Beyond Mesial Temporal Sclerosis: Optimizing MRI Evaluation in Focal Epilepsy

Epilepsy is one of the most common neurologic disorders in the United States. The importance of accurately detecting structural causes of epilepsy cannot be overstated. MRI findings initially misdiagnosed as “lesion negative” may result in delayed definitive surgical treatment and increased morbidity because patients with underlying structural lesions are more likely to be refractory to medical therapy. Under-reporting of pertinent MR imaging findings in epilepsy is due to either a failure of imaging to adequately depict the abnormality or an inability to recognize the abnormality when present. The purpose of this article is to describe optimal epilepsy MR imaging and to review common focal epileptogenic lesions, with an emphasis on subtle abnormalities.

Learning Objective: Describe the sequences necessary to optimize detection of epileptogenic lesions on MRI and identify common focal epileptogenic lesions.