A history of neuroimaging in epilepsy 1909–2009

Profound advances in the field of clinical imaging in epilepsy occurred between 1909 and 2009, the century of the International League Against Epilepsy, and these are reviewed briefly in this paper. Initially imaging was carried out with plain x-ray, air encephalography, and angiography, and these techniques had a relatively minor role in epilepsy. Computerized tomographic (CT) scanning was introduced in 1971, and magnetic resonance imaging (MRI) a decade or so later, and both these technologies had an immediate and far-reaching impact on epilepsy. MRI techniques continued to evolve during the 1990s and profoundly influenced many aspects of epilepsy clinical practice. These structural imaging techniques revealed pathological lesions in large numbers of patients with hitherto cryptogenic epilepsy, widened the indications for surgical therapy, and improved our understanding of the pathogenesis and etiology of epilepsy. In recent years, the research focus has turned to fMRI but its impact on epilepsy currently is relatively small. Magnetic resonance spectroscopy (MRS), positron emission tomography (PET) and single photon emission computed tomography (SPECT) also have had a limited impact on clinical practice in epilepsy.