Neuroimaging in the evaluation of seizures and epilepsy

INTRODUCTION

The term epileptic seizure refers to a transient occurrence of signs and/or symptoms due to abnormally excessive neuronal activity of the cerebral cortex. Epilepsy is a condition characterized by recurrent, unprovoked seizures. The diagnosis of epilepsy is often not straightforward, and misdiagnosis is not rare [1]. A detailed and reliable account of the event by an eyewitness is crucial to the diagnostic evaluation, but may not be available [2].

The purpose of the diagnostic evaluation in a patient with seizures is to provide evidence that helps confirm or refute the diagnosis of epilepsy and to identify the cause of epilepsy and/or to classify the epileptic syndrome. Neuroimaging also has a critical role in the evaluation of patients with refractory epilepsy for epilepsy surgery.

This topic will discuss neuroimaging in the diagnostic evaluation of adults with possible epileptic seizures. Other aspects of diagnostic testing for seizures and epilepsy are discussed separately. (See "Evaluation of the first seizure in adults" and "Clinical and laboratory diagnosis of seizures in infants and children" and "Electroencephalography (EEG) in the diagnosis of seizures and epilepsy" and "Video and ambulatory EEG monitoring in the diagnosis of seizures and epilepsy".)

COMPUTED TOMOGRAPHY

Computed tomography (CT) is commonly ordered in patients presenting with new-onset seizure to an emergency department. It is generally available quickly in that setting and can exclude acute neurologic problems that require urgent intervention. (See "Evaluation of the first seizure in adults".)

However, in non-emergent situations, magnetic resonance imaging is more sensitive than CT and is the neuroimaging study of choice.

            

Subscribers log in here

To continue reading this article you must have access through your hospital or your group practice, log in to your personal subscription, or purchase a personal subscription. For more information, click below.
Literature review current through: Apr 2013. | This topic last updated: Jan 25, 2013.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2013 UpToDate, Inc.
References
Top
  1. Scheepers B, Clough P, Pickles C. The misdiagnosis of epilepsy: findings of a population study. Seizure 1998; 7:403.
  2. van Donselaar CA, Stroink H, Arts WF, Dutch Study Group of Epilepsy in Childhood. How confident are we of the diagnosis of epilepsy? Epilepsia 2006; 47 Suppl 1:9.
  3. Duncan JS. Imaging and epilepsy. Brain 1997; 120 ( Pt 2):339.
  4. Recommendations for neuroimaging of patients with epilepsy. Commission on Neuroimaging of the International League Against Epilepsy. Epilepsia 1997; 38:1255.
  5. Krumholz A, Wiebe S, Gronseth G, et al. Practice Parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2007; 69:1996.
  6. King MA, Newton MR, Jackson GD, et al. Epileptology of the first-seizure presentation: a clinical, electroencephalographic, and magnetic resonance imaging study of 300 consecutive patients. Lancet 1998; 352:1007.
  7. Maehara T. Neuroimaging of epilepsy. Neuropathology 2007; 27:585.
  8. Sisodiya SM. Malformations of cortical development: burdens and insights from important causes of human epilepsy. Lancet Neurol 2004; 3:29.
  9. Oster JM, Igbokwe E, Cosgrove GR, Cole AJ. Identifying subtle cortical gyral abnormalities as a predictor of focal cortical dysplasia and a cure for epilepsy. Arch Neurol 2012; 69:257.
  10. Kim YH, Kang HC, Kim DS, et al. Neuroimaging in identifying focal cortical dysplasia and prognostic factors in pediatric and adolescent epilepsy surgery. Epilepsia 2011; 52:722.
  11. Blümcke I, Thom M, Aronica E, et al. The clinicopathologic spectrum of focal cortical dysplasias: a consensus classification proposed by an ad hoc Task Force of the ILAE Diagnostic Methods Commission. Epilepsia 2011; 52:158.
  12. Bernal B, Altman NR. Evidence-based medicine: neuroimaging of seizures. Neuroimaging Clin N Am 2003; 13:211.
  13. Adams SM, Knowles PD. Evaluation of a first seizure. Am Fam Physician 2007; 75:1342.
  14. Pohlmann-Eden B, Newton M. First seizure: EEG and neuroimaging following an epileptic seizure. Epilepsia 2008; 49 Suppl 1:19.
  15. Woermann FG, Vollmar C. Clinical MRI in children and adults with focal epilepsy: a critical review. Epilepsy Behav 2009; 15:40.
  16. Von Oertzen J, Urbach H, Jungbluth S, et al. Standard magnetic resonance imaging is inadequate for patients with refractory focal epilepsy. J Neurol Neurosurg Psychiatry 2002; 73:643.
  17. Gaillard WD, Chiron C, Cross JH, et al. Guidelines for imaging infants and children with recent-onset epilepsy. Epilepsia 2009; 50:2147.
  18. Vattipally VR, Bronen RA. MR imaging of epilepsy: strategies for successful interpretation. Neuroimaging Clin N Am 2004; 14:349.
  19. Knake S, Triantafyllou C, Wald LL, et al. 3T phased array MRI improves the presurgical evaluation in focal epilepsies: a prospective study. Neurology 2005; 65:1026.
  20. Phal PM, Usmanov A, Nesbit GM, et al. Qualitative comparison of 3-T and 1.5-T MRI in the evaluation of epilepsy. AJR Am J Roentgenol 2008; 191:890.
  21. Hashiguchi K, Morioka T, Murakami N, et al. Utility of 3-T FLAIR and 3D short tau inversion recovery MR imaging in the preoperative diagnosis of hippocampal sclerosis: direct comparison with 1.5-T FLAIR MR imaging. Epilepsia 2010; 51:1820.
  22. Rugg-Gunn FJ, Eriksson SH, Symms MR, et al. Diffusion tensor imaging of cryptogenic and acquired partial epilepsies. Brain 2001; 124:627.
  23. Duning T, Kellinghaus C, Mohammadi S, et al. Individual white matter fractional anisotropy analysis on patients with MRI negative partial epilepsy. J Neurol Neurosurg Psychiatry 2010; 81:136.
  24. Wilke C, van Drongelen W, Kohrman M, He B. Neocortical seizure foci localization by means of a directed transfer function method. Epilepsia 2010; 51:564.
  25. Rugg-Gunn FJ, Eriksson SH, Boulby PA, et al. Magnetization transfer imaging in focal epilepsy. Neurology 2003; 60:1638.
  26. Colliot O, Bernasconi N, Khalili N, et al. Individual voxel-based analysis of gray matter in focal cortical dysplasia. Neuroimage 2006; 29:162.
  27. Rugg-Gunn FJ, Boulby PA, Symms MR, et al. Whole-brain T2 mapping demonstrates occult abnormalities in focal epilepsy. Neurology 2005; 64:318.
  28. Briellmann RS, Jackson GD, Pell GS, et al. Structural abnormalities remote from the seizure focus: a study using T2 relaxometry at 3 T. Neurology 2004; 63:2303.
  29. de Souza JM, Domingues RC, Cruz LC Jr, et al. Susceptibility-weighted imaging for the evaluation of patients with familial cerebral cavernous malformations: a comparison with t2-weighted fast spin-echo and gradient-echo sequences. AJNR Am J Neuroradiol 2008; 29:154.
  30. Saini J, Kesavadas C, Thomas B, et al. Susceptibility weighted imaging in the diagnostic evaluation of patients with intractable epilepsy. Epilepsia 2009; 50:1462.
  31. Chan S, Chin SS, Nordli DR, et al. Prospective magnetic resonance imaging identification of focal cortical dysplasia, including the non-balloon cell subtype. Ann Neurol 1998; 44:749.
  32. Eriksson SH, Rugg-Gunn FJ, Symms MR, et al. Diffusion tensor imaging in patients with epilepsy and malformations of cortical development. Brain 2001; 124:617.
  33. Focke NK, Bonelli SB, Yogarajah M, et al. Automated normalized FLAIR imaging in MRI-negative patients with refractory focal epilepsy. Epilepsia 2009; 50:1484.
  34. Edwards JC, Wyllie E, Ruggeri PM, et al. Seizure outcome after surgery for epilepsy due to malformation of cortical development. Neurology 2000; 55:1110.
  35. Tassi L, Colombo N, Garbelli R, et al. Focal cortical dysplasia: neuropathological subtypes, EEG, neuroimaging and surgical outcome. Brain 2002; 125:1719.
  36. Cohen-Gadol AA, Ozduman K, Bronen RA, et al. Long-term outcome after epilepsy surgery for focal cortical dysplasia. J Neurosurg 2004; 101:55.
  37. Betting LE, Mory SB, Lopes-Cendes I, et al. MRI reveals structural abnormalities in patients with idiopathic generalized epilepsy. Neurology 2006; 67:848.
  38. Gelisse P, Genton P, Raybaud C, et al. Structural brain lesions do not influence the prognosis of juvenile myoclonic epilepsy. Acta Neurol Scand 2000; 102:188.
  39. Gelisse P, Corda D, Raybaud C, et al. Abnormal neuroimaging in patients with benign epilepsy with centrotemporal spikes. Epilepsia 2003; 44:372.
  40. de Timary P, Fouchet P, Sylin M, et al. Non-epileptic seizures: delayed diagnosis in patients presenting with electroencephalographic (EEG) or clinical signs of epileptic seizures. Seizure 2002; 11:193.
  41. Reuber M, Pukrop R, Bauer J, et al. Outcome in psychogenic nonepileptic seizures: 1 to 10-year follow-up in 164 patients. Ann Neurol 2003; 53:305.
  42. Lancman ME, Brotherton TA, Asconapé JJ, Penry JK. Psychogenic seizures in adults: a longitudinal analysis. Seizure 1993; 2:281.
  43. Reuber M, Fernández G, Helmstaedter C, et al. Evidence of brain abnormality in patients with psychogenic nonepileptic seizures. Epilepsy Behav 2002; 3:249.
  44. Ettinger, AB, Jandorf, L, Cabahug, CJ, et al. Post-ictal SPECT in epileptic vs. non-epileptic seizures. J Epilepsy 1998; 11:67.
  45. Labate A, Gambardella A, Aguglia U, et al. Temporal lobe abnormalities on brain MRI in healthy volunteers: a prospective case-control study. Neurology 2010; 74:553.
  46. Katzman GL, Dagher AP, Patronas NJ. Incidental findings on brain magnetic resonance imaging from 1000 asymptomatic volunteers. JAMA 1999; 282:36.
  47. Moore KR, Swallow CE, Tsuruda JS. Incidental detection of hippocampal sclerosis on MR images: is it significant? AJNR Am J Neuroradiol 1999; 20:1609.
  48. Adcock JE, Wise RG, Oxbury JM, et al. Quantitative fMRI assessment of the differences in lateralization of language-related brain activation in patients with temporal lobe epilepsy. Neuroimage 2003; 18:423.
  49. Liégeois F, Connelly A, Cross JH, et al. Language reorganization in children with early-onset lesions of the left hemisphere: an fMRI study. Brain 2004; 127:1229.
  50. Noppeney U, Price CJ, Duncan JS, Koepp MJ. Reading skills after left anterior temporal lobe resection: an fMRI study. Brain 2005; 128:1377.
  51. Sabsevitz DS, Swanson SJ, Hammeke TA, et al. Use of preoperative functional neuroimaging to predict language deficits from epilepsy surgery. Neurology 2003; 60:1788.
  52. Binder JR, Sabsevitz DS, Swanson SJ, et al. Use of preoperative functional MRI to predict verbal memory decline after temporal lobe epilepsy surgery. Epilepsia 2008; 49:1377.
  53. Bonelli SB, Powell R, Yogarajah M, et al. Preoperative amygdala fMRI in temporal lobe epilepsy. Epilepsia 2009; 50:217.
  54. Arora J, Pugh K, Westerveld M, et al. Language lateralization in epilepsy patients: fMRI validated with the Wada procedure. Epilepsia 2009; 50:2225.
  55. Bonelli SB, Thompson PJ, Yogarajah M, et al. Imaging language networks before and after anterior temporal lobe resection: results of a longitudinal fMRI study. Epilepsia 2012; 53:639.
  56. Benke T, Köylü B, Visani P, et al. Language lateralization in temporal lobe epilepsy: a comparison between fMRI and the Wada Test. Epilepsia 2006; 47:1308.
  57. Golby AJ, Poldrack RA, Illes J, et al. Memory lateralization in medial temporal lobe epilepsy assessed by functional MRI. Epilepsia 2002; 43:855.
  58. Rabin ML, Narayan VM, Kimberg DY, et al. Functional MRI predicts post-surgical memory following temporal lobectomy. Brain 2004; 127:2286.
  59. Richardson MP, Strange BA, Thompson PJ, et al. Pre-operative verbal memory fMRI predicts post-operative memory decline after left temporal lobe resection. Brain 2004; 127:2419.
  60. Richardson MP, Strange BA, Duncan JS, Dolan RJ. Memory fMRI in left hippocampal sclerosis: optimizing the approach to predicting postsurgical memory. Neurology 2006; 66:699.
  61. Powell HW, Richardson MP, Symms MR, et al. Preoperative fMRI predicts memory decline following anterior temporal lobe resection. J Neurol Neurosurg Psychiatry 2008; 79:686.
  62. Köylü B, Walser G, Ischebeck A, et al. Functional imaging of semantic memory predicts postoperative episodic memory functions in chronic temporal lobe epilepsy. Brain Res 2008; 1223:73.
  63. Cheung MC, Chan AS, Lam JM, Chan YL. Pre- and postoperative fMRI and clinical memory performance in temporal lobe epilepsy. J Neurol Neurosurg Psychiatry 2009; 80:1099.
  64. Bonelli SB, Powell RH, Yogarajah M, et al. Imaging memory in temporal lobe epilepsy: predicting the effects of temporal lobe resection. Brain 2010; 133:1186.
  65. Woermann FG, Jokeit H, Luerding R, et al. Language lateralization by Wada test and fMRI in 100 patients with epilepsy. Neurology 2003; 61:699.
  66. Wellmer J, Weber B, Urbach H, et al. Cerebral lesions can impair fMRI-based language lateralization. Epilepsia 2009; 50:2213.
  67. Binder JR, Swanson SJ, Sabsevitz DS, et al. A comparison of two fMRI methods for predicting verbal memory decline after left temporal lobectomy: language lateralization versus hippocampal activation asymmetry. Epilepsia 2010; 51:618.
  68. Wagner K, Hader C, Metternich B, et al. Who needs a Wada test? Present clinical indications for amobarbital procedures. J Neurol Neurosurg Psychiatry 2012; 83:503.
  69. Dym RJ, Burns J, Freeman K, Lipton ML. Is functional MR imaging assessment of hemispheric language dominance as good as the Wada test?: a meta-analysis. Radiology 2011; 261:446.
  70. Federico P, Archer JS, Abbott DF, Jackson GD. Cortical/subcortical BOLD changes associated with epileptic discharges: an EEG-fMRI study at 3 T. Neurology 2005; 64:1125.
  71. Kobayashi E, Bagshaw AP, Jansen A, et al. Intrinsic epileptogenicity in polymicrogyric cortex suggested by EEG-fMRI BOLD responses. Neurology 2005; 64:1263.
  72. Liu Y, Yang T, Yang X, et al. EEG-fMRI study of the interictal epileptic activity in patients with partial epilepsy. J Neurol Sci 2008; 268:117.
  73. Moeller F, Tyvaert L, Nguyen DK, et al. EEG-fMRI: adding to standard evaluations of patients with nonlesional frontal lobe epilepsy. Neurology 2009; 73:2023.
  74. Thornton R, Laufs H, Rodionov R, et al. EEG correlated functional MRI and postoperative outcome in focal epilepsy. J Neurol Neurosurg Psychiatry 2010; 81:922.
  75. Archer JS, Abbott DF, Masterton RA, et al. Functional MRI interactions between dysplastic nodules and overlying cortex in periventricular nodular heterotopia. Epilepsy Behav 2010; 19:631.
  76. Gholipour T, Moeller F, Pittau F, et al. Reproducibility of interictal EEG-fMRI results in patients with epilepsy. Epilepsia 2011; 52:433.
  77. Thornton R, Vulliemoz S, Rodionov R, et al. Epileptic networks in focal cortical dysplasia revealed using electroencephalography-functional magnetic resonance imaging. Ann Neurol 2011; 70:822.
  78. Pittau F, Dubeau F, Gotman J. Contribution of EEG/fMRI to the definition of the epileptic focus. Neurology 2012; 78:1479.
  79. Valk PE, Laxer KD, Barbaro NM, et al. High-resolution (2.6-mm) PET in partial complex epilepsy associated with mesial temporal sclerosis. Radiology 1993; 186:55.
  80. Ryvlin P, Bouvard S, Le Bars D, et al. Clinical utility of flumazenil-PET versus [18F]fluorodeoxyglucose-PET and MRI in refractory partial epilepsy. A prospective study in 100 patients. Brain 1998; 121 ( Pt 11):2067.
  81. Gaillard WD, Bhatia S, Bookheimer SY, et al. FDG-PET and volumetric MRI in the evaluation of patients with partial epilepsy. Neurology 1995; 45:123.
  82. Ryvlin P, Philippon B, Cinotti L, et al. Functional neuroimaging strategy in temporal lobe epilepsy: a comparative study of 18FDG-PET and 99mTc-HMPAO-SPECT. Ann Neurol 1992; 31:650.
  83. Swartz BE, Tomiyasu U, Delgado-Escueta AV, et al. Neuroimaging in temporal lobe epilepsy: test sensitivity and relationships to pathology and postoperative outcome. Epilepsia 1992; 33:624.
  84. Salanova V, Markand O, Worth R. Temporal lobe epilepsy: analysis of patients with dual pathology. Acta Neurol Scand 2004; 109:126.
  85. la Fougère C, Rominger A, Förster S, et al. PET and SPECT in epilepsy: a critical review. Epilepsy Behav 2009; 15:50.
  86. Henry TR, Engel J Jr, Mazziotta JC. Clinical evaluation of interictal fluorine-18-fluorodeoxyglucose PET in partial epilepsy. J Nucl Med 1993; 34:1892.
  87. Van Paesschen W, Dupont P, Sunaert S, et al. The use of SPECT and PET in routine clinical practice in epilepsy. Curr Opin Neurol 2007; 20:194.
  88. Lee SK, Lee SY, Kim KK, et al. Surgical outcome and prognostic factors of cryptogenic neocortical epilepsy. Ann Neurol 2005; 58:525.
  89. Willmann O, Wennberg R, May T, et al. The contribution of 18F-FDG PET in preoperative epilepsy surgery evaluation for patients with temporal lobe epilepsy A meta-analysis. Seizure 2007; 16:509.
  90. Carne RP, O'Brien TJ, Kilpatrick CJ, et al. MRI-negative PET-positive temporal lobe epilepsy: a distinct surgically remediable syndrome. Brain 2004; 127:2276.
  91. LoPinto-Khoury C, Sperling MR, Skidmore C, et al. Surgical outcome in PET-positive, MRI-negative patients with temporal lobe epilepsy. Epilepsia 2012; 53:342.
  92. Muzik O, da Silva EA, Juhasz C, et al. Intracranial EEG versus flumazenil and glucose PET in children with extratemporal lobe epilepsy. Neurology 2000; 54:171.
  93. Lee N, Radtke RA, Gray L, et al. Neuronal migration disorders: positron emission tomography correlations. Ann Neurol 1994; 35:290.
  94. Juhász C, Chugani DC, Muzik O, et al. Relationship of flumazenil and glucose PET abnormalities to neocortical epilepsy surgery outcome. Neurology 2001; 56:1650.
  95. Kim SK, Lee DS, Lee SK, et al. Diagnostic performance of [18F]FDG-PET and ictal [99mTc]-HMPAO SPECT in occipital lobe epilepsy. Epilepsia 2001; 42:1531.
  96. Lerner JT, Salamon N, Hauptman JS, et al. Assessment and surgical outcomes for mild type I and severe type II cortical dysplasia: a critical review and the UCLA experience. Epilepsia 2009; 50:1310.
  97. Knowlton RC. The role of FDG-PET, ictal SPECT, and MEG in the epilepsy surgery evaluation. Epilepsy Behav 2006; 8:91.
  98. Kaneko K, Sasaki M, Morioka T, et al. Pre-surgical identification of epileptogenic areas in temporal lobe epilepsy by 123I-iomazenil SPECT: a comparison with IMP SPECT and FDG PET. Nucl Med Commun 2006; 27:893.
  99. Umeoka S, Matsuda K, Baba K, et al. Usefulness of 123I-iomazenil single-photon emission computed tomography in discriminating between mesial and lateral temporal lobe epilepsy in patients in whom magnetic resonance imaging demonstrates normal findings. J Neurosurg 2007; 107:352.
  100. Fedi M, Reutens D, Okazawa H, et al. Localizing value of alpha-methyl-L-tryptophan PET in intractable epilepsy of neocortical origin. Neurology 2001; 57:1629.
  101. Juhász C, Chugani HT. Imaging the epileptic brain with positron emission tomography. Neuroimaging Clin N Am 2003; 13:705.
  102. Kumar JS, Mann JJ. PET tracers for 5-HT(1A) receptors and uses thereof. Drug Discov Today 2007; 12:748.
  103. Didelot A, Ryvlin P, Lothe A, et al. PET imaging of brain 5-HT1A receptors in the preoperative evaluation of temporal lobe epilepsy. Brain 2008; 131:2751.
  104. Liew CJ, Lim YM, Bonwetsch R, et al. 18F-FCWAY and 18F-FDG PET in MRI-negative temporal lobe epilepsy. Epilepsia 2009; 50:234.
  105. Juhász C, Asano E, Shah A, et al. Focal decreases of cortical GABAA receptor binding remote from the primary seizure focus: what do they indicate? Epilepsia 2009; 50:240.
  106. Kasper BS, Struffert T, Kasper EM, et al. 18Fluoroethyl-L-tyrosine-PET in long-term epilepsy associated glioneuronal tumors. Epilepsia 2011; 52:35.
  107. Salamon N, Kung J, Shaw SJ, et al. FDG-PET/MRI coregistration improves detection of cortical dysplasia in patients with epilepsy. Neurology 2008; 71:1594.
  108. Chassoux F, Rodrigo S, Semah F, et al. FDG-PET improves surgical outcome in negative MRI Taylor-type focal cortical dysplasias. Neurology 2010; 75:2168.
  109. Rubí S, Setoain X, Donaire A, et al. Validation of FDG-PET/MRI coregistration in nonlesional refractory childhood epilepsy. Epilepsia 2011; 52:2216.
  110. Rowe CC, Berkovic SF, Sia ST, et al. Localization of epileptic foci with postictal single photon emission computed tomography. Ann Neurol 1989; 26:660.
  111. Kazemi NJ, Worrell GA, Stead SM, et al. Ictal SPECT statistical parametric mapping in temporal lobe epilepsy surgery. Neurology 2010; 74:70.
  112. O'Brien TJ, So EL, Cascino GD, et al. Subtraction SPECT coregistered to MRI in focal malformations of cortical development: localization of the epileptogenic zone in epilepsy surgery candidates. Epilepsia 2004; 45:367.
  113. O'Brien TJ, So EL, Mullan BP, et al. Subtraction ictal SPECT co-registered to MRI improves clinical usefulness of SPECT in localizing the surgical seizure focus. Neurology 1998; 50:445.
  114. O'Brien TJ, So EL, Mullan BP, et al. Subtraction SPECT co-registered to MRI improves postictal SPECT localization of seizure foci. Neurology 1999; 52:137.
  115. von Oertzen TJ, Mormann F, Urbach H, et al. Prospective use of subtraction ictal SPECT coregistered to MRI (SISCOM) in presurgical evaluation of epilepsy. Epilepsia 2011; 52:2239.
  116. Lee JY, Joo EY, Park HS, et al. Repeated ictal SPECT in partial epilepsy patients: SISCOM analysis. Epilepsia 2011; 52:2249.
  117. Cascino GD, Buchhalter JR, Mullan BP, So EL. Ictal SPECT in nonlesional extratemporal epilepsy. Epilepsia 2004; 45 Suppl 4:32.
  118. Varghese GI, Purcaro MJ, Motelow JE, et al. Clinical use of ictal SPECT in secondarily generalized tonic-clonic seizures. Brain 2009; 132:2102.
  119. Dupont P, Van Paesschen W, Palmini A, et al. Ictal perfusion patterns associated with single MRI-visible focal dysplastic lesions: implications for the noninvasive delineation of the epileptogenic zone. Epilepsia 2006; 47:1550.
  120. Lewis PJ, Siegel A, Siegel AM, et al. Does performing image registration and subtraction in ictal brain SPECT help localize neocortical seizures? J Nucl Med 2000; 41:1619.
  121. Newton MR, Berkovic SF, Austin MC, et al. SPECT in the localisation of extratemporal and temporal seizure foci. J Neurol Neurosurg Psychiatry 1995; 59:26.
  122. Devous MD Sr, Thisted RA, Morgan GF, et al. SPECT brain imaging in epilepsy: a meta-analysis. J Nucl Med 1998; 39:285.
  123. Van Paesschen W. Ictal SPECT. Epilepsia 2004; 45 Suppl 4:35.
  124. Van Paesschen W, Dupont P, Van Driel G, et al. SPECT perfusion changes during complex partial seizures in patients with hippocampal sclerosis. Brain 2003; 126:1103.
  125. Lee SK, Lee SY, Yun CH, et al. Ictal SPECT in neocortical epilepsies: clinical usefulness and factors affecting the pattern of hyperperfusion. Neuroradiology 2006; 48:678.
  126. Gallen CC, Hirschkoff EC, Buchanan DS. Magnetoencephalography and magnetic source imaging. Capabilities and limitations. Neuroimaging Clin N Am 1995; 5:227.
  127. Ricci GB, Romani GL, Salustri C, et al. Study of focal epilepsy by multichannel neuromagnetic measurements. Electroencephalogr Clin Neurophysiol 1987; 66:358.
  128. Ebersole JS. Magnetoencephalography/magnetic source imaging in the assessment of patients with epilepsy. Epilepsia 1997; 38 Suppl 4:S1.
  129. Baumgartner C, Pataraia E. Revisiting the role of magnetoencephalography in epilepsy. Curr Opin Neurol 2006; 19:181.
  130. Knowlton RC, Shih J. Magnetoencephalography in epilepsy. Epilepsia 2004; 45 Suppl 4:61.
  131. Knowlton RC, Laxer KD, Aminoff MJ, et al. Magnetoencephalography in partial epilepsy: clinical yield and localization accuracy. Ann Neurol 1997; 42:622.
  132. Shiraishi H, Watanabe Y, Watanabe M, et al. Interictal and ictal magnetoencephalographic study in patients with medial frontal lobe epilepsy. Epilepsia 2001; 42:875.
  133. de Jongh A, de Munck JC, Gonçalves SI, Ossenblok P. Differences in MEG/EEG epileptic spike yields explained by regional differences in signal-to-noise ratios. J Clin Neurophysiol 2005; 22:153.
  134. RamachandranNair R, Otsubo H, Shroff MM, et al. MEG predicts outcome following surgery for intractable epilepsy in children with normal or nonfocal MRI findings. Epilepsia 2007; 48:149.
  135. Knowlton RC, Razdan SN, Limdi N, et al. Effect of epilepsy magnetic source imaging on intracranial electrode placement. Ann Neurol 2009; 65:716.
  136. Seo JH, Holland K, Rose D, et al. Multimodality imaging in the surgical treatment of children with nonlesional epilepsy. Neurology 2011; 76:41.
  137. De Tiège X, Carrette E, Legros B, et al. Clinical added value of magnetic source imaging in the presurgical evaluation of refractory focal epilepsy. J Neurol Neurosurg Psychiatry 2012; 83:417.
  138. Amo C, Saldaña C, Hidalgo MG, et al. Magnetoencephalographic localization of peritumoral temporal epileptic focus previous surgical resection. Seizure 2003; 12:19.
  139. Otsubo H, Ochi A, Elliott I, et al. MEG predicts epileptic zone in lesional extrahippocampal epilepsy: 12 pediatric surgery cases. Epilepsia 2001; 42:1523.
  140. Stefan H, Hammen T. Cavernous haemangiomas, epilepsy and treatment strategies. Acta Neurol Scand 2004; 110:393.
  141. Widjaja E, Zarei Mahmoodabadi S, Otsubo H, et al. Subcortical alterations in tissue microstructure adjacent to focal cortical dysplasia: detection at diffusion-tensor MR imaging by using magnetoencephalographic dipole cluster localization. Radiology 2009; 251:206.
  142. Stefan H, Wu X, Buchfelder M, et al. MEG in frontal lobe epilepsies: localization and postoperative outcome. Epilepsia 2011; 52:2233.
  143. Iida K, Otsubo H, Mohamed IS, et al. Characterizing magnetoencephalographic spike sources in children with tuberous sclerosis complex. Epilepsia 2005; 46:1510.
  144. Stefan H, Nimsky C, Scheler G, et al. Periventricular nodular heterotopia: A challenge for epilepsy surgery. Seizure 2007; 16:81.
  145. Stefan H, Hummel C, Hopfengärtner R, et al. Magnetoencephalography in extratemporal epilepsy. J Clin Neurophysiol 2000; 17:190.
  146. Mohamed IS, Otsubo H, Ochi A, et al. Utility of magnetoencephalography in the evaluation of recurrent seizures after epilepsy surgery. Epilepsia 2007; 48:2150.
  147. Kirchberger K, Hummel C, Stefan H. Postoperative multichannel magnetoencephalography in patients with recurrent seizures after epilepsy surgery. Acta Neurol Scand 1998; 98:1.
  148. Stefan H, Hummel C, Scheler G, et al. Magnetic brain source imaging of focal epileptic activity: a synopsis of 455 cases. Brain 2003; 126:2396.
  149. Pataraia E, Simos PG, Castillo EM, et al. Does magnetoencephalography add to scalp video-EEG as a diagnostic tool in epilepsy surgery? Neurology 2004; 62:943.
  150. Knowlton RC, Elgavish RA, Limdi N, et al. Functional imaging: I. Relative predictive value of intracranial electroencephalography. Ann Neurol 2008; 64:25.
  151. Knowlton RC, Elgavish RA, Bartolucci A, et al. Functional imaging: II. Prediction of epilepsy surgery outcome. Ann Neurol 2008; 64:35.
  152. Doss RC, Zhang W, Risse GL, Dickens DL. Lateralizing language with magnetic source imaging: validation based on the Wada test. Epilepsia 2009; 50:2242.
  153. McDonald CR, Thesen T, Hagler DJ Jr, et al. Distributed source modeling of language with magnetoencephalography: application to patients with intractable epilepsy. Epilepsia 2009; 50:2256.
  154. Findlay AM, Ambrose JB, Cahn-Weiner DA, et al. Dynamics of hemispheric dominance for language assessed by magnetoencephalographic imaging. Ann Neurol 2012; 71:668.