The Role of MRI in the Treatment of Drug-Resistant Focal Epilepsy.

BACKGROUND: Epilepsy is a prevalent chronic condition affecting about 50 million people worldwide. A third of patients with focal epilepsy suffer from seizures unresponsive to medication. Uncontrolled seizures damage the brain, are associated with cognitive decline, and have negative impact on well-being. For these patients, the surgical resection of the brain region that gives rise to seizures is the most effective treatment. SUMMARY: Magnetic resonance imaging (MRI) plays a central role in detecting epileptogenic brain lesions. In this review, we critically discuss advances in neuroimaging acquisition, analytical post-acquisition techniques, and machine leaning methods for the detection of epileptogenic lesions, prediction of clinical outcomes, and identification of disease subtypes. KEY MESSAGE: MRI is a mandatory investigation for diagnosis and treatment of epilepsy, particularly when surgery is being considered. Continuous progress in imaging techniques, combined with machine learning, will continue to push the boundaries of lesion visibility and provide increasingly precise predictors of clinical outcomes. Current efforts aiming at strengthening the competences of epileptologists in neuroimaging will ultimately reduce the need for invasive diagnostics.