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A 14-year-old girl presented with hypermotor seizures since the age of 11. MRI showed a hyperintense left-sided cingulate cortex (a,c,e: arrow). The lesion was found by scrolling through the co-registered MP2RAGE images (b: arrow). The junction parameter map displays the gray-white matter blurring (d: arrow). Histopathology revealed gliotic changes, a gray-white matter blurring, some ectopic white matter neurons, no dysplastic neurons, no balloon cells. MRI after 3 months confirmed that the lesion was resected (f). The patient was seizure-free 12 months following surgery
Source publication
Purpose
To evaluate the diagnostic accuracy of epilepsy-dedicated 3 Tesla MRI including post-processing by correlating MRI, histopathology, and postsurgical seizure outcomes.
Methods
3 Tesla-MRI including a magnetization-prepared two rapid acquisition gradient echo (MP2RAGE) sequence for post-processing using the morphometric analysis program MAP...
Citations
... Виявлення можливих структурних змін у головному мозку шляхом застосування методів нейровізуалізації є обов'язковим діагностичним методом під час обстеження дитини з ЕЕ або епілептиформними та розвитковими енцефалопатіями (ЕРЕ), який дозволяє виявити потенційно епілептогенні вогнища та, у багатьох випадках, верифікувати етіологію захворювання. Однак, у 20-50% дітей із рефрактерними до терапії нападами під час проведення МРТ головного мозку, навіть із використанням оптимального протоколу, структурні зміни в мозку не ідентифікуються, що ускладнює подальший діагностичний пошук та може вимагати проведення додаткових методів нейровізуалізації [5,12,26,27]. ...
The aim is to analyze neuroimaging changes in the nervous system of children of an early and preschool age with epileptic encephalopathies (EE) according to MR-tractography to improve the diagnosis of these conditions. Materials and methods. 157 children aged 0 to 6 years with EE, epileptiform and developmental encephalopathies (DEE) were examined. The study included MR-tractography using a 3 Tesla MR scanner. Fractional anisotropy (FA) and average diffusion coefficient (ADC) were determined in Broca's and Wernicke's areas, left arcuate tract, both uncinate tracts, corpus callosum and thalamus. The examined children were divided into 3 groups: I - 75 children with EE, with the onset of seizures before 1 year of age; II - 44 children with EE, with the onset of seizures at the age of 1-3 years; III - 38 children with DEE. Differences between groups were assessed using the Kruskal-Wallis test and Pearson's Chi-square (χ²) test. Results. In children with EE from groups I and II, there was a significant decrease in FA and an increase in ADC in the areas of both language centers and the right uncinate tract in comparison with children of group III (p<0.05). In the group I with EE, there was a significant decrease in FA in the left uncinate tract, knee and trunk of the MT in comparison with the groups II and III of children (p<0.05). It was found that more than 60% of children from group I had destruction of the fibers of the arcuate tract and in the area of one of the speech centers, and 70% had hypoplasia and destruction of the left uncinate tract. In the children of group II with EE, hypoplasia of the anterior (63.6%) and posterior (65.9%) parts of the arcuate tract and the right uncinate tract (81.8%) was detected. Among children from group III, more than 60% had an abnormal location of Broca's speech center, and more than 70 % had an abnormal location of Wernicke's center, almost 80 % had an abnormal location of the left uncinate tract. Conclusions. It was found that in children with EE and DEE, according to MR tractography, there is a decrease in FA indicators and an increase in ADC in all studied structures (arcuate and uncinate tract, corpus callosum, thalamus) in comparison with the reference values given in the scientific literature. The detected changes indicate a violation of the structural integrity of the white matter in Broca's and Wernicke's centers and associative pathways, which will lead to the optimization of early diagnosis and prognosis of consequences in children with EE and DEE. The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committees of the institutions indicated in the work. The informed consent of the children's parents was obtained for conducting the research. No conflict of interest was declared by the authors.
... All except two patients underwent 3-T MRI of the brain according to in-house standards of high-resolution epilepsy protocols. 24,25 The remaining two patients had to undergo a similar 1.5-T MRI protocol, as 3-T MRI was contraindicated because of a cardiac pacemaker. We considered all TEs ≥3 mm as potentially epileptogenic lesions. ...
Objective
We aimed to assess the ability of semiautomated electric source imaging (ESI) from long‐term video‐electroencephalographic (EEG) monitoring (LTM) to determine the epileptogenicity of temporopolar encephaloceles (TEs) in patients with temporal lobe epilepsy.
Methods
We conducted a retrospective study involving 32 temporal lobe epilepsy patients with TEs as potentially epileptogenic lesions in structural magnetic resonance imaging scans. Findings were validated through invasive intracerebral stereo‐EEG in six of 32 patients and postsurgical outcome after tailored resection of the TE in 17 of 32 patients. LTM (mean duration = 6 days) was performed using the 10/20 system with additional T1/T2 for all patients and sphenoidal electrodes in 23 of 32 patients. Semiautomated detection and clustering of interictal epileptiform discharges (IEDs) were carried out to create IED types. ESI was performed on the averages of the two most frequent IED types per patient, utilizing individual head models, and two independent inverse methods (sLORETA [standardized low‐resolution brain electromagnetic tomography], MUSIC [multiple signal classification]). ESI maxima concordance and propagation in spatial relation to TEs were quantified for sources with good signal quality (signal‐to‐noise ratio > 2, explained signal > 60%).
Results
ESI maxima correctly colocalized with a TE in 20 of 32 patients (62.5%) either at the onset or half‐rising flank of at least one IED type per patient. ESI maxima showed propagation from the temporal pole to other temporal or extratemporal regions in 14 of 32 patients (44%), confirming propagation originating in the area of the TE. The findings from both inverse methods validated each other in 14 of 20 patients (70%), and sphenoidal electrodes exhibited the highest signal amplitudes in 17 of 23 patients (74%). The concordance of ESI with the TE predicted a seizure‐free postsurgical outcome (Engel I vs. >I) with a diagnostic odds ratio of 2.1.
Significance
Semiautomated ESI from LTM often successfully identifies the epileptogenicity of TEs and the IED onset zone within the area of the TEs. Additionally, it shows potential predictive power for postsurgical outcomes in these patients.
... The study ended with 230 PWE with three lesion evaluations using conventional and HARNESS-MRI protocol followed by HARNESS plus multidisciplinary meeting. The median age at the time of scanning was 20 and IQR (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29).75) years, and gender distribution was 146 (62%) male and 91 (38%) female patients. According to the 2017 ILAE classification, 186 (80.9%) patients had focal onset seizures, while 44 (19.1%) were unknown, lateralized to the right in 57 (31%) and the left in 58 (31%). ...
... To our knowledge, no randomized controlled trials compare the HARNESS protocol to other imaging modalities or conventional MRI. However, the diagnostic accuracy of the HARNESS protocol was reported by Urbach, Scheiwe [20], who found that the results of imaging and histopathology were concordant in 101/116 patients with focal DRE undergoing resection surgery. in their study, The MRI detected abnormalities suggestive of MCDs in 38 patients, while confirmed by histopathology in only 34 patients. On the other hand, MRI detected MTS in 31 patients while only confirmed in 30 one by histopathology. ...
Objectives:
The international league against epilepsy (ILAE) recommended the harmonized neuroimaging of epilepsy structural sequences (HARNESS-MRI) to improve the detection of epileptogenic lesions in patients with focal drug-resistant epilepsy (DRE). The application of this protocol is still limited in low-resource countries, mainly due to apparent high costs. We aimed to evaluate the cost-effectiveness of the HARNESS-MRI protocol in Egypt and highlighted our experience.
Methods:
Patients diagnosed with focal DRE at Cairo University epilepsy clinic underwent both conventional MRI (c-MRI) and HARNESS-MRI. Electro-clinical data were collected and analyzed. After the radiologists' initial diagnosis, a multidisciplinary team re-evaluated the MRI. Lesion detection rate and cost for detecting an extra lesion by HARNESS-MRI protocol were calculated.
Results:
The study included 230 patients with focal DRE (146, 62% males and 91, 38% females), with a mean age of 20.5 years. Epileptogenic lesions detected by c-MRI and HARNESS-MRI before and after the board meeting were 40, 106, and 131 lesions, respectively (P < 0.001). Sixty-nine percent of the lesions detected by HARNESS-MRI were missed on c-MRI; most commonly were mesial temporal sclerosis (MTS) and Malformations of cortical development (MCDs). Thirty-seven MTS and 32 MCDs were detected with HARNESS-MRI, compared to only 6 and 3, respectively, detected on c-MRI (P < 0.001). HARNESS-MR protocol is more cost-effective than c-MRI in detecting MRI lesions; it can save about 42$ for detecting an extra lesion in MRI.
Conclusion:
The HARNESS-MRI protocol was cost-effective and highly recommended even in limited-resource countries for patients with focal DRE.
