Background: In this study, we aimed to characterise the CNS lesion and aid in planning as to whether medical or surgical modalities were necessary, aid in the diagnostic challenge in pharmacologically refractory seizure cases such as epilepsy syndromes and temporal lobe epilepsy, and to ascertain the varied role of neuroimaging in seizure disorder. Methods: This was a hospital-based cross sectional observational study, conducted among 88 patients with clinical presentation of focal seizure disorder, at the Department of Neuromedicine, including the epilepsy clinic of Bangur Institute of Neurosciences and the Department of Radiology, I.P.G.M.E. and R. and S.S.K.M. Hospital, from February 2012 to July 2013, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: The presenting seizure pattern was classified into two groups: simple partial seizures and complex partial seizures (n=88). Co-relation of a history of febrile convulsions with mesial-temporal sclerosis (n=23). The various causes of refractory epilepsy were subdivided and classified. The patients were observed for premonitory symptoms or auras and noted down (n = 88). Comparison of coronal FLAIR with an axial or coronal T2 weighted sequence for finding hippocampal hyperintensity, also called hippocampal sclerosis (n = 23). Based on MRI features, the causes were determined. Mesial temporal sclerosis (26.1%), space-occupying lesions (19.3), and patients with normal MRI appearance (22.7%) were the three most frequent causes. Conclusion: MRI is an effective tool for detecting pathologies causing focal or partial epilepsy, except in some cases of non-lesional focal epilepsy. Coronal FLAIR images are superior to axial or coronal T2-weighted images for the detection of hippocampal sclerosis. There will be future scope for functional MRI, MRI and PET fusion or MRI and interictal SPECT fusion in cases of non-lesional MRI-negative focal epilepsy.

Background: In this study, we aimed to characterise the CNS lesion and aid in planning as to whether medical or surgical modalities were necessary, aid in the diagnostic challenge in pharmacologically refractory seizure cases such as epilepsy syndromes and temporal lobe epilepsy, and to ascertain the varied role of neuroimaging in seizure disorder. Methods: This was a hospital-based cross sectional observational study, conducted among 88 patients with clinical presentation of focal seizure disorder, at the Department of Neuromedicine, including the epilepsy clinic of Bangur Institute of Neurosciences and the Department of Radiology, I.P.G.M.E. and R. and S.S.K.M. Hospital, from February 2012 to July 2013, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: The presenting seizure pattern was classified into two groups: simple partial seizures and complex partial seizures (n=88). Co-relation of a history of febrile convulsions with mesial-temporal sclerosis (n=23). The various causes of refractory epilepsy were subdivided and classified. The patients were observed for premonitory symptoms or auras and noted down (n = 88). Comparison of coronal FLAIR with an axial or coronal T2 weighted sequence for finding hippocampal hyperintensity, also called hippocampal sclerosis (n = 23). Based on MRI features, the causes were determined. Mesial temporal sclerosis (26.1%), space-occupying lesions (19.3), and patients with normal MRI appearance (22.7%) were the three most frequent causes. Conclusion: MRI is an effective tool for detecting pathologies causing focal or partial epilepsy, except in some cases of non-lesional focal epilepsy. Coronal FLAIR images are superior to axial or coronal T2-weighted images for the detection of hippocampal sclerosis. There will be future scope for functional MRI, MRI and PET fusion or MRI and interictal SPECT fusion in cases of non-lesional MRI-negative focal epilepsy.