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Magnetic Resonance Imaging in Epilepsy

      The magnetic resonance imaging (MRI) appearance of the various histologic substrates of epilepsy and the clinical role of MRI in symptomatic epilepsy are reviewed. MRI is used clinically to identify potential surgical candidates among patients with epilepsy, assist in surgical planning, and help to determine the prognosis of patients with epileptic seizures. MRI can clearly characterize the morphologic substrates that underlie the electroclinical abnormalities noted in patients with epilepsy. The histologic substrates of symptomatic epilepsy can be divided into five major categories: tumors, disorders of neuronal migration and cortical organization, vascular malformations, mesial temporal sclerosis, and neocortical sclerosis attributable to brain injury (trauma, infection, inflammation, or infarction). Because of its ability to disclose subtle alterations in cortical architecture or changes in signal intensity, MRI is the most sensitive and specific imaging technique for the noninvasive identification of each of these substrates. Introduction of MRI into clinical practice during the past 10 years has substantially changed the management of patients with epilepsy.
      AVM (arteriovenous malformation), CT (computed to mography), 3D (three-dimensional), DNETs (dysemhryoplastic neuroepithelial tumors), EEG (electroencephalographic), FLAIR (fluid-attenuated inversion attenuated inversion recovery), MRI (magnetic resonance imaging), NMDs (neuronal migration disorders)
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      References

        • Jackson JH
        A study of convulsions.
        Trans St Andrews Med Graduates Assoc. 1870; 3: 1-45
        • Jackson JH
        On the anatomical, physiological, and pathological investigation of the epilepsies.
        West Riding Lunatic Asylum Med Rep. 1873; 3: 315-332
        • Jack Jr, CR
        Magnetic resonance imaging: neuroimaging and anatomy.
        Neuroimaging Clin N Am. 1995 Nov; 5: 597-622
        • Heinz ER
        • Heinz TR
        • Radtke R
        • Darwin R
        • Drayer BP
        • Fram E
        • et al.
        Efficacy of MR vs CT in epilepsy.
        AJNR Am J Neuroradiol. 1988; 9: 1123-1128
        • Laster DW
        • Penry JK
        • Moody DM
        • Ball MR
        • Witcofski RL
        • Riela AR
        Chronic seizure disorders: contribution of MR imaging when CT is normal.
        AJNR Am J Neuroradiol. 1985; 6: 177-180
        • Latack JT
        • Abou-Khalil BW
        • Siegel GJ
        • Sackellares JC
        • Gabrielsen TO
        • Aisen AM
        Patients with partial seizures: evaluation by MR, CT, and PET imaging.
        Radiology. 1986; 159: 159-163
        • Ormson MJ
        • Kispert DB
        • Sharbrough FW
        • Houser OW
        • Earnest FIV
        • Scheithauer BW
        • et al.
        Cryptic structural lesions in refractory partial epilepsy: MR imaging and CT studies.
        Radiology. 1986; 160: 215-219
        • Schorner W
        • Meencke HJ
        • Felix R
        Temporal-lobe epilepsy: comparison of CT and MR imaging.
        AJNR Am J Neuroradiol. 1987; 8: 773-781
        • Bronen RA
        Epilepsy: the role of MR imaging.
        AJR Am J Roentgenol. 1992; 159: 1165-1174
        • Jack Jr, CR
        Epilepsy: surgery and imaging.
        Radiology. 1993; 189: 635-646
        • Cascino GD
        • Jack Jr, CR
        • Parisi JE
        • Marsh WR
        • Kelly PJ
        • Sharbrough FW
        • et al.
        MRI in the presurgical evaluation of patients with frontal lobe epilepsy and children with temporal lobe epilepsy: pathologic correlation and prognostic importance.
        Epilepsy Res. 1992; 11: 51-59
        • Cascino GD
        • Kelly PJ
        • Sharbrough FW
        • Hulihan JF
        • Hirschorn KA
        • Trenerry MR
        Long-term follow-up of stereotactic lesionectomy in partial epilepsy: predictive factors and electroencephalographic results.
        Epilepsia. 1992; 33: 639-644
        • Jack Jr, CR
        • Sharbrough FW
        • Cascino GD
        • Hirschorn KA
        • O'Brien PC
        • Marsh WR
        Magnetic resonance image-based hippocampal volumetry: correlation with outcome after temporal lobectomy.
        Ann Neurol. 1992; 31: 138-146
        • Engel Jr, J
        Outcome with respect to epileptic seizures.
        in: Engel Jr, J Surgical Treatment of the Epilepsies. Raven Press, New York1987: 553-571
        • Surgery for epilepsy [Consensus Conference]
        JAMA. 1990; 264: 729-733
        • Commission on Classification and Terminology of the International League Against Epilepsy
        Proposal for revised classification of epilepsies and epileptic syndromes.
        Epilepsia. 1989; 30: 389-399
        • Commission on Classification and Terminology of the International League Against Epilepsy
        Proposal for revised clinical and electroencephalographic classification of epileptic seizures.
        Epilepsia. 1981; 22: 489-501
        • Sperling MR
        • Wilson G
        • Engel Jr, J
        • Babb TL
        • Phelps M
        • Bradley W
        Magnetic resonance imaging in intractable par-tial epilepsy: correlative studies.
        Ann Neurol. 1986; 20: 57-62
        • Theodore WH
        • Katz D
        • Kufta C
        • Sato S
        • Patronas N
        • Smoth-ers P
        • et al.
        Pathology of temporal lobe foci: correlation with CT, MRI, and PET.
        Neurology. 1990; 40: 797-803
        • Brooks BS
        • King DW
        • El Gammal T
        • Meador K
        • Yaghmai F
        • Gay JN
        • et al.
        MR imaging in patients with intractable complex partial epileptic seizures.
        AJNR Am J Neuroradiol. 1990; 11: 93-99
        • Kuzniecky R
        • de la Sayette V
        • Ethier R
        • Melanson D
        • Andermann F
        • Berkovic S
        • et al.
        Magnetic resonance imaging in temporal lobe epilepsy: pathological correlations.
        Ann Neurol. 1987; 22: 341-347
        • Jack Jr, CR
        • Sharbrough FW
        • Twomey CK
        • Cascino GD
        • Hirschorn KA
        • Marsh WR
        • et al.
        Temporal lobe seizures: lateralization with MR volume measurements of hippocam-pal formation.
        Radiology. 1990; 175: 423-429
        • Jackson GD
        • Berkovic SF
        • Tress BM
        • Kalnins RM
        • Fabinyi GC
        • Bladin PF
        Hippocampal sclerosis can be reliably de-tected by magnetic resonance imaging.
        Neurology. 1990; 40: 1869-1875
        • Jackson GD
        • Berkovic SF
        • Duncan JS
        • Connelly A
        Op-timizing the diagnosis of hippocampal sclerosis using MR imaging.
        AJNR Am J Neuroradiol. 1993; 14: 753-762
        • Berkovic SF
        • Andermann F
        • Olivier A
        • Ethier R
        • Melanson D
        • Robitaille Y
        • et al.
        Hippocampal sclerosis in temporal lobe epilepsy demonstrated by magnetic resonance imaging.
        Ann Neurol. 1991; 29: 175-182
        • Bronen RA
        • Cheung G
        • Charles JT
        • Kim JH
        • Spencer DD
        • Spencer SS
        • et al.
        Imaging findings in hippocampal sclerosis: correlation with pathology.
        AJNR Am J Neuroradiol. 1991; 12: 933-940
      1. Friedland BR. Tumors and vascular malformations. In: Jack CR Jr, Cascino GD, editors. Neuroimaging in Epileps: Principles and Practice. Newton (MA): Butterworth-Heinemann [in press]

        • Okazaki H
        • Scheithauer BW
        Atlas of Neuropathology. Lippincott, Philadelphia1988: 59-216
        • Daumas-Duport C
        • Scheithauer BW
        • Chodkiewicz JP
        • Laws Jr, ER
        • Vedrenne C
        Dysembryoplastic neuroepithelial tumor: a surgically curable tumor of young patients with intractable partial seizures; report of thirty-nine cases.
        Neurosurgery. 1988; 23: 545-556
      2. Kuzniecky R. Migration anomalies. In: Jack CR Jr, Cascino GO, editors. Neuroimaging in Epilepsy: Principles and Practice. Newton (MA): Butterworth-Heinemann [in press]

        • Barkovich AJ
        Pédiatrie Neuroimaging. Raven Press, New York1995: 277-319 (a) 177–275; (b)
        • Barkovich AJ
        • Gressens P
        • Evrard P
        Formation, maturation, and disorders of brain neocortex.
        AJNR Am J Neuroradiol. 1992; 13: 423-446
        • Barth PG
        Disorders of neuronal migration.
        Can J Neurol Sei. 1987; 14: 1-16
        • Sidman RL
        • Rakic P
        Neuronal migration, with special refer-ence to developing human brain: a review.
        Brain Res. 1973; 62: 1-35
        • Rakic P
        Defects of neuronal migration and the pathogenesis of cortical malformations.
        Prog Brain Res. 1988; 73: 15-37
        • McConnell SK
        Development and decision-making in the mammalian cerebral cortex.
        Brain Res Brain Res Rev. 1988; 13: 1-23
        • Shatz CJ
        Dividing up the neocortex.
        Science. 1992; 258: 237-238
        • Smith AS
        • Blaser SI
        • Ross JS
        • Weinstein MA
        Magnetic resonance imaging of disturbances in neuronal migration: illustration of an embryologie process.
        Radiographies. 1989; 9: 509-522
        • Rakic P
        Neuronal migration and contact guidance in the primate telencephalon.
        Postgrad Med J. 1978; 54: 25-40
        • Barkovich AJ
        • Chuang SH
        • Norman D
        MR of neuronal migration anomalies.
        AJNR Am J Neuroradiol. 1987; 8: 1009-1017
        • Gomez MR
        Tuberous Sclerosis. 2nd ed. Raven Press, New York1988
        • Taylor DC
        • Falconer MA
        • Bruton CJ
        • Corsellis JA
        Focal dysplasia of the cerebral cortex in epilepsy.
        J Neurol Neurosurg Psychiatry. 1971; 34: 369-387
        • Byrd SE
        • Osborn RE
        • Bohan TP
        • Naidich TP
        The CT and MR evaluation of migrational disorders of the brain. Part II. Schizencephaly, heterotopia and polymicrogyria.
        Pediatr Radiol. 1989; 19: 219-222
        • Palmini A
        • Andermann F
        • Olivier A
        • Tampieri D
        • Robitaille Y
        • Andermann E
        • et al.
        Focal neuronal migration disorders and intractable partial epilepsy: a study of 30 patients.
        Ann Neurol. 1991; 30: 741-749
        • Kuzniecky R
        • Berkovic S
        • Andermann F
        • Melanson D
        • Olivier A
        • Robitaille Y
        Focal cortical myoclonus and rolandic cortical dysplasia: clarification by magnetic reso-nance imaging.
        Ann Neurol. 1988; 23: 317-325
        • Kuzniecky R
        • Andermann F
        • Tampieri D
        • Melanson D
        • Olivier A
        • Leppik I
        Bilateral central macrogyria: epilepsy, pseudobulbar palsy, and mental retardation—a recognizable neuronal migration disorder.
        Ann Neurol. 1989; 25: 547-554
        • Kuzniecky R
        • Garcia JH
        • Faught E
        • Morawetz RB
        Cortical dysplasia in temporal lobe epilepsy: magnetic resonance imaging correlations.
        Ann Neurol. 1991; 29: 293-298
        • Barkovich AJ
        • Kjos BO
        Nonlissencephalic cortical dyspla-sias: correlation of imaging findings with clinical deficits.
        AJNR Am J Neuroradiol. 1992; 13: 95-103
        • Huttenlocher PR
        • Taravath S
        • Mojtahedi S
        Periventricular heterotopia and epilepsy.
        Neurology. 1994; 44: 51-55
        • Smith AS
        • Weinstein MA
        • Quencer RM
        • Muroff LR
        • Stonesifer KJ
        • Li FC
        • et al.
        Association of heterotopic gray matter with seizures: MR imaging.
        Radiology. 1988; 168: 195-198
        • Barkovich AJ
        • Kjos BO
        Gray matter heterotopias: MR characteristics and correlation with developmental and neu-rologic manifestations.
        Radiology. 1992; 182: 493-499
        • Margerison JH
        • Corsellis JA
        Epilepsy and the temporal lobes: a clinical, electroencephalographic and neuropathological study of the brain in epilepsy, with particular refer-ence to the temporal lobes.
        Brain. 1966; 89: 499-530
        • Babb TL
        • Brown WJ
        • Pretorius J
        • Davenport C
        • Lieb JP
        • Crandall PH
        Temporal lobe volumetric cell densities in temporal lobe epilepsy.
        Epilepsia. 1984; 25: 729-740
        • Dam AM
        Epilepsy and neuron loss in the hippocampus.
        Epilepsia. 1980; 21: 617-629
        • Jack Jr, CR
        • Gehring DG
        • Sharbrough FW
        • Felmlee JP
        • Forbes G
        • Hench VS
        • et al.
        Temporal lobe volume measure-ment from MR images: accuracy and left-right asymmetry in normal persons.
        J Comput Assist Tomogr. 1988; 12: 21-29
        • Jack Jr, CR
        • Twomey CK
        • Zinsmeister AR
        • Sharbrough FW
        • Petersen RC
        • Cascino GD
        Anterior temporal lobes and hippocampal formations: normative volumetric measure-ments for MR images in young adults.
        Radiology. 1989; 172: 549-554
        • Jack Jr, CR
        • Bentley MD
        • Twomey CK
        • Zinsmeister AR
        MR imaging-based volume measurements of the hippocampal formation and anterior temporal lobe: validation studies.
        Radiology. 1990; 176: 205-209
        • Cascino GD
        • Jack Jr, CR
        • Parisi JE
        • Sharbrough FW
        • Hirschorn KA
        • Meyer FB
        • et al.
        Magnetic resonance imaging-based volume studies in temporal lobe epilepsy: patho-logical correlations.
        Ann Neurol. 1991; 30: 31-36
        • Lencz T
        • McCarthy G
        • Bronen RA
        • Scott TM
        • Inserni JA
        • Sass KJ
        • et al.
        Quantitative magnetic resonance imaging in temporal lobe epilepsy: relationship to neuropathology and neuropsychological function.
        Ann Neurol. 1992; 31: 629-637
        • Jack Jr, CR
        • Trenerry MR
        • Cascino GD
        • Sharbrough RW
        • So EL
        • O'Brien PC
        Bilaterally symmetric hippocampi and surgical outcome.
        Neurology. 1995; 45: 1248-1250
        • Trenerry MR
        • Jack Jr, CR
        • Ivnik RJ
        • Sharbrough FW
        • Cascino GD
        • Hirschorn KA
        • et al.
        MRI hippocampal volumes and memory function before and after temporal lobectomy.
        Neu-rology. 1993; 43: 1800-1805
        • Trenerry MR
        • Jack Jr, CR
        • Sharbrough FW
        • Cascino GD
        • Hirschorn KA
        • Marsh WR
        • et al.
        Quantitative MRI hippo-campal volumes: association with onset and duration of epilepsy, and febrile convulsions in temporal lobectomy patients.
        Epilepsy Res. 1993; 15: 247-252
        • Jackson GD
        • Connelly A
        • Duncan JS
        • Grunewald RA
        • Gadian DG
        Detection of hippocampal pathology in intractable par-tial epilepsy: increased sensitivity with quantitative magnetic resonance T2 relaxometry.
        Neurology. 1993; 43: 1793-1799
        • Cascino GD
        • Jack Jr, CR
        • Parisi JE
        • Sharbrough FW
        • Schreiber CP
        • Kelly PJ
        • et al.
        Operative strategy in patients with MRI-identified dual pathology and temporal lobe epi-lepsy.
        Epilepsy Res. 1993; 14: 175-182
        • Horsley V
        Brain-surgery.
        BMJ. 1886; 2: 670-674
        • Rasmussen T
        • Olszewski J
        • Lloyd-Smith DL
        Focal seizures due to chronic localized encephalitis.
        Neurology. 1958; 8: 435-445
        • Rogers SW
        • Andrews PI
        • Gahring LC
        • Whisenand T
        • Cauley K
        • Crain B
        • et al.
        Autoantibodies to glutamate receptor GluR3 in Rasmussen's encephalitis.
        Science. 1994; 265: 648-651
        • Bergin PS
        • Fish DR
        • Shorvon DS
        • Oatridge A
        • de Souza NM
        • Bydder GM
        Magnetic resonance imaging in partial epilepsy: additional abnormalities shown with the fluid attenuated in-version recovery (FLAIR) pulse sequence.
        J Neurol Neurosurg Psychiatry. 1995; 58: 439-443
        • Rydberg JN
        • Hammond CA
        • Grimm RC
        • Erickson BJ
        • Jack Jr, CR
        • Huston J
        • et al.
        Initial clinical experience in MR imaging of the brain using a fast fluid-attenuated inversion-recovery pulse sequence.
        Radiology. 1994; 193: 173-180
        • Jack Jr, CR
        • Rydberg CH
        • Krecke KN
        • Trenerry MR
        • Parisi JE
        • Rydberg JN
        • et al.
        Comparison of FLAIR and spin echo MR imaging in the diagnosis of mesial temporal sclerosis.
        Radiology. 1996; 199: 367-373