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International Veterinary Epilepsy Task Force recommendations for a veterinary epilepsy-specific MRI protocol.

Rusbridge C, Long S, Jovanovik J, Milne M, Berendt M, Bhatti SF, De Risio L, Farqhuar RG, Fischer A, Matiasek K, Muñana K, Patterson EE, Pakozdy A, Penderis J, Platt S, Podell M, Potschka H, Stein VM, Tipold A, Volk HA - BMC Vet. Res. (2015)

Bottom Line: As a result, there is a need to standardize MRI examination in veterinary patients with techniques that reliably diagnose subtle lesions, identify post-seizure changes, and which will allow for future identification of underlying causes of seizures not yet apparent in the veterinary literature.There is a need for a standardized veterinary epilepsy-specific MRI protocol which will facilitate more detailed examination of areas susceptible to generating and perpetuating seizures, is cost efficient, simple to perform and can be adapted for both low and high field scanners.Standardisation of imaging will improve clinical communication and uniformity of case definition between research studies.A 6-7 sequence epilepsy-specific MRI protocol for veterinary patients is proposed and further advanced MR and functional imaging is reviewed.

View Article: PubMed Central - PubMed

Affiliation: Fitzpatrick Referrals, Halfway Lane, Eashing, Godalming, GU7 2QQ, Surrey, UK. ClareR@fitzpatrickreferrals.co.uk.

ABSTRACT
Epilepsy is one of the most common chronic neurological diseases in veterinary practice. Magnetic resonance imaging (MRI) is regarded as an important diagnostic test to reach the diagnosis of idiopathic epilepsy. However, given that the diagnosis requires the exclusion of other differentials for seizures, the parameters for MRI examination should allow the detection of subtle lesions which may not be obvious with existing techniques. In addition, there are several differentials for idiopathic epilepsy in humans, for example some focal cortical dysplasias, which may only apparent with special sequences, imaging planes and/or particular techniques used in performing the MRI scan. As a result, there is a need to standardize MRI examination in veterinary patients with techniques that reliably diagnose subtle lesions, identify post-seizure changes, and which will allow for future identification of underlying causes of seizures not yet apparent in the veterinary literature.There is a need for a standardized veterinary epilepsy-specific MRI protocol which will facilitate more detailed examination of areas susceptible to generating and perpetuating seizures, is cost efficient, simple to perform and can be adapted for both low and high field scanners. Standardisation of imaging will improve clinical communication and uniformity of case definition between research studies. A 6-7 sequence epilepsy-specific MRI protocol for veterinary patients is proposed and further advanced MR and functional imaging is reviewed.

No MeSH data available.


Related in: MedlinePlus

Hippocampal changes in an 8 month male neutered Oriental Shorthair presented with status epilepticus. a Transverse TW2 at level of pituitary gland. There is hyperintensity of the right temporal lobe (red arrow) (b) Transverse FLAIR at level of pituitary gland also demonstrating hyperintensity of the right temporal lobe (red arrow) (c) Transverse TW1 at level of pituitary gland. There is slight gadolinium contrast enhancement in the mesial temporal lobe. Images reproduced with the kind permission of Dr Ane Uriarte . The cat was suspected to have limbic encephalitis
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Fig2: Hippocampal changes in an 8 month male neutered Oriental Shorthair presented with status epilepticus. a Transverse TW2 at level of pituitary gland. There is hyperintensity of the right temporal lobe (red arrow) (b) Transverse FLAIR at level of pituitary gland also demonstrating hyperintensity of the right temporal lobe (red arrow) (c) Transverse TW1 at level of pituitary gland. There is slight gadolinium contrast enhancement in the mesial temporal lobe. Images reproduced with the kind permission of Dr Ane Uriarte . The cat was suspected to have limbic encephalitis

Mentions: Longitudinal studies of epileptic humans suggest that 10 % of newly diagnosed patients and 25 % of those with chronic active epilepsy develop significant cerebral, hippocampal or cerebellar atrophy over 3.5 years [20]. More acute changes secondary to seizures have also been reported (Fig. 1) and it is important that imaging techniques are able to differentiate these resultant, reversible changes from those that may be the cause of seizures. Most commonly, changes that are the result of seizures are found as T2-weighted hyperintensities predominantly in the piriform and temporal lobes, as well as the cingulate gyrus and hippocampus [21]. These changes resemble those reported in humans and are likely to represent a mixture of cytotoxic oedema and gliosis [21]. In some cases mild contrast uptake may also be apparent [22]. In general these changes are diffuse, relatively extensive, and their characteristic location makes it straightforward to distinguish them from epileptogenic lesions with either high-field or low-field scanners. However sometimes in can be difficult to ascertain if the changes are cause or effect for example in VGKC-complex/LGI1 antibody-associated limbic encephalitis in cats (Fig. 2) [23]. Cerebrospinal fluid analysis can be unhelpful because post-ictal pleocytosis can occur [24]. In ideal circumstances it would be preferred to repeat imaging in the post ictal period and also assess changes in brain volume/ atrophy however available finances can limit this opportunity. In those patients with whom some doubt may remain, however, the most useful procedure for identifying post-ictal MRI changes is to repeat the scan at a later date, since these changes resolve usually within 16 weeks [21].Fig. 1


International Veterinary Epilepsy Task Force recommendations for a veterinary epilepsy-specific MRI protocol.

Rusbridge C, Long S, Jovanovik J, Milne M, Berendt M, Bhatti SF, De Risio L, Farqhuar RG, Fischer A, Matiasek K, Muñana K, Patterson EE, Pakozdy A, Penderis J, Platt S, Podell M, Potschka H, Stein VM, Tipold A, Volk HA - BMC Vet. Res. (2015)

Hippocampal changes in an 8 month male neutered Oriental Shorthair presented with status epilepticus. a Transverse TW2 at level of pituitary gland. There is hyperintensity of the right temporal lobe (red arrow) (b) Transverse FLAIR at level of pituitary gland also demonstrating hyperintensity of the right temporal lobe (red arrow) (c) Transverse TW1 at level of pituitary gland. There is slight gadolinium contrast enhancement in the mesial temporal lobe. Images reproduced with the kind permission of Dr Ane Uriarte . The cat was suspected to have limbic encephalitis
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4594743&req=5

Fig2: Hippocampal changes in an 8 month male neutered Oriental Shorthair presented with status epilepticus. a Transverse TW2 at level of pituitary gland. There is hyperintensity of the right temporal lobe (red arrow) (b) Transverse FLAIR at level of pituitary gland also demonstrating hyperintensity of the right temporal lobe (red arrow) (c) Transverse TW1 at level of pituitary gland. There is slight gadolinium contrast enhancement in the mesial temporal lobe. Images reproduced with the kind permission of Dr Ane Uriarte . The cat was suspected to have limbic encephalitis
Mentions: Longitudinal studies of epileptic humans suggest that 10 % of newly diagnosed patients and 25 % of those with chronic active epilepsy develop significant cerebral, hippocampal or cerebellar atrophy over 3.5 years [20]. More acute changes secondary to seizures have also been reported (Fig. 1) and it is important that imaging techniques are able to differentiate these resultant, reversible changes from those that may be the cause of seizures. Most commonly, changes that are the result of seizures are found as T2-weighted hyperintensities predominantly in the piriform and temporal lobes, as well as the cingulate gyrus and hippocampus [21]. These changes resemble those reported in humans and are likely to represent a mixture of cytotoxic oedema and gliosis [21]. In some cases mild contrast uptake may also be apparent [22]. In general these changes are diffuse, relatively extensive, and their characteristic location makes it straightforward to distinguish them from epileptogenic lesions with either high-field or low-field scanners. However sometimes in can be difficult to ascertain if the changes are cause or effect for example in VGKC-complex/LGI1 antibody-associated limbic encephalitis in cats (Fig. 2) [23]. Cerebrospinal fluid analysis can be unhelpful because post-ictal pleocytosis can occur [24]. In ideal circumstances it would be preferred to repeat imaging in the post ictal period and also assess changes in brain volume/ atrophy however available finances can limit this opportunity. In those patients with whom some doubt may remain, however, the most useful procedure for identifying post-ictal MRI changes is to repeat the scan at a later date, since these changes resolve usually within 16 weeks [21].Fig. 1

Bottom Line: As a result, there is a need to standardize MRI examination in veterinary patients with techniques that reliably diagnose subtle lesions, identify post-seizure changes, and which will allow for future identification of underlying causes of seizures not yet apparent in the veterinary literature.There is a need for a standardized veterinary epilepsy-specific MRI protocol which will facilitate more detailed examination of areas susceptible to generating and perpetuating seizures, is cost efficient, simple to perform and can be adapted for both low and high field scanners.Standardisation of imaging will improve clinical communication and uniformity of case definition between research studies.A 6-7 sequence epilepsy-specific MRI protocol for veterinary patients is proposed and further advanced MR and functional imaging is reviewed.

View Article: PubMed Central - PubMed

Affiliation: Fitzpatrick Referrals, Halfway Lane, Eashing, Godalming, GU7 2QQ, Surrey, UK. ClareR@fitzpatrickreferrals.co.uk.

ABSTRACT
Epilepsy is one of the most common chronic neurological diseases in veterinary practice. Magnetic resonance imaging (MRI) is regarded as an important diagnostic test to reach the diagnosis of idiopathic epilepsy. However, given that the diagnosis requires the exclusion of other differentials for seizures, the parameters for MRI examination should allow the detection of subtle lesions which may not be obvious with existing techniques. In addition, there are several differentials for idiopathic epilepsy in humans, for example some focal cortical dysplasias, which may only apparent with special sequences, imaging planes and/or particular techniques used in performing the MRI scan. As a result, there is a need to standardize MRI examination in veterinary patients with techniques that reliably diagnose subtle lesions, identify post-seizure changes, and which will allow for future identification of underlying causes of seizures not yet apparent in the veterinary literature.There is a need for a standardized veterinary epilepsy-specific MRI protocol which will facilitate more detailed examination of areas susceptible to generating and perpetuating seizures, is cost efficient, simple to perform and can be adapted for both low and high field scanners. Standardisation of imaging will improve clinical communication and uniformity of case definition between research studies. A 6-7 sequence epilepsy-specific MRI protocol for veterinary patients is proposed and further advanced MR and functional imaging is reviewed.

No MeSH data available.


Related in: MedlinePlus