Neuroradiologische Diagnostik in der Epileptologie

Zusammenfassung

Die Magnetresonanztomographie (MRT) ist die neuroradiologische Methode der ersten Wahl bei Epilepsie. Ein MR-Untersuchungsprotokoll, das koronare, an der Hippokampuslängsachse angulierte FLAIR- und T₂-Sequenzen enthält, erhöht die Chance, eine morphologische Läsion bei dieser chronischen Erkrankung zu identifizieren. Eine anfallsverursachende Läsion kann die medikamentöse Epilepsiebehandlung erschweren. Ihr Nachweis ermöglicht andererseits aber die chirurgische Behandlung. Die präoperative Abgrenzung eloquenter Kortexareale von dieser Läsion erlaubt die Abschätzung postoperativer Morbidität. Diese Übersicht befasst sich mit dem Beitrag, den verschiedene Bildgebungsmethoden zur Beantwortung dieser klinischen Fragen nach anfallsverursachenden Läsionen und benachbarter neuronaler Funktion leisten (visuell beurteilte MRT, quantitative strukturelle und funktionelle MR-Verfahren sowie nuklearmedizinische Methoden). Die Bearbeitung aktueller wissenschaftlicher Fragen in der klinischen Epileptologie (zur Optimierung der bildgebenden Verfahren, zu Ursachen und Konsequenzen von epileptischen Anfällen, zur Pharmakoresistenz) mittels dieser Methoden wird diskutiert.

Abstract

Magnetic resonance imaging is the neuroimaging modality of first choice in epilepsy. A protocol incorporating coronal FLAIR- and T₂-weighted images perpendicular to the long axis of the hippocampus increases the yield to detect epilepsy-associated lesions. The presence of an epileptogenic lesion decreases the probability to render the patient seizure free by anti-epileptic drugs only. The detection of a lesion, however, is a prerequisite for epilepsy surgery. To avoid postsurgical morbidity, identification of eloquent cortex in relation to the epileptogenic lesion is necessary prior to surgery. This review describes the clinical impact of different neuroimaging modalities on lesion detection and on the delineation of adjacent neuronal function (qualitative and quantitative structural and functional MR methods, methods using radioactive nuclids). Recent contributions of neuroimaging research to current topics in the field (increasing sensitivity of neuroimaging, differentiating causes from consequences of seizures, defining medical untreatability) are discussed.

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