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Neuroimaging in the Investigation of Epilepsy 

Neuroimaging in the Investigation of Epilepsy
Neuroimaging in the Investigation of Epilepsy

Trevor T.-J. Chong

and Mark Cook

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date: 02 July 2022

Recent advances in neuroimaging have meant that a wide variety of modalities are available to evaluate patients with epilepsy. Within this population, the key questions are whether there exists a single, resectable seizure focus and, if so, how to minimize the disruption to adjacent areas of eloquent cortex following its resection. The mainstays of structural imaging remain computerized tomography (CT) and magnetic resonance imaging (MRI), with more recently derived MR-based techniques including voxel-based morphometry (VBM), and diffusion tensor imaging (DTI) or tractography, which permit the imaging of white matter tracts. Cerebral metabolism or haemodynamics can be visualised with established techniques such as positron emission tomography (PET), single photon emission computerized tomography (SPECT), magnetic resonance spectroscopy (MRS) or functional MRI (fMRI). Finally, the electrophysiological activity of the brain can be more directly imaged with magnetoencephalography (MEG) and, more recently, epileptiform discharges have also been successfully localized by performing simultaneous fMRI-EEG recordings. In this chapter, we summarize the role of these modalities in managing the patient with epilepsy, and provide a synopsis of the current state of the art, including a discussion of the promise and limitations of each technique. We conclude by describing the dynamic state of the neuroimaging landscape, with recent attempts at multi-modal imaging and the need for a greater evidence base to guide our choice of imaging modalities in individual patients.

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