Skip to main content
SpringerLink
Log in

Imaging of the epilepsies

  • Neuro
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Imaging of epilepsy patients is challenging, since epileptogenic lesions (defined as structural lesions causally related to the epilepsy syndrome) may be small and often do not change during life. Prior clinical information about the epilepsy syndrome and the semiology of the seizures is needed in order to plan the examination properly. The effort to detect an epileptogenic lesion is directed to partial (focal) epilepsy syndromes whereas—by definition—no lesion is identified in idiopathic epilepsies. Most patients with partial epilepsies suffer from mesial temporal lobe epilepsies. In these patients, 2- to 3-mm-thick T2-weighted and fluid-attenuated inversion-recovery (FLAIR) fast spin echo slices along or perpendicular to the temporal lobe length axis have the highest diagnostic efficacy. In contrast, in patients with extratemporal lobe epilepsies perpendicular FLAIR slices through the anatomic region, from which, due to clinical and EEG criteria, the seizures are likely to originate, are preferred. The imaging features of common epileptogenic lesions (hippocampal sclerosis, long-term epilepsy-associated tumours, focal cortical dysplasias, vascular malformations, encephalitis including limbic and Rasmussen’s encephalitis, gyral scarring including ulegyria) are detailed in the second section of this paper.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4A–C

Similar content being viewed by others

References

  1. Engel J Jr (1993) Update on surgical treatment of the epilepsies. Summary of the second international palm desert conference on the surgical treatment of the epilepsies. Neurology 43:1612–1617

    Google Scholar 

  2. Urbach H, Hattingen J, von Oertzen J, Luyken C, Clusmann H, Kral T, Kurthen M, Schramm J, Blümcke I, Schild HH (2004) MR imaging in the presurgical workup of patients with drug-resistant epilepsy. Am J Neuroradiol 25:919–926

    Google Scholar 

  3. Rosenow F, Lüders H (2001) Presurgical evaluation of epilepsy. Brain 124:1683–1700

    Article  CAS  PubMed  Google Scholar 

  4. Lüders HO, Awad I (1992) Conceptual considerations. In: Lüders HO, (ed) Epilepsy surgery. Raven Press, New York, pp 51–62

    Google Scholar 

  5. Bien CG, Benninger FO, Urbach H, Schramm J, Kurthen M, Elger CE (2000) Localizing value of epileptic visual auras. Brain 123:244–253

    Article  Google Scholar 

  6. Blümcke I, Thom M, Wiestler OD (2002) Ammon’s horn sclerosis: a maldevelopmental disorder associated with temporal lobe epilepsy. Brain Pathol 12:199–211

    PubMed  Google Scholar 

  7. Engel J Jr, Van Ness PC, Rasmussen TB, Ojemann LM (1993) Outcome with respect to epileptic seizures. In: Engel J Jr (ed) Surgical treatment of the epilepsies. Raven Press, New York, pp 609–621

    Google Scholar 

  8. Hirai T, Korogi Y, Yoshizumi Y, Shigematsu Y, Sugahara T, Takahashi M (2000) Limbic lobe of the human brain: evaluation with turbo fluid-attenuated inversion—recovery MR imaging. Radiology 215:470–475

    Google Scholar 

  9. von Oertzen J, Urbach H, Bluemcke I, Reuber M, Traeber F, Peveling T, Menzel C, Elger CE (2002) Time-efficient relaxometry of the entire hippocampus is feasible in temporal lobe epilepsy. Neurology 58:257–264

    Google Scholar 

  10. Luyken C, Blümcke I, Fimmers R, Urbach H, Elger CE, Wiestler OD, Schramm J (2003) The spectrum of long-term epilepsy associated tumors: long-term seizure and tumor outcome and neurosurgical aspects. Epilepsia 44:822–830

    Article  Google Scholar 

  11. Blümcke I, Giencke K, Wardelmann E, et al (1999) The CD34 epitope is expressed in neoplastic and malformative lesions associated with chronic, focal epilepsies. Acta Neuropathol 97:481–490

    Article  Google Scholar 

  12. Blümcke I, Luyken C, Urbach H, Wiestler OD, Schramm J (2004) A new clinico-histopathological subtype of low-grade astrocytoma associated with long-term epilepsy and benign prognosis. Acta Neuropathol 107:381–388

    Article  PubMed  Google Scholar 

  13. Schramm J, Luyken C, Urbach H, Fimmers R, Blümcke I (2004) Evidence for a clinically distinct new subtype of grade II astrocytomas in patients with long-term epilepsy. Neurosurgery 55:340–347

    Article  Google Scholar 

  14. Daumas-Duport C, Scheithauer BW, Chodkiewicz JP, Laws ER Jr, Vedrenne C (1988) Dysembryoplastic neuroepithelial tumor: a surgically curable tumor of young patients with intractable partial seizures. Report of thirty-nine cases. Neurosurgery 23:545–556

    Google Scholar 

  15. Mischel PS, Nguyen LP, Vinters HV (1995) Cerebral cortical dysplasia associated with pediatric epilepsy. Review of neuropathologic features and proposal for a grading system. J Neuropathol Exp Neurol 54:137–153

    Google Scholar 

  16. Palmini A, Lüders H (2002) Classification issues in malformations caused by abnormalities of cortical development. Neurosurg Clin N Am 13:1–16

    PubMed  Google Scholar 

  17. Tassi L, Colombo N, Garbelli R, Francione S, Lo Russo G, Mai R, Cardinale F, Cossu M, Ferrario A, Galli C, Bramerio M, Citterio A, Spreafico R (2002) Focal cortical dysplasia: neuropathological subtypes, EEG, neuroimaging and surgical outcome. Brain 125:1719–1732

    Article  CAS  PubMed  Google Scholar 

  18. Barkovich AJ, Kuzniecky RI, Jackson GD, Guerrini R, Dobyns WB (2001) Classification system for malformations of cortical development: update 2001. Neurology 57:2168–2178

    CAS  PubMed  Google Scholar 

  19. Urbach H, Blümcke I, Becker A, Solymosi L (2003) Störungen der kortikalen Entwicklung: Bildgebung und Klassifizierung. Klin Neuroradiol 13:163–172

    Article  Google Scholar 

  20. Urbach H, Scheffler B, Heinrichsmeier T, von Oertzen J, Kral T, Wellmer J, Schramm J, Wiestler OD, Blümcke I (2002) Focal cortical dysplasia of Taylor’s balloon cell type: A clinicopathological entity with characteristic neuroimaging and histopathological features, and favorable postsurgical outcome. Epilepsia 43:33–40

    Article  Google Scholar 

  21. Zabramski JM, Wascher TM, Spetzler RF, et al (1994) The natural history of familial cavernous malformations: results of an ongoing study. J Neurosurg 80:422–432

    CAS  PubMed  Google Scholar 

  22. Bien CG, Schulze-Bonhage A, Deckert-Schlüter M, Urbach H, Helmstaedter C, Grunwald T, Schaller C, Elger CE (2000) Limbic encephalitis unrelated to neoplasm as a cause of temporal lobe epilepsy. Neurology 55:1823–1828

    Google Scholar 

  23. Bien CG, Urbach H, Deckert M, Schramm J, Wiestler OD, Lassmann H, Elger CE (2002) Diagnosis and staging of Rasmussen’s encephalitis by serial MRI and histopathology. Neurology 58:250–257

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology/Neuroradiology, University of Bonn Medical Center, Sigmund Freud Str. 25, 53105, Bonn, Germany

    H. Urbach

Authors
  1. H. Urbach
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Urbach.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Urbach, H. Imaging of the epilepsies. Eur Radiol 15, 494–500 (2005). https://doi.org/10.1007/s00330-004-2629-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-004-2629-1

Keywords

Search

Navigation