Neuroimaging in the Diagnosis of Epilepsy

Neuroimaging is commonly used for presurgical evaluation in epilepsy surgery. Neuroimaging for epilepsy includes structural and functional neuroimaging. Lesions detected by structural neuroimaging are crucial to determine the indication of epilepsy surgery, as well as to predict seizure outcomes, as patients with MRI-visible lesions are likely to have better seizure outcomes. However, MRI lesions sometimes show very faint findings; therefore, the diagnosis of structural neuroimaging requires sophisticated skills. Moreover, the epilepsy focus should not only involve the MRI-visible lesion, but also the surrounding tissue with abnormal neuronal function. The MRI-lesion, which is almost the same as that epileptogenic lesion, is a part of the epileptogenic zone. Surgical strategy should be conducted by comprehensive evaluation including neuroimaging in addition to other modalities.