Diffusion-weighted magnetic resonance imaging and identification of the epileptogenic tuber in patients with tuberous sclerosis.
BACKGROUND
Patients with tuberous sclerosis complex and drug-resistant epilepsy may be considered candidates for epilepsy surgery. This demands the unambiguous demonstration of the epileptogenicity of one of the tubers.


OBJECTIVE
To test whether diffusion-weighted magnetic resonance imaging enables differentiation of epileptogenic tubers from inert ones.


METHODS
In 4 patients with clear unifocal interictal spike activity, fluid-attenuated inversion recovery and diffusion-weighted magnetic resonance imaging were performed. Apparent diffusion coefficient maps were calculated in the identified epileptogenic tuber and compared withthose in nonepileptogenic tubers and regions of normal-appearing cortex.


RESULTS
A significant increase in the apparent diffusion coefficient was found in the epileptogenic tubers. Furthermore, the apparent diffusion coefficient of the nonepileptogenic tubers was significantly higher than the trace apparent diffusion coefficient of regions of normal-appearing cortex.


CONCLUSIONS
Diffusion-weighted magnetic resonance imaging may be of clinical importance for the identification of epileptogenic tubers in patients with tuberous sclerosis and intractable epilepsy.
Jansen
Floor E
FE
Department of Child Neurology, University Medical Center, Utrecht, the Netherlands. f.e.jansen@neuro.azu.nl
Braun
Kees P J
KP
van Nieuwenhuizen
Onno
O
Huiskamp
Geertjan
G
Vincken
Koen L
KL
van Huffelen
Alexander C
AC
van der Grond
Jeroen
J
D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D002675:Child, Preschool; D038524:Diffusion Magnetic Resonance Imaging; D004569:Electroencephalography; D004827:Epilepsy / Q000209:etiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007223:Infant; D015225:Magnetoencephalography; D011859:Radiography; D014402:Tuberous Sclerosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology