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Epilepsy: Clinical Applications of Diffusion Tensor Imaging

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Functional Neuroradiology

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Abstract

Diffusion MRI has many potential advantages over conventional anatomic imaging for detecting and characterizing both acute seizures and epilepsy. This chapter reviews how diffusion tensor imaging (DTI) and tractography have provided many novel insights into epilepsy-induced changes to the functional and structural organization of the hippocampus, cortex, and underlying white matter for patients with various epilepsy disorders. In temporal lobe epilepsy (TLE) patients, DTI has demonstrated that (1) there are extensive, often bilateral white matter and extrahippocampal changes; (2) significant white matter structural differences between right and left temporal lobe epilepsy; (3) seizure propagation and white matter reorganization may be more widespread when seizures are generated in the dominant cerebral hemisphere due to greater pre-existing connectivity; and (4) the extent of white matter and hippocampal diffusion changes can correlate with the duration or age of onset of seizures, supporting the hypothesis that seizures may damage the brain in a dose-dependent fashion. Furthermore, white matter assessment in TLE patients prior to surgical resection can predict visual field defects based on the extent of resection and also provide objective surrogate markers for language lateralization, verbal, and memory function. In malformations of cortical development or tuberous sclerosis, DTI also demonstrates clinically relevant abnormalities of structural organization both in focal lesions and in nearby or remote normal-appearing white matter. At present, DTI is rapidly expanding our knowledge of functional and structural changes associated with various seizure disorders and is likely to have a growing positive impact on the clinical management of epilepsy patients. Several potential future directions for research are discussed.

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Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, Room L-358, San Francisco, CA, 94143, USA

    Timothy M. Shepherd MD, PhD (Neuradiology Fellow)

  2. Department of Radiology and Biomedical Imaging, San Francisco VA Medical Center, University of California, San Francisco, 505 Parnassus Avenue, Room L-358, San Francisco, CA, 94143, USA

    Christopher P. Hess MD, PhD (Assistant Professor, Neuroradiology, Neuroradiology Chief)

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Correspondence to Timothy M. Shepherd MD, PhD .

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Editors and Affiliations

  1. Temple University School of Medicine, 3401 Broad Street, Philadelphia, 19140-5189, Pennsylvania, USA

    Scott H. Faro

  2. Dept. of Radiology, Temple University Hospital, 3401 Broad Street, Philadelphia, 19140-5189, Pennsylvania, USA

    Feroze B. Mohamed

  3. , Radiology, University of Southern California School, Zonal Avenue 1975, Los Angeles, 90033, California, USA

    Meng Law

  4. , Department of Radiology, Medical College of Wisconsin, Watertown Plank Road 8701, Milwaukee, 53226, USA

    John T. Ulmer

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Shepherd, T.M., Hess, C.P. (2011). Epilepsy: Clinical Applications of Diffusion Tensor Imaging. In: Faro, S., Mohamed, F., Law, M., Ulmer, J. (eds) Functional Neuroradiology. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-0345-7_38

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  • Print ISBN: 978-1-4419-0343-3

  • Online ISBN: 978-1-4419-0345-7

  • eBook Packages: MedicineMedicine (R0)

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