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Kourosh Jafari-Khouzani |
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Temporal Lope Epilepsy Lateralization |
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Epilepsy is one of the most common disorders of the nervous system, which causes seizure by a temporary change in the electrical functioning of brain. Mesial temporal lobe epilepsy (mTLE) is a type of epilepsy where the abnormal electrical discharges arise in the mesial temporal lobe of the brain. When treatment with medication is not effective, surgical removal of the epileptogenic tissue is recommended. A series of preoperative examinations including brain MRI scan is performed to determine if the patient is a good candidate for surgery. One of the challenges in surgical treatment is the localization of epileptogenic site.
The hippocampus (shown by arrows in the image) is the primary region of interest in the preoperative imaging investigation of mTLE. Hippocampal damage is the most common pathology underlying mTLE. With mesial temporal sclerosis, the imaging features of the hippocampi declare a clear asymmetry of volume, signal intensity and curvature that often lateralizes the site of epileptogenicity. Quantitative studies have shown that reduced hippocampal volume, in particular, strongly correlates with an ipsilateral mTLE. In 15% of mTLE cases, however, there is no evidence of such asymmetry despite clear indication of ictal origin in the area.
The conventional gold standard method of evaluating an epileptic patient for surgical candidacy is lengthy, painful, and costly. It requires phase I EEG exam to detect irritative zones. If the epileptic focus is not sufficiently localized in phase I, the patient will need to undergo phase II of the surgical evaluation which involves implantation of electrodes intracranially and monitoring the patient for nearly two weeks.
In this project, we investigated the MR signal characteristics that correlate with the epileptogenic site. In particular, we have quantitatively evaluated the signal properties of FLAIR images.
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Temporal lope epilepsy lateralization |
