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E1786. Epilepsy: Puzzle Pieces Together – Seizures, Tests, Disease
Authors
  1. Claudia Moldovanu; Emergency Clinical County Hospital; University of Medicine, Pharmacy, Sciences and Technology
  2. Roxana Ciocan; Hospital Paris Saint Joseph, Neurology Department
  3. Mathieu Zuber; Hospital Paris Saint Joseph, Neurology Department
  4. Andrei Lebovici; "Iuliu Hatieganu" University of Medicine and Pharmacy; Emergency Clinical County Hospital
Background
Epilepsy is one of the most common neurological disorders. Its etiology is variable and sometimes multifactorial. Clinical course and response to treatment largely depend on the precise etiology of the seizures. Along with the electroencephalogram (EEG), neuroimaging techniques, in particular, magnetic resonance imaging (MRI), are the most important tools for determining the possible etiology of epilepsy. Cryptogenic epilepsy is often refractory to anti-epileptic drug treatment. In drug-resistant patients with structural or consistent functional lesions related to the epilepsy syndrome, surgery is the only treatment that can offer a seizure-free outcome. The pre-operative detection of the underlying structural condition increases the odds of successful surgical treatment of pharmacoresistant epilepsy.

Educational Goals / Teaching Points
In this educational exhibit, we aim to address the clinical and neurophysiologic data of epilepsy, potential morphological imaging causes and to discuss treatment strategies.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The goal of imaging is to find a potential surgical target – “lesion”. MRI becomes an important tool for prognostic counseling and defining treatment strategy, may assist in determining the etiology of focal epilepsy and demonstrating the anatomical changes associated with seizure activity. The high diagnostic yield of MRI to identify the common pathological findings in individuals with focal seizures including mesial temporal sclerosis, vascular anomalies, low-grade glial neoplasms and malformations of cortical development has been demonstrated. But, not all MRI abnormalities cause seizures and not all seizures originate from identified structural cerebral abnormalities. It is necessary to establish with clinical and neurophysiologic data whether a given lesion is likely to cause the seizures. Combining these different techniques will allow surgery to be appropriately guided and offer these patients the chance of a seizure-free life, as well as allay some of the negative cognitive, psychological and socioeconomic consequences of drug-resistant epilepsy.

Conclusion
Despite recent advances in neuroimaging methods, diagnosis of specific epileptogenic lesions remains challenging and a close correlation with semiology, EEG findings and imaging findings, both structural and metabolic, is mandatory.