Neuroimaging in refractory epilepsy. Current practice and evolving trends

• Neuroimaging is imperative in diagnostic work up and therapeutic assessment of refractory epilepsy.
• Identification of epileptogenic zone on EEG, MRI and functional imaging improves the success of surgery.
• High performance MRI greatly enhanced metabolic information and elucidate brain functions.
• Optimisation of epilepsy protocols in structural and functional MRI are presented in this article.

Identification of the epileptogenic zone is of paramount importance in refractory epilepsy as the success of surgical treatment depends on complete resection of the epileptogenic zone. Imaging plays an important role in the locating and defining anatomic epileptogenic abnormalities in patients with medically refractory epilepsy. The aim of this article is to present an overview of the current MRI sequences used in epilepsy imaging with special emphasis of lesion seen in our practices. Optimisation of epilepsy imaging protocols are addressed and current trends in functional MRI sequences including MR spectroscopy, diffusion tensor imaging and fusion MR with PET and SPECT are discussed.