Zusammenfassung
Die diagnostische Abklärung von Patienten mit chronischen Epilepsien, die in ca. 30
% der Fälle als kryptogen eingestuft werden, stellt besondere Anforderungen an die
bildgebende Diagnostik. Nur durch eine hochauflösende Bildgebung der Magnetresonanztomographie
(MRT) kann hier die symptomatische Ursache von Epilepsien dargelegt und hierdurch
einer adäquaten Therapie zugeführt werden. Der folgende Artikel gibt einen Überblick
über ein für diese Patientengruppe optimiertes MRT-Untersuchungsprotokoll. Zusätzlich
wird auf die Indikationen der Bildgebung in der Abklärung von Epilepsien eingegangen.
Zahlreiche Abbildungen veranschaulichen die häufigsten Befunde bei chronischen Epilepsien.
Hierbei werden neben Heterotopien, Hippokampussklerosen und tumorösen Raumforderungen
auch auf seltene Krankheitsbilder wie kortikale Dysgenisien, Lissenzephalien, Schizenzephalien
und Polymikrogyrien eingegangen. Abschließend werden die Möglichkeiten der funktionellen
MR-Bildgebung in der Epilepsiediagnostik dargestellt.
Abstract
Diagnosis in patients with chronic epilepsy, of which 30 % still remain cryptogenic,
is still a challenge. In this patient group imaging modalities play an important role
for sufficient diagnosis. In most cases only high resolution imaging of the CNS is
able to determine the symptomatic lesions, which is the basis for rational therapy
strategies. The following article presents an overview of optimised standard examination
protocols in Magnetic Resonance Imaging (MRI) and their indications in the diagnosis
of epilepsies. Numerous images illustrate current findings in the mentioned patient
group. In addition to heterotopias, hippocampal sclerosis and intracranial neoplasm,
infrequent diseases like cortical dysgenesis, lissencephalies, schizencephalies and
polymicrogyria are presented. Applications of functional MRI in the diagnosis of epilepsies
are illustrated in the end.
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Prof. Dr. Stefan Hermann
Epilepsiezentrum Erlangen (ZEE) · Neurologische Klinik und Poliklinik · Universitätsklinikum
Erlangen
Schwabachanlage 6
91054 Erlangen
Email: hermann.Stefan@neuro.imed.uni-erlangen.de