The Diagnostic Efficacy of MRI Dedicated-Epilepsy Protocol in Evaluation of Seizures

Main Article Content

Rawa Saad
Fawaz Baddour
Hala Saeed


Aims: The aims of this study were to identify the diagnostic efficacy of dedicated epilepsy protocol in detecting possible structural abnormalities that underlie seizure disorders, and compare the diagnostic yields of MRI and electroencephalogram individually and in combination.

Study Design: This was a cross-sectional analytic study.

Place and Duration of Study: Medical Imaging and Diagnostic Radiology Department at Tishreen University Hospital, Lattakia, Syria; between July 2019 and July 2020.

Methodology: Our study included 100 cases (58 females, 41 males, age range 13-77 years) who presented with seizure over 18 months. Patients underwent complete neurological examination, EEG, and MRI with a standard and dedicated epilepsy protocol.

Results: We found epileptogenic lesions in MRI in 55.5%. MRI detected epileptogenic lesions in 74.5% patients who had focal onset seizures. Mesial temporal lobe sclerosis was the most common epileptogenic lesion (45.5%). The diagnostic efficacy of MRI had increased with dedicated epilepsy protocol compared to standard protocol. Abnormal MRI and EEG were compatible in 21%.

Conclusion: Dedicated epilepsy protocol increased the diagnostic efficacy of brain MRI in detecting a structural epileptogenic lesion, with 100% of mesial temporal sclerosis, the most common lesion in our study, was detected only in dedicated epilepsy protocol and missed in standard protocol.

Brain MRI, dedicated-epilepsy protocol, routine electroencephalogram, seizures, standard protocol

Article Details

How to Cite
Saad, R., Baddour, F., & Saeed, H. (2020). The Diagnostic Efficacy of MRI Dedicated-Epilepsy Protocol in Evaluation of Seizures. Asian Journal of Medicine and Health, 18(9), 62-71.
Original Research Article


Annegers JF, Hauser WA, Lee JR, Rocca WA. Incidence of acute symptomatic seizures in Rochester, Minnesota, 1935-1984. Epilepsia. 1995;36:327.

Hauser WA, Annegers JF, Kurland LT. Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935-1984. Epilepsia. 1993;34:453.

Pohlmann-Eden B, Newton M. First seizure: EEG and neuroimaging following an epileptic seizure. Epilepsia. 2008;49(1): 19-25.

Pohlmann-Eden B, Legg KT. Treatment of first seizure in adults: A comprehensive approach integrating 10 key principles. Epileptology. 2013;1:61-67.

Deblaere K, Achten E. Structural magnetic resonance imaging in epilepsy. Eur Radiol. 2008;18:119–129.

Krumholz A, Wiebe S, Gronseth G, et al. Practice parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review)—report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2007;69:1996–2007.

Fisher RS, Acevedo C, Arzimanoglou A, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014; 55(4):475–482.

DOI: 10.1111/epi.12550

Fisher RS, Cross JH, French JA, et al. Operational classification of seizure types by the International League Against Epilepsy: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58(4):522–530.

DOI: 10.1111/epi.13670

Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies: position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017:58(4):512–521.

DOI: 10.1111/epi.13709

Berg AT, Berkovic SF, Brodie MJ, et al. revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia. 2010;51(4):676–685.

DOI: 10.1111/j.1528-1167.2010.02522.x

Gavvala JR, Schuele SU. New-onset seizure in adults and adolescents: A review. JAMA. 2016;316(24):2657–2668.

DOI: 10.1001/jama.2016.18625

Janardhana Ponnatapura, Suresh Vemanna, Sandeep Ballal, and Avisha Singla. Utility of Magnetic Resonance Imaging Brain Epilepsy Protocol in New-Onset Seizures: How is it Different in Developing Countries? J Clin Imaging Sci. 2018;8:43.

Hakami T, McIntosh A, Todaro M, Lui E, Yerra R, Tan KM, et al. MRI-identified pathology in adults with new-onset seizures. Neurology. 2013;81:920-7. [PubMed: 23925763]

Pohlmann-Eden B, Schreiner A. Epileptology of the first-seizure presentation. Lancet. 1998;352:1855–6. [PubMed: 9851407]

King MA, Newton MR, Jackson GD, Fitt GJ, Mitchell LA, Silvapulle MJ, et al. Epileptology of the first- seizure presentation: A clinical, electroencephalographic, and magnetic resonance imaging study of 300 consecutive patients. Lancet. 1998;352: 1007–11.

[PubMed: 9759742].

Liu RS, Lemieux L, Bell GS, Sisodiya SM, Bartlett PA, Shorvon SD, et al. The structural consequences of newly diagnosed seizures. Ann Neurol. 2002; 52:573–80. [PubMed: 12402254].

Van Paesschen W, Sisodiya S, Connelly A, Duncan JS, Free SL, Raymond AA, et al. Quantitative hippocampal MRI and intractable temporal lobe epilepsy. Neurology. 1995;45:2233–40.

[PubMed: 8848199]

Von Oertzen J, Urbach H, Jungbluth S, Kurthen M, Reuber M, Fernández G, et al. Standard magnetic resonance imaging is inadequate for patients with refractory focal epilepsy. J Neurol Neurosurg Psychiatry. 2002;73:643–7.

[PMCID:PMC1757366] [PubMed: 12438463].