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February 2014; 4 (1) The Nerve! Readers Speak

Neuroimaging of first-ever seizure: Contribution of MRI if CT is normalAuthors Respond:

Nitin K. Sethi, Kevin Ho, Nicholas Lawn, Michael Bynevelt, Judy Lee, John Dunne
First published February 17, 2014, DOI: https://doi.org/10.1212/01.CPJ.0000442688.05566.eb
Nitin K. Sethi
New York–Presbyterian Hospital.
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Kevin Ho
New York–Presbyterian Hospital.
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Nicholas Lawn
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Michael Bynevelt
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Judy Lee
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John Dunne
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Neuroimaging of first-ever seizure: Contribution of MRI if CT is normalAuthors Respond:
Nitin K. Sethi, Kevin Ho, Nicholas Lawn, Michael Bynevelt, Judy Lee, John Dunne
Neurol Clin Pract Feb 2014, 4 (1) 2; DOI: 10.1212/01.CPJ.0000442688.05566.eb

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I read with interest the study by Ho et al.1 on the contribution of MRI scan in the diagnostic management of first-ever seizure. Standard MRI may fail to detect potential focal epileptogenic lesions and thus MRI using a dedicated epilepsy protocol such as that performed at epilepsy surgery centers is recommended nowadays.2 That it is superior to CT scan to detect potential epileptogenic lesions is well-established and the Ho et al. study attests to this. However, one should not forget a few situations such as a calcified neurocysticercosis lesion where a CT scan may have superior sensitivity for lesion detection.3 When a potential epileptogenic lesion is detected on MRI, whether it is the culprit lesion or an incidental finding needs to be determined, for patients can harbor dual pathologies such as mesial temporal sclerosis and focal cortical dysplasia.4 With rapid advances occurring in MRI technology, we can soon expect to have higher resolution MRI scans with more sensitive imaging protocols. The Ho et al. study helps reinforce the importance of EEG in the “neuroimaging” of first-ever seizure. Concordance of EEG and MRI findings is paramount for establishing the true epileptogenic potential of the lesion.

Disclosures

N. Sethi serves as Associate Editor for The Eastern Journal of Medicine.

  • © 2014 American Academy of Neurology

Authors Respond:

We thank Dr. Sethi for his comments.

Disclosures

K. Ho reports no disclosures. N. Lawn has received funding for travel from UCB Pharma and research support from UCB Pharma and from the Royal Perth Hospital Medical Research Foundation. M. Bynevelt and J. Lee report no disclosures. J. Dunne has received funding for travel from UCB Pharma and from several nonprofit organizations.

References

  1. 1.↵
    1. Ho K,
    2. Lawn N,
    3. Bynevelt M,
    4. Lee J,
    5. Dunne J
    . Neuroimaging of first-ever seizure: contribution of MRI if CT is normal. Neurol Clin Pract 2013;3:398–403.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Von Oertzen J,
    2. Urbach H,
    3. Jungbluth S,
    4. et al
    . Standard magnetic resonance imaging is inadequate for patients with refractory focal epilepsy. J Neurol Neurosurg Psychiatry 2002;73:643–647.
    OpenUrlAbstract/FREE Full Text
  3. 3.↵
    1. Patel NH,
    2. Jain AR,
    3. Iyer VK,
    4. Shah AG,
    5. Jain DA,
    6. Shah AA
    . Clinico-diagnostic and therapeutic relevance of computed tomography scan of brain in children with partial seizures. Ann Indian Acad Neurol 2013;16:352–356.
    OpenUrlPubMed
  4. 4.↵
    1. Sanon NT,
    2. Desgent S,
    3. Carmant L
    . Atypical febrile seizures, mesial temporal lobe epilepsy, and dual pathology. Epilepsy Res Treat 2012;2012:342928.
    OpenUrlPubMed
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