The role of functional neuroimaging in pre-surgical epilepsy evaluation.
The prevalence of epilepsy is about 1% and one-third of cases do not respond to medical treatment. In an eligible subset of patients with drug-resistant epilepsy, surgical resection of the epileptogenic zone is the only treatment that can possibly cure the disease. Non-invasive techniques provide information for the localization of the epileptic focus in the majority of cases, whereas in others invasive procedures are required. In the last years, non-invasive neuroimaging techniques, such as simultaneous recording of functional magnetic resonance imaging and electroencephalogram (EEG-fMRI), positron emission tomography (PET), single photon emission computed tomography (SPECT), electric and magnetic source imaging (MSI, ESI), spectroscopy (MRS), have proved their usefulness in defining the epileptic focus. The combination of these functional techniques can yield complementary information and their concordance is crucial for guiding clinical decision, namely the planning of invasive EEG recordings or respective surgery. The aim of this review is to present these non-invasive neuroimaging techniques, their potential combination, and their role in the pre-surgical evaluation of patients with pharmaco-resistant epilepsy.
Presurgical Epilepsy Evaluation Unit, Neurology Department, University Hospital of Geneva , Geneva , Switzerland.
Francesca
F
Pittau
Department of Radiology and Medical Informatics, University Hospital of Geneva , Geneva , Switzerland.
Frédéric
F
Grouiller
Presurgical Epilepsy Evaluation Unit, Neurology Department, University Hospital of Geneva , Geneva , Switzerland.
Laurent
L
Spinelli
Presurgical Epilepsy Evaluation Unit, Neurology Department, University Hospital of Geneva , Geneva , Switzerland.
Margitta
M
Seeck
Functional Brain Mapping Laboratory, Department of Fundamental Neurosciences, University of Geneva , Geneva , Switzerland.
Christoph M
CM
Michel
Presurgical Epilepsy Evaluation Unit, Neurology Department, University Hospital of Geneva , Geneva , Switzerland.
Serge
S
Vulliemoz
EEG-fMRI; ESI; MRS; PET; SPECT; focal epilepsy; functional neuroimaging