Epileptic Disorders


ILAE Neuroimaging Task Force Highlight: harnessing optimized imaging protocols for drug-resistant childhood epilepsy Volume 23, numéro 5, October 2021


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1 Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
2 Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada
3 Phramongkutklao Hospital, Bangkok, Thailand
4 The Florey Institute of Neuroscience and Mental Health and The University of Melbourne, Australia
5 Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, USA
6 Department of Neurosurgery, University Hospital Erlangen, Germany
7 Neurology Unit, University of Modena and Reggio Emilia, Modena, Italy
8 Epilepsy Center, Cleveland Clinic, Cleveland, USA
9 Department of Neurology, University of Campinas – UNICAMP, Campinas, SP, Brazil
10 BC Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
11 Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
* Correspondence: Boris C. Bernhardt Montreal Neurological Institute (NW-256), 3801 University Street, Montreal, Quebec, H3A 2B4 Canada Dewi V. Schrader BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1 Canada
* These authors contributed equally

The ILAE Neuroimaging Task Force aims to publish educational case reports highlighting basic aspects related to neuroimaging in epilepsy consistent with the educational mission of the ILAE. Previous quantitative MRI studies have established important imaging markers of epilepsy-related pathology, including features sensitive to hippocampal cell loss and reactive astrogliosis. Here, we review the case of a female with pediatric drug-resistant epilepsy. Throughout her course of treatment, she had seven MRI investigations at several centers; the first three did not follow optimized epilepsy imaging protocols whereas the remaining four adhered to HARNESS-MRI protocols (harmonized neuroimaging of epilepsy structural sequences). Visual inspection of a set of HARNESS-MR images revealed conspicuous left hippocampal hyperintensity which may have been initially overlooked on non-optimized MR images. Quantitative analysis of these multimodal imaging data along hippocampal subfields provided clear evidence of hippocampal sclerosis, with increased atrophy, increased mean diffusivity, increased T2-FLAIR signal, and lower qT1 values observed in the anterior portions of the left, compared to the right hippocampus. The patient underwent a left anterior temporal lobectomy with amygdalohippocampectomy at age 16 years. Histopathology of the resected specimen also confirmed hippocampal sclerosis with widespread gliosis and focal neuronal loss in the hippocampal subfields overlapping with regions of multimodal quantitative alterations. The patient remains seizure-free one year after surgery. Collectively, this case highlights the need for optimized data acquisition protocols early in the treatment of epilepsy and supports quantitative analysis of MRI contrasts to enhance personalized diagnosis and prognosis of drug-resistant patients with epilepsy.

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