Approximately 4 % of the general population will experience a seizure during their lifetime. Imaging in these “first-ever” seizure patients is in most cases normal, and abnormalities are only present in approximately 15 % of patients as seizures can be provoked by fever, sleep deprivation, stroboscopic lights, or drugs. However, an underlying lesion will lower the seizure threshold and thus make a patient more susceptible to experience a seizure. As “first-ever seizures” are a medical emergency, the treatment modality of choice in these cases is an unenhanced CT to exclude acute medical emergencies that may go along with seizures prior to a more extensive workup depending on clinical history and presentation. Imaging abnormalities encountered in patients experiencing their first-ever seizures include (but are not restricted to) virtually all diseases affecting the brain. As such you may find vascular abnormalities (such as microangiopathy, arteriovenous malformations (AVM), sinus thrombosis, hemorrhage, cavernomas, or stroke), tumors (metastases, primary tumors), infections (encephalitis, meningitis, abscess), sequelae of previous head injury, and toxic or metabolic conditions (e.g., PRES) in these patients.
MRI Neuroimaging Epilepsy Seizures
This is a preview of subscription content, log in to check access.
von Oertzen J, Urbach H, Jungbluth S et al (2002) Standard magnetic resonance imaging is inadequate for patients with refractory focal epilepsy. J Neurol Neurosurg Psychiatry 73:643–647CrossRefGoogle Scholar
Téllez-Zentenoa JF, Ronquilloa H, Moien-Afshari F et al (2010) Surgical outcomes in lesional and non-lesional epilepsy: a systematic review and meta-analysis. Epilepsy Res 89:310–318CrossRefGoogle Scholar
Wellmer J, Quesada CM, Rothe L et al (2013) Proposal for a magnetic resonance imaging protocol for the detection of epileptogenic lesions at early outpatient stages. Epilepsia 54:1977–1987CrossRefPubMedGoogle Scholar
Strandberg M, Larsson EM, Backman S et al (2008) Pre-surgical epilepsy evaluation using 3T MRI. Do surface coils provide additional information? Epileptic Disord 10:83–92PubMedGoogle Scholar
Winstona GP, Micallef C, Brian E, Kendell BE (2013) The value of repeat neuroimaging for epilepsy at a tertiary referral centre: 16 years of experience. Epilepsy Res 105:349–355CrossRefGoogle Scholar
Bauer PR, Reitsma JB, Bernard M, Houweling BM et al (2014) Can fMRI safely replace the Wada test for preoperative assessment of language lateralisation? A meta-analysis and systematic review. J Neurol Neurosurg Psychiatry 85:581–588CrossRefPubMedGoogle Scholar
Piper RJ, Yoong MM, Kandasamy J et al (2014) Application of diffusion tensor imaging and tractography of the optic radiation in anterior temporal lobe resection for epilepsy: a systematic review. Clin Neurol Neurosurg 124:59–65CrossRefPubMedGoogle Scholar
Desai A, Bekelis K, Thadani VM et al (2013) Interictal PET and ictal subtraction SPECT: sensitivity in the detection of seizure foci in patients with medically intractable epilepsy. Epilepsia 54:341–350CrossRefPubMedGoogle Scholar
Barkovich AJ, Guerrini R, Kuzniecky RI et al (2012) A developmental and genetic classification for malformations of cortical development: update. Brain 135:1348–1369CrossRefPubMedPubMedCentralGoogle Scholar
Guerrini R, Duchowny M, Jayakar P et al (2015) Diagnostic methods and treatment options for focal cortical dysplasia. Epilepsia 56:1669–1686CrossRefPubMedGoogle Scholar
Pohlmann-Eden B, Crocker CE, Matthias H, Schmidt MH (2013) A conceptual framework for the use of neuroimaging to study and predict pharmacoresistance in epilepsy. Epilepsia 54:75–79CrossRefPubMedGoogle Scholar