Advanced imaging techniques in the diagnosis of nonlesional epilepsy: MRI, MRS, PET, and SPECT

Once patients have a diagnosis of localization related epilepsy (LRE), it is critical to further classify those patients into lesional or nonlesional for treatment and prognostic reasons. An individual with LRE may be classified as nonlesional for two reasons: 1) a lesion may not exist; that is, the structural abnormality that gives rise to seizures may be at the channel level or be spatially distributed in such a way that it would not be accurately termed a lesion, or 2) a lesion exists but is so subtle that standard clinical imaging is not sensitive enough to discriminate between the lesion and surrounding healthy brain tissue. As with any technology and disease process, this definition is dynamic, as we know that future imaging techniques will be developed and new disease mechanisms will be discovered, making detection of the epileptogenic underlying abnormality an ever-changing target.