New Treatments for Epilepsy| U.S. News

Lena Weib

Exciting new MRI – magnetic resonance imaging – technologies allow doctors to detect subtle abnormalities in the brain that may otherwise be difficult to identify. This is important because detecting a brain abnormality on MRI is often the most significant factor in developing a plan for epilepsy surgery to stop a person’s seizures. Missing an abnormality may lead to a lost opportunity for surgery and a better life.

MRI Technology for Epilepsy

Part of MRI scan emulsion ready for examination.(iStockPhoto)

The newest type of MRI is called 7T because its magnetic field is 7 tesla units strong. For context, one tesla is about 20,000 times stronger than the earth’s magnetic field, and most MRIs in medical use are about one and a half times more powerful than that, or 1.5T. Once high-field MRIs using 3T magnets became available, research showed them to be superior to the 1.5T scans for detecting subtle brain abnormalities. The new 7T MRIs can bring abnormalities to light with even more clarity and precision.

While 7T MRI technology opens exciting possibilities, the more widely available 3T MRIs can also be used to their maximum advantage to provide highly detailed brain images. For example, additional sensors can be added to sharpen the images.

Another factor is how the images are acquired. A neuroradiologist can vary different parameters (called “sequences”) to optimize and acquire different “views” of the MRI, just as a photographer may take pictures using different filters on the camera lens. Performing the sequences that are most useful for epilepsy can further improve the results.

While obtaining high-quality images is crucial, the next step is equally important. Viewing and interpreting the images introduces the human element, which varies based on specialist physicians’ experience and expertise. Neuroradiologists have special training in finding subtle brain abnormalities, and neuroradiologists who work closely with an advanced epilepsy center are uniquely well prepared to detect the specific abnormalities that may cause seizures. When the team of experts at an advanced epilepsy center meet to discuss individual patients and review multiple types of evidence together, it can help the neuroradiologist focus on specific brain regions to detect hard-to-find abnormalities.

Advanced Techniques for Detecting Brain Abnormalities

New computer techniques also enhance the detection of brain abnormalities that may cause seizures. These techniques are particularly helpful for identifying abnormalities involving the brain’s outer cortical layer, which are easy for the human eye to miss.

These advanced techniques include the following:

  • Voxel-based morphometry, which meticulously compares a patient’s MRI to a large database of normal MRIs and looks for areas with abnormal differences. 
  • MR fingerprinting, which is a fundamentally new way to make MRI images that can compute the fraction of white matter and gray matter anywhere in the brain to spotlight abnormalities that are otherwise buried within the routine image. 
  • Radiomics, which is used to examine subtle variations between the small discrete elements of an image, known as pixels, and the surrounding pixels. Measuring these variations can reveal the texture of normal brain images and expose abnormal textures that are otherwise invisible to the eye. 
  • Simultaneous acquisition of MRI and EEG, which enables a computer to use the EEG information to help locate abnormalities in the brain that are otherwise undetectable. 
  • Other imaging combinations. After acquisition, MRI can also be combined with positron emission tomography, or PET, which maps brain metabolism, or with magnetoencephalography, or MEG, which detects minute changes in the brain’s electromagnetic activity. 

Since all these new methods are based on the same anatomy – the human brain – they can be combined into a single common overlapping image to increase the probability of detecting subtle brain abnormalities.

The most frequently missed abnormalities on MRI are related to a misstep in early prenatal brain development that may cause severe epilepsy despite a subtle appearance on MRI. The good news is that new technologies are now available to detect these abnormalities with greater accuracy, potentially identifying patients who may benefit from epilepsy surgery and have a chance at a better life.

What to Do if You’re Experiencing Uncontrolled Seizures

  • Seek consultation at a specialized epilepsy center.
  • Ask about advanced neuroimaging to detect a subtle brain abnormality.
  • If a brain abnormality is discovered, speak with your neurologist about whether epilepsy surgery may be right for you.

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