Brief Answer:
MRI done using a seizure protocol may be useful

Detailed Answer:
Good morning XXXXXXX

How have you been?

Your present question revolves around the efficacy of MR imaging in looking for a seizure focus, specifically in the temporal lobes. Is that correct?

Well, in general, any type of imaging will only be as good as the SIZE of a suspected focus as well as what that focus actually is (i.e. tumor, vascular malformation, bleed, granuloma, area of stroke, etc.). When we order MRI's of the brain to localize foci of seizure we order what WE call a SEIZURE protocol. What this means is that the MR technician/operator as well as the radiologist will be looking at very thinly sliced images typically from the optic chiasm (where the optic nerves cross themselves) back through the temporal lobes themselves.

What we are typically looking for is what's known as MESIAL TEMPORAL LOBE SCLEROSIS. MRI with gadolinium contrast in this setting is very good at picking up such abnormalities. It is very bad at picking up specific POINTS which could be thought of as seizure generators in ANY of the brain lobes if the problem really isn't that of MTLS.

Functional MRI or fMRI may be utilized to help guide more invasive procedures such as electrode placements intracranially or even mesh networks which can be placed directly upon the brain and are essentially EEG monitors without the interference of the skull. However, these types of invasive procedures are usually only referred for people who have full blown REFRACTORY seizures and have a general region of suspected abnormalities to begin with which have been identified on surface EEG or perhaps clinically if their seizure episodes involve focal limbs or specific behaviors which can be localized to brain lobes and also to specific hemispheres.

PET technology is also available but is a much more expensive modality than MRI for localizing seizure foci. There are ictal as well as interictal studies that are performed but again, the cost of these studies is so high that we tend to reserve them only for patients in whom it is either already known or strongly suspected through clinical and other testing that a true foci exists.

T2 flair and other sequences you mention are usually chosen at the discretion of the radiologist depending upon what the clinician describes as being present thereby directing the radiologist to choose the best sequences to look at under the order of a SEIZURE PROTOCOL. We never go to the length of specifically asking for a particular sequence.

I hope that has answered your question sufficiently to earn your ongoing trust in asking questions and look forward to hearing some updates on your condition. I don't recall but was there an EEG obtained on you in the past and if so, did it show something clearly focal in nature or is that not an official opinion necessarily?

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This query required 19 minutes of physician specific review, research, and final draft documentation for envoy.

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