Magnetic resonance imaging (MRI) is a key imaging technique in the diagnosis of patients with epilepsy. It can contribute to the identification of patients who are, in the case of pharmacoresistance, good candidates for epilepsy surgery. Yet, "standard head/brain" MRI examinations often fail to displaying therapeutically relevant epileptogenic lesions. Thus an epilepsy-specific MRI protocol, which is sensitive for even small epileptogenic lesions was determined based on a large European presurgical epilepsy program1,2. The aim of the current preliminary study was the assessment of the usefulness...

Thirty six children with pharmacoresistant epilepsy underwent MRI brain examination according to the "Essential Six" epilepsy-specific MRI protocol between October 2016 and September 2017. The protocol included 6 following sequences: 3D T1-weighted images at 1 mm isotropic voxels size and 5 sequences of ≤ 3 mm slice thickness, a hemosiderin/calcification-sensitive sequence in axial section and T2-weigted/STIR and FLAIR images in axial and coronal sections. All examinations were performed with Siemens Aera 48-channel 1.5T MRI scanner. Patients' age ranged from 3 to 18 years. All patients...

Eleven out of 36 children (30%) included into the study presented the spectrum of epileptogenic lesions. Four of the eleven children (36%) with diagnosed pathologies in the MRI performed according to the "Essential Six" protocol had not presented obvious pathologies in previously performed brain MRI in the standard protocol. In a retrospective assessment of the 4 patients: In 2 patients the changes were visible also in the previous examination performed according to the standard protocol but were very discreet, difficult to identify prospectively (Fig. 1...

Our initial experience shows that the "Essential Six" MRI protocol specific for epilepsy can contribute to improved and earlier identification of epileptogenic lesions in children with pharmacoresistant epilepsy and seems to be more sensitive compared to standard head/brain MRI protocol.

Magdalena Maria Woźniak, MD, PhD. Department of Pediatric Radiology, Medical University of Lublin, Children's University Hospital, Gębali 6, 20-093, Lublin, Poland. Email: [email protected]

Wellmer J, Quesada CM, Rothe L, Elger CE, Bien CG, Urbach H. Proposal for a Magnetic Resonance Imaging Protocol for the Detection of Epileptogenic Lesions at Early Outpatient Stages. Epilepsia 2013;54:1977–1987. Spencer D. MRI (Minimum Recommended Imaging) in Epilepsy. Epilepsy Currents, Vol. 14, No. 5 (September/October) 2014 pp. 261–263