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Neuroradiological Evaluation of Patients with Seizures

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Clinical Neuroradiology

Abstract

The management of patients with epilepsy is usually achieved through antiepileptic drugs (AED). However, it is essential to know if there is an underlying cause of epilepsy that may put patient’s life at risk, such as brain tumors, presenting with seizures as the first manifestation. The role of clinical neuroimaging was, for a long time, only to rule out underlying pathology causing epileptic seizures. Advances in magnetic resonance imaging have allowed detection of small malformations of cortical development (MCD), hippocampal sclerosis (HS), or other subtle brain lesions that can be resected in order to achieve seizure freedom. It is well known that patients with a detected epileptogenic lesion have a better prognosis after surgery than patients with negative imaging findings. Therefore, an accurate clinical neuroimaging evaluation in epilepsy is crucial for clinical management. Structural MR with dedicated protocol interpreted by expertise neuroradiologist is essential. Advanced MR techniques, discussed in this chapter, such as MR quantification, diffusion weighted MR imaging (DWI), diffusion tensor imaging (DTI), perfusion MR, functional MR (fMRI), MR spectroscopy (MRS), and nuclear medicine techniques (18F-FDG PET, SPECT and SISCOM), are also crucial in the evaluation of epilepsy.

This publication is endorsed by: European Society of Neuroradiology (www.esnr.org)

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Abbreviations

18F-FDG:

18-fluoro-2-deoxyglucose

ADC:

apparent diffusion coefficient

AED:

Antiepileptic drugs

AIDS:

Acquired immunodeficiency syndrome

ASL:

Arterial Spin Labeling

AVM:

Arteriovenous malformation

BOLD:

Blood Oxygen Level-Dependent

Cr:

Creatine

CSI:

Chemical shift image

CT:

Computer tomography

DIR:

Double inversion recovery

DTI:

Diffusion Tensor Imaging

DWI:

Diffusion Weighted Imaging

ECD:

ethyl cysteine dimer

EEG:

Electroencephalography

FCD:

Focal Cortical Dysplasia

FLAIR:

Fluid attenuated inversion recovery

fMRI:

Functional Magnetic Resonance Imaging

GE:

Gradient echo

HMPAO:

hexamethylpropylenaminooxime

HS:

Hippocampal sclerosis

ILAE:

International League Against Epilepsy

IR:

Inversion recovery

MAP:

Morphometric analysis program

MCD:

Malformations of cortical development

MELAS:

Mitochondrial Myopathy, Encephalopathy, Lactic Acidosis, and Stroke-Like Episodes syndrome

MRI:

Magnetic Resonance Imaging

MRS:

Magnetic Resonance Spectroscopy.

MRSI:

multislice magnetic resonance spectroscopic imaging

MTLE:

Mesial temporal lobe epilepsy

NAA:

N-acetylaspartate

NTLE:

Neocortical temporal lobe epilepsy

PET:

Positron Emission Tomography

PRES:

Posterior reversible encephalopathy syndrome

rCBF:

relative cerebral blood flow

SBM:

Surface-based morphometry

SE:

Status epilepticus

SEEG:

stereoelectroencephalography

SISCOM:

Subtracted Ictal SPECT CO-registered to MRI

SNR:

Signal-to-noise ratio

SPECT:

Single Photon Emission Computed Tomography.

STATSISCOM:

ictal SPECT with statistical ictal SPECT coregistered to MRI

SWI:

Susceptibility weighted imaging

TLE:

Temporal lobe epilepsy

VBM:

Voxel-based morphometry

VEEG:

Video electroencephalography

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Author information

Authors and Affiliations

  1. Radiology Department, Clinic Image Diagnostic Center (CDIC), Hospital Clinic of Barcelona and Magnetic Resonance Image Core Facility, IDIBAPS, Barcelona, Spain

    Nuria Bargalló

  2. Nuclear Medicine Department, Clinic Image Diagnostic Center (CDIC), Hospital Clinic of Barcelona and CIBER-BBN, Barcelona, Spain

    Xavier Setoain

  3. Epilepsy Unit, Neurology Department, Neuroscience Institute, Hospital Clinic of Barcelona and IDIBAPS, Barcelona, Spain

    Mar Carreño

Authors
  1. Nuria Bargalló
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  2. Xavier Setoain
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  3. Mar Carreño
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Corresponding author

Correspondence to Nuria Bargalló .

Editor information

Editors and Affiliations

  1. Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands

    Frederik Barkhof

  2. National Hosp.f Neurology & Neurosurgery, UCL National Hosp.f Neurology & Neurosurgery, London, UK

    Rolf Jager

  3. Division of Neuroradiology, University Hospital Vienna Division of Neuroradiology, Wien, Austria

    Majda Thurnher

  4. Department of Neuroradiology, Hospital Vall d’Hebrón Department of Neuroradiology, Barcelona, Spain

    Alex Rovira Cañellas

Section Editor information

  1. Magnetic Resonance Image Core Facility. Institut de Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Image Diagnosis Center (CDIC). Hospital Clínic de Barcelona, Barcelona, Spain

    N. Bargalló

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Bargalló, N., Setoain, X., Carreño, M. (2019). Neuroradiological Evaluation of Patients with Seizures. In: Barkhof, F., Jager, R., Thurnher, M., Rovira Cañellas, A. (eds) Clinical Neuroradiology. Springer, Cham. https://doi.org/10.1007/978-3-319-61423-6_49-1

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  • DOI: https://doi.org/10.1007/978-3-319-61423-6_49-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-61423-6

  • Online ISBN: 978-3-319-61423-6

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