Focal Cortical Dysplasia in Temporal Lobe Epilepsy

The Role of Magnetic Resonance Imaging
  • R. Kuzniecky
Part of the NATO ASI Series book series (NSSA, volume 264)


Magnetic resonance imaging (MRI) has proved to be extremely useful in the detection of central nervous system pathology (Brant-Zawadzki et al, 1983). Its value in the investigation of patients with epilepsy has been confirmed by our studies (Kuzniecky et al., 1988; Berkovic et al, 1991) and by those of others (Jack et al., 1990; Bronen et al., 1991; Theodore, 1986; Duncan, 1990). In the majority of patients with intractable temporal lobe epilepsy the underlying pathological substrate is mesial temporal sclerosis (MTS). This abnormality can be detected by MRI in almost all cases, if the appropriate techniques are used (Kuzniecky et al., 1987). The typical imaging findings consist of hippocampal and amygdaloid atrophy, increased T2-weighted signal from the abnormal hippocampi and loss of internal structure of the hippocampal formation. Other pathological abnormalities include glial and non-glial neoplasms, vascular malformations, post-traumatic changes and other conditions (Avrahami et al., 1987; Altman, 1988; Bracchi, 1988). A less common pathological entity encountered in patients with intractable partial seizures is focal cortical dysplasia (Kuzniecky et al, 1991). It is characterised by a lack of cortical organisation associated with abnormal giant neurons and increased astrocytosis (Taylor et al., 1971; Kuzniecky et al., 1991). Although this anomaly was originally reported in 1971 by Taylor et al., it was not until recently that other investigators reported similar findings in surgical specimens from other brain regions. As high-resolution MRI is sensitive in the detection of subtle lesions, it has been possible to detect pre-operatively these developmental lesions in some patients selected for resective surgery. Recognition of these peculiar and often subtle abnormalities in patients with intractable temporal lobe epilepsy has increased the value of MRI in the pre-surgical investigation of these patients.


Temporal Lobe Epilepsy Hippocampal Sclerosis Focal Cortical Dysplasia Cortical Dysplasia Left Temporal Lobe 
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  1. Altman, N. R., 1988, MR and CT characteristics and gangliocytoma: a rare cause of epilepsy in children, AJNR 9: 917–921.PubMedGoogle Scholar
  2. Avrahami, E., Cohn, D., Neufeld, M., et al., 1987, Magnetic resonance imaging (MRI) in patients with complex partial seizures and normal computerised tomography (CT) scan, Clin Neurol Neurosurg. 89: 89–94.CrossRefGoogle Scholar
  3. Baker, L., and Barkovich, A., 1992, The large temporal horn: MR analysis in developmental brain anomalies versus hydrocephalus, AJNR 13: 115–122.PubMedGoogle Scholar
  4. Berkovic, S. F., Andermann, F., Ethier, R., et al., 1991, Hippocampal sclerosis in temporal lobe epilepsy demonstrated by magnetic resonance imaging, Ann Neurol. 29: 175–182.PubMedCrossRefGoogle Scholar
  5. Bracchi, M., 1988, MR in epilepsies: methodological aspects, Boll Lega Ital Epilessia 63: 47–50.Google Scholar
  6. Brant-Zawadzki, M., Davis, P., Crooks, L., et al., 1983, NMR demonstration of cerebral abnormalities: Comparison with CT, AJNR 4: 117–124.Google Scholar
  7. Bronen, R., Chevny, G., Charles, J., et al., 1991, Imaging findings in hippocampal sclerosis: correlation with pathology, AJNR 12: 933–940.PubMedGoogle Scholar
  8. Duncan, R., et al., 1990, CT, MR and SPECT imaging in temporal lobe epilepsy, J Neurol Neurosurg Psychiat. 53: 11–15.PubMedCrossRefGoogle Scholar
  9. Hardiman, O., Burke, T., Phillips, J., et al., 1988, Microdysgenesis in resected temporal neocortex: incidence and clinical significance in focal epilepsy, Neurology 38: 1041–1047.PubMedCrossRefGoogle Scholar
  10. Jack, C., Sharbrough, F., Twomey, C., et al., 1990, Temporal lobe seizures: lateralisation with MR volume measurements of the hippocampal formation, Radiology 175: 423–429.PubMedGoogle Scholar
  11. Kuzniecky, R., de La Sayetle, Ethier R., et al., 1987, Magnetic resonance imaging in temporal lobe epilepsy: pathological correlations, Ann Neurol. 22: 341–347.PubMedCrossRefGoogle Scholar
  12. Kuzniecky, R., Berkovic, S., Andermann, F., et al., 1988, Focal cortical myoclonus and rolandic cortical dysplasia: clarification by magnetic resonance imaging, Ann Neurol. 23: 317–325.PubMedCrossRefGoogle Scholar
  13. Kuzniecky, R., Faught, E., and Garcia, J., 1991, Cortical dysplasia in temporal lobe epilepsy: magnetic resonance correlations, Ann Neurol. 29: 293–298.PubMedCrossRefGoogle Scholar
  14. Kuzniecky, R., Murro, A., King, D., et al., 1992, MRI in intractable epilepsy of childhood: pathological correlations, Epilepsia 33: 102.CrossRefGoogle Scholar
  15. Taylor, D., Falconer, M., Bruton, C., 1971, Focal dysplasia of the cerebral cortex in epilepsy, J Neurol Neurosurg Psychiat. 34: 369–387.PubMedCrossRefGoogle Scholar
  16. Theodore, W. H., 1986, Neuroimaging, Neurol Clin. 4: 645–668.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1994

Authors and Affiliations

  • R. Kuzniecky
    • 1
  1. 1.UAB Epilepsy Center Department of NeurologyUniversity of Alabama at BirminghamBirminghamUSA

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