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Diffusion-based MRI has the potential to identify potentially epileptogenic abnormalities, including those that appear normal

on standard MRI sequences. Tractography may be used to map white matter tracts, and their relationship to epileptogenic tissue and eloquent cortex. This information may be used to improve surgical planning in order to minimize postoperative deficits including memory, language, and visual field loss. The measurement of water diffusion therefore provides a means of probing cellular integrity and pathology (Le Bihan, 2003). (DWI), images are sensitized to the diffusional properties of water by the incorporation of pulsed magnetic field gradients into a standard spin echo sequence (Merboldt et al., 1985; Taylor & Bushell, 1985). By taking measurements in at least three directions, it is possible to characterize the mean diffusion properties within a voxel in the image by way of a single scalar apparent diffusion coefficient (ADC). White matter tracts parallel to an applied gradient had the greatest ADC whereas those lying oblique or transverse to a gradient had smaller ADC values. This gave rise to the concept of asymmetry of diffusion of molecules in three directions, or “anisotropy” (Basser, 1995).

Despite the encouraging nature of these results, it is important to note that in several of the aforementioned studies, details of the “conventional” MRI sequences used were not available. Tertiary referral centers can increase their diagnostic yield in patients with refractory epilepsy, with the use of epilepsy-specific, high-resolution volumetric imaging (Von Oertzen et al., 2002). In those cases that remain “MR negative” after such imaging, interictal diffusion imaging has a role to play. The derivation of quantitative ADC/MD/FA maps and their analysis either by ROI or VBM methods provides a useful tool in the localization of subtle structural abnormalities, as part of a multimodality evaluation that should include interictal and ictal EEG recordings, neuro psychiatric and psychological evaluations and other imaging modalities such as PET, SPECT and MEG

Despite these limitations tractography is the only technique available for tracing the white matter pathways in the living brain. By isolating specific pathways from adjacent gray and white matter and CSF, tract-specific qualitative and quantitative information such as volume, anisotropy, and connectivity indices can also be derived (Ciccarelli et al., 2003a). Tracts can also be normalized and combined to generate group maps that indicate how reproducible a given tract or connection is across a group of subjects (Ciccarelli et al., 2003b). This information can be used to locate and assess the pathophysiological effects of chronic epilepsy on the white matter anatomy, including the structural reorganization of higher cortical functions such as language and memory. The technique can also be used to investigate white matter anatomy (Catani et al., 2002), which can aid preoperative planning, and prevent damage to eloquent cortical functions, particularly when combined with functional activation studies (Guye et al., 2003). Conclusiones: En periodos peri y post ictales, la interpretacion de las alteraciones de la diffusion sigue siendo compleja, pero tiene el potencial de mejorar el conocimiento de la fisiologia dela crisis. Los estudios interictales tienen algun valor localizador en pacientes con epilepsia focal y MRI estructural normal.

El uso de mapas cuantitativos derivados de estudios de difusión, sobre todo en el contexto de estudios multimodalidad, es un instrumento poderosos para investigar lesiones sutiles. Ademas es importante en la planificación de estudios EEG intracraneales y de la reseccion quirurgica. La tractografia tiene un paple a determinar. No spuede ayuidar a entender la plasticidad estructural y funcional que ocurre en ETL cornica. Podra ser uti8l en evoluciones prwquirurgicas