High-resolution Multi-parametric Magnetic Resonance Imaging for Focal Epilepsy
- Conditions
- Epilepsies, Partial
- Interventions
- Diagnostic Test: Magnetic Resonance Imaging
- Registration Number
- NCT06550726
- Lead Sponsor
- Chinese University of Hong Kong
- Brief Summary
Patients with focal epilepsy often have diagnostic difficulties as their culprit for seizures are difficult to be picked up using conventional imaging. The current study is to investigate the utility of advanced MRI sequences on detection of subtle lesions accountable for focal epilepsy.
- Detailed Description
Focal epilepsy refers to having seizures arising from a specific part of the brain. In these patients, workup in magnetic resonance imaging is often necessary as patients with structural lesions have a much higher rate of seizures, ranging from 10% to 26% at 1 year and from 29% to 48% at 5 years. However, there is also a subgroup of patients who has epilepsy not adequately controlled by anti-epileptics with unrevealing first MRI study, a dedicated MRI protocol may reveal positive lesion in 30-65% of the cases. In these patients, several tricks can be applied to increase the detection rate. First, the used of a high-resolution MRI on a high-field scanner could be helpful, which can be increased the sensitivity up to 90%. The use of 7T-MRI in further picking up subtle lesions in patients presenting with epilepsy has been investigated, further affirming the role of high resolution MRI imaging. Secondly, the use of dedicated sequences, such as T1-weighted inversion recovery sequences which allow better distinction of grey and white matter, could also reveal subtle lesions such as polymicrogyria or Type 1 focal cortical dysplasia.
This study is therefore aimed to apply the findings to the local settings, and specifically to investigate if T1-weighted inversion recovery sequences provides additional benefit in picking up more subtle lesions in patients who had an initial first negative MRI.
Recruitment & Eligibility
- Status
- NOT_YET_RECRUITING
- Sex
- All
- Target Recruitment
- 66
-
Consecutive patients with drug-resistant focal epilepsy fulfilling the following criteria -
- Diagnosis of focal epilepsy with a probable site identified, as defined by concordant results from any TWO of the following:
-
Clinical seminology compatible with focal epilepsy.
-
Electroencephalography pointing towards a specific site for focal epilepsy.
-
Positive ictal brain scintigraphy with SPECT-CT correlation. AND 2. Previous MRI (at least one study with protocol tailored for epilepsy) which did not reveal accountable focal lesion.
AND 3. Able to consent for MRI examination (if patient under age of 18, consent for MRI will be obtained from guardian). Patients will be provided information leaflets to read on, and written consent before taking part in this study and MRI examination.
- Patients who are contraindicated to magnetic resonance imaging (such as due to underlying MRI incompatible metallic implants)
- Patients who cannot cooperate for MRI scanning.
- Patients show are unable to provide informed consent.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Study subjects Magnetic Resonance Imaging Study subjects will be recruited for scanning in a 3T MRI scanner with dedicated high-resolution MRI sequences as stated in our research protocol.
- Primary Outcome Measures
Name Time Method Accuracy of high resolution MRI in diagnosis At the time of MRI scanning, typically 1 day the sensitivity and specificity of the baseline MRI (bMRI) and the high-resolution MRI (hrMRI) studies, based on the standard of surgical findings on patients who underwent either intracranial EEG or surgical resection
- Secondary Outcome Measures
Name Time Method