Skip to main content

Why imaging is so important in the evaluation of epilepsy


For any person with epilepsy, it is important to have appropriate images of the brain to assist in determining the cause of epilepsy, expected course of epilepsy, and treatment options. Oftentimes, when someone comes to the emergency department (ED), a CT scan is performed. CT scans are advantageous because they are readily available in nearly all emergency departments, only take a couple of minutes to complete, and show any large or immediately dangerous abnormalities. However, CT scans lack the level of detail needed for a comprehensive evaluation of epilepsy. CT will detect only about 30% of abnormalities that result in epilepsy.
Magnetic resonance imaging (MRI) allows for detailed imaging of the brain and visualization of subtle or small abnormalities that may result in epilepsy. MRI allows for identification for causes of epilepsy such as medial temporal sclerosis, malformations of cortical development, and low grade or benign tumors. All of these findings can result in long term epilepsy – emphasizing the need for imaging – even in someone with a long history of epilepsy! Once it is known which area of the brain seizures arise from, extra review is often required. With extra attention to a specific region, subtle lesions can sometimes be found that were missed in the initial review.
Example 1
Example 1
This MRI is from a 36-year-old woman with an 8-year history of epilepsy. Her first seizure was a generalized tonic-clinic seizure. She continued to have complex partial seizures, which were not controlled despite trials of multiple medications. A repeat MRI was performed, and right mesial temporal sclerosis (MTS) was seen. MTS is the most common cause of epilepsy that is refractory to medical therapy. In these cases, surgery offers the greatest chance of a cure for epilepsy.
Example 2
Example 2
This MRI is from a gentleman that was referred for spells. He describes a lifelong history of recurrent "laughing" spells, without loss of awareness. His wife states she can tell when he is having the events, because he will have a brief smile, which is not his normal smile. He had at least one CT in the past, which was normal, but never an MRI. The arrow points to ahypothalamic hamartoma. These are noncancerous growths in the hypothalamus that characteristically cause laughing or "gelastic" seizures. Other seizure types can occur, including generalized tonic clinic seizures. Treatment options include surgical resection, focused radiation, or laser ablation.
Authored by: Amy Crepeau, MD
Post a Comment

Popular posts from this blog

What Is Continuous Spike-Wave in Slow Wave Sleep Syndrome? (A RARE EPILEPSY)

Image via Wikipedia Continuous spike-wave in slow wave sleep syndrome (CSWS) is a rare epilepsy syndrome in which children lose a wide range of developmental abilities, including language, motor skills, memory, and visuospatial skills. This syndrome occurs in school-aged children. Development prior to onset of CSWS may be normal, but children with CSWS often have some pre-existing learning difficulties. In many children there is no known cause of epilepsy, although some children are found to have abnormal brain formation or have a prior history of brain infection. We still do not understand how these structural changes result in the continuous EEG discharge.

Many, but not all, children with CSWS also have seizures. There can be many different seizure types, including absence, generalized tonic-clonic, and focal seizures. The seizures can be difficult to treat. Even in those who already had learning difficulties, there is a clear loss of skills across multiple deve…

Vitamin B12: The Most Important Nutrient You Need

Image via Wikipedia
Image by icethim via Flickr If you aren’t getting enough vitamin B12, it is indeed very important – and you may very well not be thinking about it. One reason you aren’t thinking about it is that we tend to fall in (and out!) of love with one nutrient at a time (such as vitamin C, beta carotene, lycopene and so on), and vitamin B12 isn’t the nutrient du jour. But the other reason you may not be thinking about it is … because you can’t. A deficiency of vitamin B12 can limit your ability to think clearly about anything! (More on that momentarily.)
Like all vitamins, B12 is an organic compound, made from carbons (as opposed to minerals, which are inorganic), and essential for our normal metabolic function and health. Also, like most vitamins, B12 plays a wide variety of roles in our metabolism. The short list of important effects B12 has on your health includes these: Vitamin B12 is essential for the manufacture of red blood cells; a deficiency leads to a cha…

Aloe Vera - diabetes, asthma, epilepsy, burns, sunburns, psoriasis and osteoarthritis

Introduction This fact sheet provides basic information about aloe vera—common names, uses, potential side effects, and resources for more information. Aloe vera's use can be traced back 6,000 years to early Egypt, where the plant was depicted on stone carvings. Known as the "plant of immortality," aloe was presented as a burial gift to deceased pharaohs.
What Aloe Vera Is Used ForTraditionally, aloe was used topically to heal wounds and for various skin conditions, and orally as a laxative.Today, in addition to traditional uses, people take aloe orally to treat a variety of conditions, including diabetes, asthma, epilepsy, and osteoarthritis. People use aloe topically for osteoarthritis, burns, sunburns, and psoriasis.Aloe vera gel can be found in hundreds of skin products, including lotions and sunblocks.The Food and Drug Administration (FDA) has approved aloe vera as a natural food flavoring. Aloe vera ...Lô Hội, Nha Đam..#1 (Photo credit: Vietnam Plants &…