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05 October 2015

Sophisticated scans show rare cause of epilepsy

A Finnish study has highlighted the importance of using the most dedicated neuroimaging techniques when assessing a person with drug-resistant epilepsy for surgery.

Research led by Ritva Vanninen from Kuopio University Hospital, Finland, has shown that tiny 'brain hernias' in the anterior and inferior temporal lobe of people with refractory epilepsy can be the cause of severe epilepsy with uncontrolled complex partial seizures.

In a study of 23 patients in whom these anteroinferior encephaloceles were the underlying cause of their epilepsy, the 12 patients who underwent surgery all achieved an improvement in their seizures with nine being seizure free, 2.8 years after surgery.

The majority of those who did not undergo surgery were achieving good seizure control on anti-epileptic drugs.

Epilepsy surgery assessments

Professor Matthias Koepp, a leading epileptologist at Epilepsy Society, said that this was an important area of research which emphasised the value of dedicated imaging prior to surgery. The suite of pre-surgery assessments at the National Hospital for Neurology and Neurosurgery include magnetic resonance imaging (MRI),shown above, functional MRI, magnetoencephalography, positron emission tomography and intracranial EEG telemetry.

'These all contribute to our ability to be able to identify the epileptogenic zone in the brain,' he said. 'The Finnish study is an interesting area of research. The jury is presently out on the frequency of anteroinferior encephaloceles in the general population and their significance but our sophisticated neuroimaging techniques and MRI protocol mean we are able to pick up these important subtleties.'

The Finnish report by Ritva Vanninen was first published in Neurology.

Read more about epilepsy surgery at the National Hospital for Neurology and Neurosurgery.