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MRI-Negative Epilepsies

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Surgical Treatment of Epilepsies

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Abstract

The term “MRI-negative” means the absence of an MRI-detectable lesion, while the term “non-lesional” refers to the absence of a specific abnormality on pathological evaluation. During the last years, the quality of MRI has enormously improved facilitating detection of subtle lesions to the range of 1 mm3, that is to an accuracy approximating histopathological analysis. Therefore, from today’s view, the synonymous use of the terms “MRI-negative” and “non-lesional” seems to be justified. MRI-negative epilepsies constitute a heterogeneous group of focal epilepsies amounting to 20–40% (dependent on quality of MRI) of surgical candidates in epilepsy centers. MRI-negative temporal lobe epilepsy seems to represent a distinct syndrome associated with a milder course of the disease and better drug response as compared to classical mesiotemporal lobe epilepsy caused by hippocampal sclerosis and has been thought to primarily involve neocortical rather than mesiotemporal structures. Thus, classical anterior temporal lobectomy may be the treatment of choice for this entity. Surgical results in MRI-negative epilepsies are less favorable as compared with lesional cases. However, careful selection of appropriate candidates using noninvasive and invasive EEG recordings and radionuclide imaging facilitates seizure-free outcome mainly ranging between 40% and 50% in temporal and between 30% and 40% in extratemporal and multilobar procedures.

Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less.

Marie Curie

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    Josef Zentner

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Zentner, J. (2020). MRI-Negative Epilepsies. In: Surgical Treatment of Epilepsies. Springer, Cham. https://doi.org/10.1007/978-3-030-48748-5_10

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