MRI-negative epilepsy treatment [Neurosurgery Wiki]

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====== MRI-negative epilepsy treatment ======

Several methods for processing MRI postacquisition data have identified either previously undetectable or overlooked MRI abnormalities. The resection of these abnormalities is associated with excellent postsurgical seizure control. There have been major advances in functional imaging as well, one of which is the application of statistical parametric mapping analysis for comparing patient data against normative data. This approach has specifically improved the usefulness of both PET and single-photon emission computed tomography in MRI-negative epilepsy surgery evaluation. One other development of importance is that of PET-MRI coregistration, which has recently been shown to be superior to conventional PET. More recent publications on magnetoencephalography have added to the literature of its use in MRI-negative epilepsy surgery evaluation, which up to now remains somewhat limited. However, recent data now indicate that a single magnetoencephalography cluster is associated with better chance of concordance with intracranial EEG localization, and with excellent postsurgical seizure control if completely resected.

Summary: Advanced MRI and functional imaging and subsequent intracranial EEG confirmation of the seizure-onset zone are essential to make MRI-negative epilepsy surgery possible and worthwhile for the patient
((So EL, Lee RW. Epilepsy surgery in MRI-negative epilepsies. Curr Opin Neurol. 2014 Apr;27(2):206-12. doi: 10.1097/WCO.0000000000000078. PMID: 24553461.)).
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The optimal [[management]] of [[MRI-negative epilepsy]] may involve [[invasive monitoring]] followed by [[resection]] or [[responsive neurostimulation]] in most cases, as these treatments were associated with the best [[seizure outcome]]s in a [[cohort]] of the [[Yale New Haven Hospital]]. Unless multifocal [[epileptogenesis]] is clear from the non-invasive evaluation, [[epilepsy invasive monitoring]] is preferred before pursuing [[deep brain stimulation]] or [[vagus nerve stimulation]] directly
((McGrath H, Mandel M, Sandhu MRS, Lamsam L, Adenu-Mensah N, Farooque P, Spencer DD, Damisah EC. Optimizing the surgical [[management]] of [[MRI-negative epilepsy]] in the [[neuromodulation]] era. [[Epilepsia Open]]. 2022 Jan 17. doi: 10.1002/epi4.12578. Epub ahead of print. PMID: 35038792.)).
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[[Magnetoencephalography]] ([[MEG]]) is valuable for guiding in [[resective epilepsy surgery]]. 
MEG is a useful supplement for patients with [[MRI-negative epilepsy]]. MEG can be applied in [[minimally invasive]] [[treatment]]. MEG clusters can help identify better candidates and provide a valuable target for [[stereoelectroencephalography guided radiofrequency thermocoagulation]], which leads to better outcomes.
((Gao R, Yu T, Xu C, Zhang X, Yan X, Ni D, Zhang X, Ma K, Qiao L, Zhu J, Wang X,
Ren Z, Zhang X, Zhang G, Li Y. The value of magnetoencephalography for
stereo-EEG-guided radiofrequency thermocoagulation in MRI-negative epilepsy.
Epilepsy Res. 2020 Mar 20;163:106322. doi: 10.1016/j.eplepsyres.2020.106322.
[Epub ahead of print] PubMed PMID: 32278277.
)).