Abstract Details

Title Epilepsy MRI Interpretations Outside Of Comprehensive Epilepsy Centers Often Miss Epileptogenic Lesions

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 6-022

Objective

To assess the rate of MRI detected epileptogenic lesions on outside reported normal MRIs compared to epilepsy protocol MRIs at our CEC.

Background Patients with drug resistant epilepsy (DRE) benefit from evaluation at a comprehensive epilepsy center (CEC). It is established that epilepsy surgery outcomes are improved when an epileptogenic MRI lesion is present compared to those with MRI negative epilepsy. Epilepsy specific MRI protocols, which utilize thin slice thickness and high-resolution brain imaging, better detect these types of lesions. However, standard MRI sequences and lower resolution magnets continue to be used and can limit the detection of these lesions.

Design/Methods Retrospective review of electronic medical records of patients with DRE who underwent epilepsy surgery evaluation at the University of Kansas Medical Center (KUMC) from January 2014 to October 2018. MRIs are reviewed by both the epileptologist and a neuroradiologist who regularly attends epilepsy surgery conference.

Results 171 patients with DRE underwent surgical evaluation during this period. A total of 51 patients (29.8%) had standard MRIs at outside hospital or imaging facilities interpreted as normal, but were found to have epileptogenic lesions on a 3 Tesla epilepsy protocol MRI at KUMC. 55 epileptogenic lesions were found including: 25 mesial temporal sclerosis (45%), 10 sphenoid wing encephalocele (18%), 7 gray matter heterotopias (13%), 6 focal cortical dysplasia (11%), 4 amygdala enlargements (7%), 2 polymicrogyria (4%) and 1 frontal meningocele (2%).

Conclusions MRI imaging with epilepsy protocol and expert evaluation at a CEC identify previously missed epileptogenic lesions nearly 30% of the time based on our results. This finding has significant treatment implications. Early referral to a CEC is recommended and can result in improved patient prognosis.

Authors/Disclosures
Gloria Ortiz-Guerrero PRESENTER	No disclosure on file
Prompan Mingbunjerdsuk, MD (Marshfield Clinic)	No disclosure on file
John Leever, MD (Kansas University Medical Center)	Dr. Leever has nothing to disclose.
Utku Uysal, MD (University of Kansas Medical Center Department of Neurology)	Dr. Uysal has nothing to disclose.
Patrick Landazuri, MD, FAAN (University of Kansas - Department of Neurology - Comprehensive Epilepsy Center)	Dr. Landazuri has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neuropace. Dr. Landazuri has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Neuropace. Dr. Landazuri has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Federal Public Defender - District of Kansas. Dr. Landazuri has received publishing royalties from a publication relating to health care.
Carol M. Ulloa, MD, FAES, FAAN, FAAN (University of Kansas Medical Center)	The institution of Dr. Ulloa has received research support from medtronics. An immediate family member of Dr. Ulloa has received research support from NIH.

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