Heterogeneous profile of organic brain lesions in adult patients with focal epilepsy

DOI: 10.47026/2413-4864-2026-2-21-34

UDC: 616.853-073.7
BBC: Р627.709.2-436.1

Melnikov A.A., Voronkova K.V., Khovrin V.V.

Heterogeneous profile of organic brain lesions in adult patients with focal epilepsy

Keywords: focal epilepsy, magnetic resonance imaging, isovoxel pulse sequences, organic epileptogenic lesions

The article presents a series of clinical observations of adult patients with focal epilepsy with lifetime magnetic resonance verification of the epileptogenic substrate. The paper describes in detail a comprehensive clinical and instrumental approach to the diagnosis of focal epilepsy in adult patients at the stage of first-time hospitalization in the neurological (epileptological) department, which made it possible to confirm the diagnosis of focal epilepsy (G40.2). The aim of the study was to identify the spectrum and frequency of organic epileptogenic brain lesions in adults with focal epilepsy based on high-field magnetic resonance imaging. Materials and methods. In the period from 2022 to 2025 at the Russian Surgery Research Center named after Academician B.V. Petrovsky a prospective study was conducted to find the most common organic causes of epilepsy; 6 adult patients with different abnormalities and lifetime brain lesions, as well as differing in clinical presentation and electroencephalography data, were selected. A comprehensive instrumental examination was performed using high-field magnetic resonance imaging (3T) and video electroencephalography monitoring. Results. The results obtained clearly demonstrate the heterogeneous neuroradiological profile of pathological organic brain lesions in adult patients with focal epilepsy, which differ in both etiology and pathogenesis. In addition to the neuroradiological polymorphism, the clinical presentation of the disease was also variable in each case, including differences in frequency and kinematics of seizures, as well as their qualitative characteristics. The etiology of organic brain lesions in adult patients with focal epilepsy is heterogeneous, but it has a feature in the form of predominance of acquired etiological factors (stroke, traumatic brain injury) in the development of focal epilepsy over congenital and genetically determined ones (in contrast to children and newborns). Neuroimaging using high-field magnetic resonance imaging is an essential and mandatory diagnostic requirement in every clinical case, with the aim of optimising anticonvulsant therapy, assessing drug-induced pathomorphological changes in brain tissue during antiepileptic treatment (atrophy, microangiopathy), for preoperative planning and intraoperative neuronavigation, as well as for determining the prognosis of the disease. Conclusions. In adult patients with focal epilepsy, a diverse etiological background should be taken into account when conducting structural magnetic resonance analysis, drawing the researcher's attention to the patient's past history of diseases, in particular traumatic brain injury and strokes, specifying the timing of the onset of focal seizures. Identification of congenital structural organic pathology requires particular attention from the researcher, given the presence of ‘minor’ cortical malformations in groups of adult patients.

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About authors

Melnikov Alexander A.: Candidate of Medical Sciences, Radiologist, Petrovsky National Research Center of Surgery, Russia, Moscow (alexradiology@rambler.ru; ORCID: https://orcid.org/0009-0008-7409-0957)

Voronkova Kira V.: Doctor of Medical Sciences, Professor, Neurologist (Epileptologist), Petrovsky National Research Center of Surgery, Russia, Moscow (kiravoronkova@yandex.ru; ORCID: https://orcid.org/0000-0003-1111-6378)

Khovrin Valeriy V.: Doctor of Medical Sciences, Chief Researcher, Radiologist, Petrovsky National Research Center of Surgery, Russia, Moscow (mdct2001@yandex.ru; ORCID: https://orcid.org/0000-0002-6720-4126)

Article link

Melnikov A.A., Voronkova K.V., Khovrin V.V. Heterogeneous profile of organic brain lesions in adult patients with focal epilepsy [Electronic resource] // Acta medica Eurasica. – 2026. – №2. P. 21-34. – URL: https://acta-medica-eurasica.ru/en/single/2026/2/3/. DOI: 10.47026/2413-4864-2026-2-21-34.

Single article

Melnikov A.A., Voronkova K.V., Khovrin V.V.