Epileptogenic lesions in the Australian epilepsy project: A harmonized 3-T magnetic resonance imaging protocol and its diagnostic yield.

The Role of MRI Volumetric Assessment of Hippocampus and its Parts in Early Diagnosis of Mesial Temporal Lobe Epilepsy in Epileptic Children. A case-control study.

Risk Factors for White Matter Lesion Burden in Adults with Focal Epilepsy.

WMH are common in adults with focal epilepsy, and the frontal lobe is the most frequently affected region, and age, seizure duration, interictal epileptiform discharges, and seizure duration are independent risk factors for greater WMH burden.

Subtle Hippocampal Subfield Volumetric Alterations in Clinically Diagnosed MRI-Negative Temporal Lobe Epilepsy.

Introduction Approximately 20-30% of temporal lobe epilepsy (TLE) cases present with no visible abnormalities on conventional magnetic resonance imaging (MRI). When interictal electroencephalography (EEG) recordings are also persistently normal, the diagnosis and lateralization become major clinical challenges. We aimed to investigate whether automated hippocampal subfield volumetry could detect subtle structural alterations in these "electro-clinically silent" MRI-negative cases and to correlate these findings with seizure semiology. Methods We analyzed 24 patients with clinically diagnosed MRI-negative/EEG-negative TLE and 26 age-matched healthy controls. Despite normal visual inspection on 1.5-T MRI, hippocampal subfield volumes were extracted using an automated segmentation pipeline (volBrain). Seizure semiology was systematically categorized to provide clinical-anatomical correlation. Results TLE patients exhibited a significant and selective volume reduction in the right CA4-dentate gyrus (CA4-DG) subfield compared to healthy controls (p=0.003), even after adjusting for age, sex, and total intracranial volume (p=0.002). No statistically significant differences were observed in other hippocampal subfields (CA1, CA2/3, or subiculum), indicating a highly localized pattern of structural alteration. Conclusion These results imply that selective CA4-DG atrophy is a defining characteristic of the MRI-negative TLE phenotype, thereby corroborating the "dentate gate" failure hypothesis. Quantitative volumetry provides a crucial diagnostic tool in settings with limited resources, where advanced techniques like 3-T MRI or invasive monitoring are not accessible. This objective structural marker, when integrated with comprehensive semiological analysis, improves diagnostic accuracy and facilitates early clinical intervention in difficult non-lesional TLE cases.

Magnetic Resonance Imaging of the Neonatal Brain: Modalities, Scoring Systems, and Clinical Applications

Magnetic resonance imaging (MRI) has become the gold standard for evaluating brain injury and development in newborn infants, providing structural, metabolic, and functional information without ionizing radiation. This review comprehensively examines the principal MRI modalities used in current neonatal neuroimaging for a novice/intermediate-level reader—including conventional T1- and T2-weighted imaging, diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping, diffusion tensor imaging (DTI), magnetic resonance spectroscopy (MRS), susceptibility-weighted imaging (SWI), volumetric analysis, arterial spin labeling (ASL), and functional connectivity MRI—with particular attention to their applications in preterm and term populations. Additionally, validated MRI scoring systems for quantifying brain injury severity and predicting neurodevelopmental outcomes are reviewed and summarized. Understanding the technical principles, clinical applications, and limitations of these modalities is essential for optimal interpretation of neonatal brain MRI, and for advancing prognostication and therapeutic decision-making in this vulnerable population.

Impact of 18 Months of Magnetoencephalography-Magnetic Source Imaging on Presurgical Decision-Making for Epilepsy Surgery in South Korea: A Single Pediatric Epilepsy Center Study

Purpose: This study evaluated the impact of magnetoencephalography-magnetic source imaging (MEG-MSI) on the presurgical evaluation of patients with epilepsy. Methods: We retrospectively analyzed presurgical evaluation reports for 64 patients considered for epilepsy surgery at a single pediatric epilepsy center. Results: Overall, 52 of 64 patients (81%) were considered candidates for resective surgery before MEG-MSI. In 37 of these 52 patients (71%), MEG-MSI findings were concordant with those of other modalities, supporting the clinical decision to proceed with resective surgery. However, in 11 of the 52 cases (21%), resective surgery was no longer considered beneficial after MEG-MSI. Among these 11 patients, five underwent either corpus callosotomy or vagus nerve stimulator insertion. Conclusion: Since MEG was incorporated into routine presurgical evaluation for patients with epilepsy, MEG-MSI findings have influenced clinical decision-making in 11 patients.

Accelerated Brain Atrophy in Epilepsy: A Prospective Population-Based Study.

OBJECTIVE Previous longitudinal neuroimaging studies suggest that epilepsy is a progressive disorder. To date, these findings have relied largely on populations from tertiary centers, resulting in ascertainment bias, as severely affected individuals are more likely to be rescanned. We aimed to determine rates of progressive brain atrophy in a prospective, population-based cohort. METHODS We analyzed longitudinal magnetic resonance imaging (MRI) data from 116 individuals with epilepsy and 89 age- and sex-matched healthy controls recruited from a prospective, longitudinal, community-based cohort in the United Kingdom. All participants underwent 2 scans 3.5 years apart, regardless of seizure status. We quantified progressive changes in cortical thickness and subcortical volumes using state-of-the-art longitudinal morphometry. RESULTS People with epilepsy exhibited accelerated but modest global grey matter volume (GMV) loss compared with controls (2.7 vs 2.4 ml/year; p = 0.01). This acceleration was associated with specific phenotypes: focal epilepsy, MRI-identifiable lesions, and ongoing seizures. In contrast, generalized epilepsy and seizure-free periods were associated with more stable global trajectories. Cortical regions identified as vulnerable were characterized by markedly accelerated thinning compared to controls (5.3 vs 3.4 μm/year; p < 0.001) and were pervasive across most epilepsy phenotypes. INTERPRETATION Epilepsy is associated with progressive structural brain damage that exceeds normal aging, but the trajectory is heterogeneous. These prospective population-based data confirm that vulnerable regions show progressive atrophy, particularly in focal and lesional epilepsy and individuals with ongoing seizures. ANN NEUROL 2026.