Skip to main content
SpringerLink
Log in

Neuroimaging Evaluation in Neocortical Epilepsies

  • Reference work entry
  • First Online:
Clinical Neuroradiology

  • 3224 Accesses

Abstract

Neocortical epilepsy is a chronic condition characterized by focal or generalized seizures starting within the cortex of any lobe of the brain. In this chapter, some of the most common epileptogenic lesions will be discussed, including malformations of cortical development (MCDs) comprising focal cortical dysplasia (FCD), polymicrogyria (PMG), heterotopia (HTP), hemimegalencephaly (HME), and acquired lesions after vascular and traumatic injuries that can develop to post-stroke epilepsy (PSE) or post-traumatic epilepsy (PTE). Some other lesions like cortical tubers of tuberous sclerosis complex and cavernous angioma, which can be associated to neocortical epilepsy, are treated in other chapters of this book. Clinical neuroradiology plays a pivotal role to establish the diagnosis and to select patient candidate to surgery. The radiological technique fundamental for neocortical epilepsies is brain magnetic resonance imaging (MRI). It is mandatory in patients with drug-resistant focal epilepsy (DRFE) aimed to detect the suspected associated anatomical lesion and to define its location, extension, and relationship with the eloquent brain areas.

An epilepsy-specific protocol is needed to identify even very subtle lesions, particularly tiny FCDs. Knowledge of the electro-clinical presentation is key for planning a correct MRI examination to use the proper sequence angulation. The MRI study should cover the whole brain including different weighted sequences in three planes. Interpretation should be performed by experienced readers and particularly focused on the brain area suspected as the epileptogenic zone (EZ). In non-lesional MRI patients, re-evaluation of MRI could be helpful after all ancillary tests are completed, including nuclear medicine and invasive electrophysiological investigation, such as stereo-electroencephalography (SEEG), to search retrospectively for subtle structural lesions.

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

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 979.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 1,399.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

18F-FDG PET:

18-Fluoro-2-deoxyglucose positron emission tomography

DRFE:

Drug-resistant focal epilepsy

EZ:

Epileptogenic zone

FCD:

Focal cortical dysplasia

HME:

Hemimegalencephaly

HTP:

Heterotopia

MCDs:

Malformations of cortical development

PMG:

Polymicrogyria

PSE:

Post-stroke epilepsy

PSS:

Post-stroke seizures

PTE:

Post-traumatic epilepsy

PTS:

Post-traumatic seizures

SISCOM:

Subtracted ictal SPECT co-registered to MRI

References

  • Barkovich AJ, Guerrini R, Kuzniecky RI, et al. A developmental and genetic classifications for malformations of cortical development: update 2012. Brain. 2012;135:1348–69.

    Article  PubMed  PubMed Central  Google Scholar 

  • Benbir G, Ince B, Bozluolcay M. The epidemiology of post-stroke epilepsy according to stroke subtypes. Acta Neurol Scand. 2006;114(1):8–12.

    Article  CAS  PubMed  Google Scholar 

  • Blümcke I, Thom M, Aronica E, et al. The clinicopathologic spectrum of focal cortical dysplasias: a consensus classification proposed by an ad hoc task force of the ILAE diagnostic methods commission. Epilepsia. 2011;52(1):158–74.

    Article  PubMed  PubMed Central  Google Scholar 

  • Blümcke I, Spreafico R, Haaker G, et al. Histopathologic findings in brain tissue obtained during epilepsy surgery. N Engl J Med. 2017;377:1648–56.

    Google Scholar 

  • Colombo N, Tassi L, Deleo F, et al. Focal cortical dysplasia type IIa and type IIb: MRI aspects in 118 cases proven by histopathology. Neuroradiology. 2012;54(10):1065–77.

    Article  PubMed  Google Scholar 

  • Holthausen H, Pieper T, Coras R, et al. Isolated focal cortical dysplasias type Ia (FCD type Ia) as cause of severe focal epilepsies in children. Neuropediatrics. 2014;45(Suppl):51–5.

    Google Scholar 

  • Pitkänen A, Immonen R. Epilepsy related to traumatic brain injury. Neurotherapeutics. 2014;11(2):286–96.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rossini L, Villani F, Granata T, et al. FCD type II and mTOR pathway: evidence for different mechanisms involved in the pathogenesis of dysmorphic neurons. Epilepsy Res. 2017;129:146–56.

    Article  CAS  PubMed  Google Scholar 

  • Tassi L, Garbelli R, Colombo N, et al. Type I focal cortical dysplasia: surgical outcome is related to histopathology. Epileptic Disord. 2010;12:181–91.

    PubMed  Google Scholar 

  • Tassi L, Garbelli R, Colombo N, et al. Electroclinical, MRI and surgical outcomes in 100 epileptic patients with type II FCD. Epileptic Disord. 2012;14(3):257–66.

    PubMed  Google Scholar 

  • Taylor DC, Falconer MA, Bruton CJ, et al. Focal dysplasia of the cerebral cortex in epilepsy. J Neurol Neurosurg Psychiatry. 1971;34:369–87.

    Article  CAS  Google Scholar 

Suggested Reading

  • Barkovich AJ, Dobyns WB, Guerrini R. Malformations of cortical development and epilepsy. Cold Spring Harb Perspect Med. 2015;5(5):a022392.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bernasconi A, Bernasconi N, Bernhardt BC, et al. Advances in MRI for “cryptogenic” epilepsies. Nat Rev Neurol. 2011;7:99–108.

    Article  PubMed  Google Scholar 

  • Cianfoni A, Caulo M, Cerase A, et al. Seizure-induced brain lesions: a wide spectrum of variably reversible MRI abnormalities. Eur J Radiol. 2013;82(11):1964–72.

    Article  CAS  PubMed  Google Scholar 

  • Cossu M, Pelliccia V, Gozzo F, et al. Surgical treatment of polymicrogyria-related epilepsy. Epilepsia. 2016;57(12):2001–10.

    Article  PubMed  Google Scholar 

  • Fischl B. FreeSurfer. NeuroImage. 2012;62(2):774–81

    Article  PubMed  Google Scholar 

  • Mellerio C, Labeyrie MA, Chassoux F, et al. 3T MRI improves the detection of transmantle sign in type 2 focal cortical dysplasia. Epilepsia. 2014;55(1):117–22.

    Article  PubMed  Google Scholar 

  • Pitkänen A, Roivainen R, Lukasiuk K. Development of epilepsy after ischaemic stroke. Lancet Neurol. 2016;15(2):185–97.

    Article  PubMed  Google Scholar 

  • Thesen T, Quinn BT, Carlson C, et al. Detection of epileptogenic cortical malformations with surface-based MRI morphometry. PLoS One. 2011;6(2):e16430.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Veersema TJ, Ferrier CH, Van Eijsden P, et al. Seven tesla MRI improves detection of focal cortical dysplasia in patients with refractory focal epilepsy. Epilepsia Open. 2017;2(2):162–71.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wagner J, Weber B, Urbach H, et al. Morphometric MRI analysis improves detection of focal cortical dysplasia type II. Brain. 2011;134(Pt 10):2844–54.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neuroradiology Department, Centro Regionale Chirurgia dell’Epilessia “Claudio Munari”, ASST Grande Ospedale Metropolitano Niguarda Cà Granda, Milano, Italy

    Nadia Colombo

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

    Nuria Bargalló

  3. Neuroimaging Laboratory Scientific Institute IRCCS Eugenio Medea, Lecco, Italy

    D. Redaelli

Authors
  1. Nadia Colombo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nuria Bargalló
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Redaelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nadia Colombo .

Editor information

Editors and Affiliations

  1. Department of Radiology and Nuclear Medicine, VU University Medical Centre (VUmc), Amsterdam, The Netherlands

    Frederik Barkhof

  2. The National Hospital for Neurology and Neurosurgery and University College Hospital (UCH), UCL Institute of Neurology, London, UK

    Hans Rolf Jäger

  3. Section of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, University Hospital Vienna, Vienna, Austria

    Majda M. Thurnher

  4. Department of Radiology and Nuclear Medicine Vall d’Hebron University Hospital Professor of Radiology and Neuroimmunology, Autonomous University of Barcelona Vall d’Hebron Research Institute (VHIR), Barcelona, Spain

    Àlex Rovira

Section Editor information

  1. Image Diagnosis Center (CDIC), Hospital Clínic de Barcelona, Barcelona, Spain

    Nuria Bargalló

  2. Magnetic Resonance Image Core Facility, Institut de Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Barcelona, Spain

    Nuria Bargalló

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Colombo, N., Bargalló, N., Redaelli, D. (2019). Neuroimaging Evaluation in Neocortical Epilepsies. In: Barkhof, F., Jäger, H., Thurnher, M., Rovira, À. (eds) Clinical Neuroradiology. Springer, Cham. https://doi.org/10.1007/978-3-319-68536-6_51

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-68536-6_51

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-68535-9

  • Online ISBN: 978-3-319-68536-6

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation