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Advanced imaging in epilepsy: literature review and our experience


Background. The diagnosis of epilepsy is mostly based on clinical features of seizures and the results of electrophysiological and neuroimaging methods. Unluckily, there is no single imaging technique that can provide all the needed information: to confirm the etiology of seizures, to prognose the outcome of the disease and provide both structural and functional information that is required in pre-surgical evaluation of patients with drug-resistant epilepsy.

Aims and Objectives. 1. Systematic literature review of existing evidence. 2. To share our experience with epilepsy imaging.

Materials and methods. 1. A systemic search for relevant studies was performed from Medline (PubMed), Lippincott Williams & Wilkins, ScienceDirect, SpringerLink and Cochrane Library databases (these databases have been submitted on LSMUNI Library list of subscribed databases). 2. Thirty five patients with clinically proven refractory epilepsy were included into the study. All patients underwent a Fluorodeoxyglucose-18-PET/CT scan, MRI scan with epilepsy protocol used in our center, and an EEG at least 1 hour prior to a PET study and minimum 60 min in duration. The MRI was performed not earlier than 6 months before the PET/CT scan. All diagnostic tests were performed at Lithuanian University of Health Sciences hospital.

Results. We reviewed literature and characterized the complex correlation between imaging studies. Neuroimaging plays an important role in workup of patients with epilepsy. It helps to identify brain pathologies that require specific treatment. Identification of these lesions often helps in managing epilepsies more effectively.

In our experience most common localization of epileptogenic focus on all three imaging methods we chose were right temporal lobe. According to Wilcoxon signed ranks test results there is statistically significant difference in lesion amount between the different diagnostic methods.

Conclusions. This review compares available advanced imaging modalities, their specific role in patients with epilepsy, and practical applications of imaging data in the management of patients with epilepsy.

Keywords: epilepsy, MRI, FDG-PET, SPECT, spectroscopy, diffusion tensor imaging