Ultra-high-field MRI for identification and assessment of epileptogenic lesions

Epilepsy is the most common serious brain disorder worldwide. The majority of patients diagnosed with epilepsy suffer from localisation-related epilepsies. Most patients achieve control of their seizures by conventional treatment strategies including medications. However, one third of patients do not achieve satisfactory seizure control with medications alone. In these cases, focal resection of the epileptogenic zone provides an excellent prognosis for seizure control. Unfortunately, current medical imaging techniques show no abnormalities in a significant proportion of patients with localization-related seizures. These patients may have subtle structural abnormalities in their brain, the most common of which is focal cortical dysplasia. MRI at ultra-high-field (7T) provides a significant increase in the signal-tonoise-ratio of the measured signals, which can be used to increase the spatial resolution of images. In addition, 7T provides easier access to important image contrasts. The aim of this project is therefore to evaluate whether ultra-high-field MRI can improve the detection and characterization of subtle structural epileptogenic abnormalities in epilepsy. The importance of this research is that the identification of a focal epileptogenic lesion in people with refractory epilepsy has crucial management implications, as surgical removal of such lesion may dramatically improve outcomes and the chance of seizure freedom.