsy, whose prognosis for a seizure-free outcome after surgery is worse than for patients with an epileptogenic lesion on structural MRI.

Address correspondence to Dr Gregory D. Cascino, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, gcascino@mayo.edu.

Relationship Disclosure: Dr Lapalme-Remis reports no disclosure. Dr Cascino serves on the board of directors of the American Academy of Neurology and as an associate editor of Neurology. Dr Cascino receives royalties from Mayo Medical Ventures and UpToDate, Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Drs Lapalme-Remis and Cascino report no disclosures.

© 2016 American Academy of Neurology
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