Decoding Epilepsy Through Magnetic Resonance Imaging: Structural Insights for Improved Diagnosis

Abstract

Background: Epilepsy is a chronic neurological disorder characterized by recurrent, unprovoked seizures, often resulting from underlying structural brain abnormalities. While electroencephalography is essential for functional assessment, magnetic resonance imaging (MRI) provides crucial anatomical insights for diagnosis, seizure localization, and treatment planning, especially in focal and drug-resistant epilepsy. Objective: This study aimed to evaluate structural brain abnormalities associated with epilepsy using advanced MRI techniques and to correlate these findings with seizure type and duration in adult patients, thereby enhancing diagnostic precision and guiding individualized management. Methods: A descriptive cross-sectional study was conducted over four months at two tertiary hospitals in Lahore, Pakistan. Forty-three adult epilepsy patients underwent MRI using standardized sequences including T1-weighted, T2-weighted, FLAIR, and DTI protocols. Clinical data on age, gender, seizure characteristics, and family history were recorded. MRI findings were analyzed in relation to seizure type and duration using SPSS version 25. Results: Focal seizures were predominant (79.1%), particularly among males aged 20–40 years. MRI detected structural abnormalities in 74.4% of patients, with lacunar infarcts (25.6%), gliosis (16.3%), and hippocampal sclerosis (16.3%) being most frequent. Focal seizures were significantly associated with hippocampal sclerosis and gliosis (p=0.048), and longer seizure duration correlated with increased lesion prevalence. Conclusion: MRI effectively identified structural lesions linked to focal epilepsy, supporting its critical role in diagnostic evaluation and tailored treatment planning.