Structural Imaging

Imaging studies should always be performed when a symptomatic etiology is suspected. Cranial computed tomography (CCT) is a quick, easy, and relatively cheap technique. The sensitivity can be improved by scanning in the axis of the temporal lobe (in cases of Temporal Lobe Epilepsy) and by using intravenous contrast enhancement. Except for a few pathologies such as calcifications, magnetic resonance imaging (MRI) is superior to CCT in terms of sensitivity and specificity in detecting epilepsy-related lesions such as malformations, gliosis, and tumors. With optimized MRI techniques, including T2-weighted images, inverse recovery sequences, and coronal images perpendicular to the hippocampus and thin sections, the sensitivity in depicting mesial temporal sclerosis reaches 90% (Fig. 3). Diagnosis of hippocampal pathology can be improved by quantitative MRI techniques such as T2 relaxometry and volumetric studies.

MR spectroscopy (MRS) is a noninvasive method for measuring chemicals in the body. MRS does not produce images but instead generates numerical values for chemicals. With phosphate spectroscopy it is possible to study energy metabolism in relation to seizure activity. Proton MRS is a technique that measures neuronal density, which has been found to be significantly decreased in the mesial temporal lobe of patients with mesial temporal sclerosis. MRS is a time-consuming procedure and therefore not routine.

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