Epilepsy Diagnosis When the Routine Ancillary Tests Are Normal
<b>Background/Objectives:</b> In a patient suspected of having epilepsy, routine EEG primarily contributes to the recording of interictal epileptiform discharges (IEDs). Similarly, magnetic resonance imaging (MRI) has become the gold standard imaging technique for identifying epileptogen...
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MDPI AG
2025-04-01
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| author | Boulenouar Mesraoua Bassel Abou-Khalil Bernhard Schuknecht Hassan Al Hail Musab Ali Majd A. AbuAlrob Khaled Zammar Ali A. Asadi-Pooya |
| author_facet | Boulenouar Mesraoua Bassel Abou-Khalil Bernhard Schuknecht Hassan Al Hail Musab Ali Majd A. AbuAlrob Khaled Zammar Ali A. Asadi-Pooya |
| author_sort | Boulenouar Mesraoua |
| collection | DOAJ |
| description | <b>Background/Objectives:</b> In a patient suspected of having epilepsy, routine EEG primarily contributes to the recording of interictal epileptiform discharges (IEDs). Similarly, magnetic resonance imaging (MRI) has become the gold standard imaging technique for identifying epileptogenic structural brain abnormalities. Various EEG and MRI tools to improve epilepsy diagnosis will be presented. <b>Methods:</b> When the initial EEG fails to record IEDs, various EEG measures that can improve EEG performance are presented; a comprehensive epilepsy-targeted MRI protocol to identify, localize, and characterize an epileptogenic lesion will also be described. <b>Results:</b> Studies show that the initial routine EEG fails to record IEDs in approximately 47–50% of epileptic patients. To improve the yield of EEG, subsequent EEG recording should include sleep deprivation, sleep recording, prolonged hyperventilation, optimized light stimulation, addition of an inferior temporal electrode chain, extended EEG duration, and continuous video-EEG monitoring, all measures known to activate IEDs. Furthermore, MRI is interpreted as “normal” in many epilepsy patients, even when performed according to an epilepsy-specific protocol and evaluated by a specialized MRI reader. In such case, the use of the Harmonized Epilepsy Structural Sequence Imaging (HARNESS-MRI) protocol and other imaging tools will improve the detection of potential epileptic lesions, as described in this study. <b>Conclusions:</b> In a patient with a clinical diagnosis of epilepsy but a normal EEG and brain MRI, several options can improve the performance of subsequent EEG and MRI examinations, the subjects of this review. |
| format | Article |
| id | doaj-art-3698e8fd2b99498f9e2c3312b2b429c5 |
| institution | OA Journals |
| issn | 2035-8377 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Neurology International |
| spelling | doaj-art-3698e8fd2b99498f9e2c3312b2b429c52025-08-20T02:33:55ZengMDPI AGNeurology International2035-83772025-04-011756610.3390/neurolint17050066Epilepsy Diagnosis When the Routine Ancillary Tests Are NormalBoulenouar Mesraoua0Bassel Abou-Khalil1Bernhard Schuknecht2Hassan Al Hail3Musab Ali4Majd A. AbuAlrob5Khaled Zammar6Ali A. Asadi-Pooya7Neurosciences Department, Hamad Medical Corporation, Doha P.O. Box 3050, QatarDepartment of Neurology, Vanderbilt University, Nashville, TN 2301, USAMedical Radiological Institute, 8001 Zurich, SwitzerlandNeurosciences Department, Hamad Medical Corporation, Doha P.O. Box 3050, QatarNeurosciences Department, Hamad Medical Corporation, Doha P.O. Box 3050, QatarNeurosciences Department, Hamad Medical Corporation, Doha P.O. Box 3050, QatarNeurosciences Department, Hamad Medical Corporation, Doha P.O. Box 3050, QatarDepartment of Neurology, Shiraz University of Medical Sciences, Shiraz P.O. Box 71348-14336, Iran<b>Background/Objectives:</b> In a patient suspected of having epilepsy, routine EEG primarily contributes to the recording of interictal epileptiform discharges (IEDs). Similarly, magnetic resonance imaging (MRI) has become the gold standard imaging technique for identifying epileptogenic structural brain abnormalities. Various EEG and MRI tools to improve epilepsy diagnosis will be presented. <b>Methods:</b> When the initial EEG fails to record IEDs, various EEG measures that can improve EEG performance are presented; a comprehensive epilepsy-targeted MRI protocol to identify, localize, and characterize an epileptogenic lesion will also be described. <b>Results:</b> Studies show that the initial routine EEG fails to record IEDs in approximately 47–50% of epileptic patients. To improve the yield of EEG, subsequent EEG recording should include sleep deprivation, sleep recording, prolonged hyperventilation, optimized light stimulation, addition of an inferior temporal electrode chain, extended EEG duration, and continuous video-EEG monitoring, all measures known to activate IEDs. Furthermore, MRI is interpreted as “normal” in many epilepsy patients, even when performed according to an epilepsy-specific protocol and evaluated by a specialized MRI reader. In such case, the use of the Harmonized Epilepsy Structural Sequence Imaging (HARNESS-MRI) protocol and other imaging tools will improve the detection of potential epileptic lesions, as described in this study. <b>Conclusions:</b> In a patient with a clinical diagnosis of epilepsy but a normal EEG and brain MRI, several options can improve the performance of subsequent EEG and MRI examinations, the subjects of this review.https://www.mdpi.com/2035-8377/17/5/66epilepsyseizureelectroencephalogram (EEG)interictal epileptiform discharges (IEDs)EEG measures to improve EEG yieldmagnetic resonance imaging (MRI) |
| spellingShingle | Boulenouar Mesraoua Bassel Abou-Khalil Bernhard Schuknecht Hassan Al Hail Musab Ali Majd A. AbuAlrob Khaled Zammar Ali A. Asadi-Pooya Epilepsy Diagnosis When the Routine Ancillary Tests Are Normal Neurology International epilepsy seizure electroencephalogram (EEG) interictal epileptiform discharges (IEDs) EEG measures to improve EEG yield magnetic resonance imaging (MRI) |
| title | Epilepsy Diagnosis When the Routine Ancillary Tests Are Normal |
| title_full | Epilepsy Diagnosis When the Routine Ancillary Tests Are Normal |
| title_fullStr | Epilepsy Diagnosis When the Routine Ancillary Tests Are Normal |
| title_full_unstemmed | Epilepsy Diagnosis When the Routine Ancillary Tests Are Normal |
| title_short | Epilepsy Diagnosis When the Routine Ancillary Tests Are Normal |
| title_sort | epilepsy diagnosis when the routine ancillary tests are normal |
| topic | epilepsy seizure electroencephalogram (EEG) interictal epileptiform discharges (IEDs) EEG measures to improve EEG yield magnetic resonance imaging (MRI) |
| url | https://www.mdpi.com/2035-8377/17/5/66 |
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