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KMID : 1161920140110020127
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Journal of Medicine and Life Science
2014 Volume.11 No. 2 p.127 ~ p.131
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Usability of the FLAIR Image in Temporal Lobe Epilepsy
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Yage Tae-Ki
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Abstract
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It is necessary to identify the epileptogenic zone in patients with intractable epilepsy. It is, however, difficult to identify the lesion in conventional MRI including T1WI and T2WI. Another pulse sequence, FLAIR (Fluid-attenuated inversion recovery) image, may give a clue to identify the epileptogenic lesion in MRI. This study included 20 patients, who did not show discrete unilateral hippocampal atrophy or sclerosis, and who showed unilateral hippoccampal atrophy and contralateral sclerosis in T1WI or T2WI. Preoperatively, all patients had chronic video-EEG (Electroencephalography) monitoring with standard surface electrodes and depth electrodes in bilateral hippocampus. Standard anterior temporal lobectomy was performed in 17 patients, and selective amygdalohippocampectomy was done in three. MRI including T1WI and T2WI recognized unilateral hippocampal atrophy and sclerosis in three, unilateral hippocampal atrophy and contralateral hippocampal sclerosis in three. The rest of the patients did not show any identifiable lesion in MRI. FLAIR image, however, identified high signal intensity of the unilateral hippocampus in 12, bilateral hippocampus in three, and showed none of change in five. Anterior temporal lobectomy was performed based on the data of the MRI with FLAIR image and depth EEGs. Histopathologic findings revealed hippocampal sclerosis in all. 18 patients were seizure free at the follow-up period of 16- 28 months. In patients with intractable temporal lobe epilepsy who had difficulty in lateralizing the epileptogenic temporal lobe in semiology, surface EEG, and the conventional MRI including T1WI and T2WI, FLAIR image is of value in identifying the epileptoge nic hippocampus.
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KEYWORD
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Temporal lobe epilepsy, Fluid-attenuated inversion recovery
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