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Floor E. Jansen, MD; Kees P. J. Braun, MD, PhD; Onno van Nieuwenhuizen, MD, PhD; Geertjan Huiskamp, PhD; Koen L. Vincken, PhD; Alexander C. van Huffelen, MD, PhD; Jeroen van der Grond, PhD

Arch Neurol. 2003;60:1580-1584.

Background  Patients with tuberous sclerosis complex and drug-resistant epilepsy may be considered candidates for epilepsy surgery. This demands the unambiguous demonstration of the epileptogenicity of one of the tubers.

Objective  To test whether diffusion-weighted magnetic resonance imaging enables differentiation of epileptogenic tubers from inert ones.

Methods  In 4 patients with clear unifocal interictal spike activity, fluid-attenuated inversion recovery and diffusion-weighted magnetic resonance imaging were performed. Apparent diffusion coefficient maps were calculated in the identified epileptogenic tuber and compared withthose in nonepileptogenic tubers and regions of normal-appearing cortex.

Results  A significant increase in the apparent diffusion coefficient was found in the epileptogenic tubers. Furthermore, the apparent diffusion coefficient of the nonepileptogenic tubers was significantly higher than the trace apparent diffusion coefficient of regions of normal-appearing cortex.

Conclusion  Diffusion-weighted magnetic resonance imaging may be of clinical importance for the identification of epileptogenic tubers in patients with tuberous sclerosis and intractable epilepsy.

From the Departments of Child Neurology (Drs Jansen, Braun, and van Nieuwenhuizen) and Clinical Neurophysiology (Drs Huiskamp and van Huffelen) and the Image Sciences Institute (Drs Vincken and van der Grond), University Medical Center, Utrecht, the Netherlands.

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