How Are MRIs Used for Detecting or Monitoring People with Epilepsy?

One of the most important diagnostic techniques for observing alterations in the brain linked to epilepsy and seizures is magnetic resonance imaging (MRI).

The hallmark of epilepsy is recurrent seizures without a recognised, treatable cause, such as:

brain infection
electrolyte imbalances
medication side effects

In the United States, 1.2% of people have epilepsy.

Magnetic resonance imaging (MRI) is one of several techniques used by medical professionals to identify epilepsy. An MRI could be performed to:

search for brain abnormalities connected to epilepsy.
identify the kind of epilepsy you have
and ascertain if surgery might be beneficial for you.
determine the optimal surgical procedure.

We examine in more detail the use of MRIs in the diagnosis and treatment of epilepsy in this article.

Can an MRI tell if you have epilepsy?

While an MRI cannot definitively diagnose epilepsy, it may be able to detect unusual indicators of seizures in the brain, such as tumours or scars.

Furthermore, an MRI can assist medical professionals in deciding whether surgery is necessary for you and what kind of surgery would be most beneficial.

For instance, one of the most prevalent focal epilepsies is temporal lobe epilepsy associated with hippocampal sclerosis, which frequently isn't responsive to treatment. About 80% of the time, surgery is successful in treating this kind of epilepsy.

Types of MRI scans for epilepsy

Many people use MRIs to aid in the diagnosis of epilepsy.

MRI methods consist of:

Volumetric MRI: Certain areas of your brain, such as the hippocampus, have volumes that are compared to expectations.
MRI fingerprinting: With just one scan, several tissue attributes may now be measured thanks to this innovative method. According to research published in 2021, it might make it easier to identify anomalies in the brain's medial and temporal regions.
Diffused weighted MRI: This method generates an image by tracking the movement of water molecules inside brain cells.
Functional MRI: Variations in your brain's blood flow are measured using a functional MRI. Traditionally, surgical decisions have been guided by it.
MR spectroscopy imaging: Your doctor can see biochemical changes in your brain, especially those associated with tumours, thanks to MR spectroscopy.

When can an MRI be ordered for people diagnosed with epilepsy?

2019 saw the release of revised guidelines by the International League Against Epilepsy Neuroimaging Task Force. They advise performing a sequence of MRIs known as the HARNESS-MRI:

shortly following the initial seizure, especially in younger patients
for those with unusual symptoms, such as cognitive deterioration
once more if the quality of the prior pictures was not ideal, especially in patients with drug-resistant epilepsy.

Furthermore, the NICE recommendations from the United Kingdom suggest:

providing MRI scans to individuals with an epilepsy diagnosis, unless they have benign Rolandic epilepsy or hereditary generalised epilepsy

Considering recurrent scanning for epileptic individuals if:

The initial scan wasn't the best.
New signs appear.
First-line therapy is ineffective for benign Rolandic epilepsy or hereditary generalised epilepsy.
There is talk of surgery.

What are common MRI findings in epilepsy?

Almost 50% of individuals with epilepsy experience atypical imaging findings.

An MRI could show:

brain growths
atypical blood vessel bundles, or arteriovenous malformations
the degeneration of hippocampal brain tissue (hippocampal sclerosis)
brain damage caused by gliosis
abnormal brain development that occurs before birth (polymicrogyria)
a region with dysplastic cortical neurons

Are MRIs safe for people with seizures?

MRIs don't hurt and are safe. They don't subject your body to radioactive exposure.

How to prepare for an MRI for epilepsy

For a head MRI, there is typically very minimal specific preparation. However, it's crucial to let the technicians and your doctor know before the surgery if you:

feel constricted in little areas
possess any metal implants, such as pacemakers or clips for brain aneurysms
having previously suffered injuries from metal shrapnel

You have to take off all jewellery and other metal-containing items before your operation.

Epilepsy MRI procedure

Depending on the sort of MRI you have, the process you undergo will look something like this:

Before their MRI, nervous patients and children may need to be sedated orally or intravenously (IV) to assist them in remaining motionless.
Your bed will glide inside the MRI machine, which is fashioned like a tube. A coil might be applied to your head.
When the MRI scanner is turned on by your technician, it will generate a lot of loud noises as it takes pictures.
If the clarity of the images is confirmed, you should be permitted to return home.

The three scans that make up the HARNESS-MRI technique take seven to ten minutes each.

What other brain scans are available for epilepsy?

Additional brain scans that are used to look at epilepsy include:

magnetoencephalography (MEG)
ultrasound
CT scans
single-photon emission computed tomography (SPECT) scans
positron emission tomography (PET) scan

The electroencephalogram (EEG) is another of the most widely utilised diagnostic procedures for epilepsy. It includes using electrodes on your scalp to measure brain activity.

EEGs trace brain activity rather than creating an image of the brain. It can identify seizures that are still occurring as well as, in certain cases, abnormal electrical activity in the brain region where seizures originate, even in the absence of a seizure.

When choosing an epileptic medication and scheduling epilepsy surgery, an EEG is used in conjunction with imaging studies such as MRIs.

What is the difference between MRI and epilepsy protocol MRI?

An image of your brain's structures can be obtained with a routine MRI. A collection of various MRI picture types called an epilepsy protocol MRI is used to search for structural abnormalities in the brain that could cause a seizure.

Takeaway

Seizures are frequently investigated for their underlying aetiology using MRI scans. They might make alterations to your brain, such as tumours, scarring, or a decrease in brain mass, visible.

Doctors can also decide which kind of surgery would be ideal for you and whether you would benefit from it with the use of an MRI.

Usually, there isn't much you need to do in advance of an MRI. The imaging process itself usually takes less than half an hour.

FAQs

Is MRI safe for epilepsy?

Yes. As long as the proper safety precautions are taken, there is no risk associated with the MRI examination.

Can I sleep during MRI?

You may even be able to fall asleep

Can I wear a bra for an MRI?

You should wear clothes without metal zips, fasteners, buttons, underwire (bras)