title: Postictal diffusion-weighted imaging for the localization of focal epileptic areas in temporal lobe epilepsy.
abstract: OBJECTIVE
  Diffusion-weighted MR imaging (DWI) is a novel technique to delineate focal areas of cytotoxic edema of various etiologies. We hypothesized that DWI may also detect the epileptogenic region and adjacent areas during the ictal and early postictal periods in patients with temporal lobe epilepsy (TLE).
  
  
  METHODS
  We studied patients with intractable TLE (n = 9), due to hippocampal sclerosis (HS, n = 7), left mesial temporal lobe tumor (n = 1), and of unknown etiology (n = 1). Informed consent was obtained before inclusion in the study. All patients with single short seizures were scanned immediately after EEG-documented seizures (between 45 and 150 min); one of two patients in status was scanned 14 h after cessation of seizures. DWI results were analyzed visually and by calculating apparent diffusion coefficient (ADC) maps.
  
  
  RESULTS
  We found significant decreases in ADC postictally in one of six patients with TLE due to HS and single short seizures. One patient with an incompletely resected temporal lobe tumor also exhibited ADC abnormalities. One patient in focal status epilepticus revealed a decrease in ADC, and one patient with a continuous aura had no DWI abnormality.
  
  
  CONCLUSIONS
  Postictal DWI technique may occasionally help delineate epileptic areas in some patients with TLE. Yield is low in patients with HS and single short seizures: it may be higher in patients with tumor or status epilepticus.
authors.affiliation: Department of Neurology, The Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, Ohio 44195, U.S.A. diehlb@ccf.org
authors.forename: B
authors.initials: B
authors.lastname: Diehl
authors.forename: I
authors.initials: I
authors.lastname: Najm
authors.forename: P
authors.initials: P
authors.lastname: Ruggieri
authors.forename: J
authors.initials: J
authors.lastname: Tkach
authors.forename: A
authors.initials: A
authors.lastname: Mohamed
authors.forename: H
authors.initials: H
authors.lastname: Morris
authors.forename: E
authors.initials: E
authors.lastname: Wyllie
authors.forename: E
authors.initials: E
authors.lastname: Fisher
authors.forename: J
authors.initials: J
authors.lastname: Duda
authors.forename: M
authors.initials: M
authors.lastname: Lieber
authors.forename: W
authors.initials: W
authors.lastname: Bingaman
authors.forename: H O
authors.initials: HO
authors.lastname: Lüders
mesh_terms: D000293:Adolescent; D000328:Adult; D001834:Body Water / Q000378:metabolism*; D001921:Brain / Q000378:metabolism*; D004058:Diffusion; D004569:Electroencephalography / Q000706:statistics & numerical data; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D006624:Hippocampus / Q000378:metabolism / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012598:Sclerosis / Q000378:metabolism; D013702:Temporal Lobe / Q000378:metabolism / Q000503:physiopathology*