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Recommendations of the Russian League Against Epilepsy (RLAE) on the use of magnetic resonance imaging in the diagnosis of epilepsy

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Introduction. The MRI method has revolutionized the diagnosis of epilepsy. However, the widespread adoption of MRI in clinical practice is slowed by an insufficient number of high-field MRI scanners, a shortage of trained specialists, and the lack of standard examination protocols. The aim of this article is to present the Recommendations of the Russian League Against Epilepsy (RLAE) on the use of magnetic resonance imaging in the diagnosis of epilepsy.

Materials and methods. As a structural element of the International League Against Epilepsy (ILAE), the RLAE considers it important to adapt the Protocol developed by ILAE for specialists in Russia and EAEU countries. The working group analyzed and generalized the clinical practice existing in the Russian Federation, the Republic of Kazakhstan, the Republic of Belarus and the Republic of Uzbekistan. These recommendations are intended for doctors in specialized centers of epilepsy surgery, and for doctors in general medical centers. The recommendations are applicable primarily to adult patients, but the general principles are relevant to children as well.

Results. In all patients with convulsive seizures shortly after the first seizure, or patients diagnosed with epilepsy who have an unexplained increase in the frequency of seizures, rapid decrease in cognitive functions or the appearance / worsening of neuropsychiatric symptoms, the RLAE recommends using a unified MR protocol for the neuroimaging of structural sequences in epilepsy with three-dimensional pulse sequences T1 and T2 FLAIR with isotropic voxel 1 × 1 × 1 mm3 and two-dimensional T2- weighted pulse sequences with a pixel size of 1 × 1 mm2 or less. The MRI examination should be combined with EEG or EEG-video monitoring. Using this protocol allows one to set a unified standard for examining patients with epilepsy in order to detect (with high sensitivity) brain lesions playing a key role in the occurrence of seizures. Here, all 13 recommendations are presented.

Conclusion. Implementation of these recommendations in clinical practice will improve the access to high-tech medical care and optimize health care costs. 

About the Authors

G. N. Avakyan
Pirogov Russian National Research Medical University
Russian Federation

MD, PhD, Honored Scientist of Russia, Professor, Department of Neurology, Neurosurgery and Medical Genetics, 

1 Ostrovityanova Str., Moscow 117997

D. V. Blinov
Institute for Preventive and Social Medicine; Moscow Haass Medical – Social Institute; Lapino Clinic Hospital, MD Medical Group
Russian Federation

MD, PhD, MBA, Head of Medical and Scientific Affairs, 4-10 Sadovaya-Triumfalnaya Str., Moscow 127006;

Faculty Member, Department of Neurology, Psychiatry and Narcology, 5 p. 1-1a 2nd Brestskaya Str., Moscow 123056;

Neurologist, 1st Uspenskoye Highway, 111, Moscow Region, Odintsovo District, Lapino 143081

A. A. Alikhanov
Pirogov Russian National Research Medical University
Russian Federation

MD, PhD, Professor & Head, Department of Diagnostic Radiology,

1 Ostrovityanova Str., Moscow 117997

E. M. Perepelova
Sechenov University
Russian Federation

MD, PhD, Head of the Department of Radiology,

8-2 Trubetskaya Str., Moscow 119048

V. A. Perepelov
Russian Medical Academy of Postgraduate Education
Russian Federation

MD, Medical Resident, 

2-1 Barrikadnaya Str., Moscow 123995

S. G. Burd
Pirogov Russian National Research Medical University
Russian Federation

MD, PhD, Professor at the Department of Neurology, Neurosurgery and Medical Genetics, Faculty of Pediatrics,

1 Ostrovityanova Str., Moscow 117997

A. V. Lebedeva
Pirogov Russian National Research Medical University
Russian Federation

MD, PhD, Professor at the Department of Neurology, Neurosurgery and Medical Genetics, Faculty of Pediatrics,

1 Ostrovityanova Str., Moscow 117997

G. G. Avakyan
Pirogov Russian National Research Medical University
Russian Federation

MD, PhD, Associate Professor, Department of Neurology, Neurosurgery and Medical Genetics,

1 Ostrovityanova Str., Moscow 117997


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For citations:

Avakyan G.N., Blinov D.V., Alikhanov A.A., Perepelova E.M., Perepelov V.A., Burd S.G., Lebedeva A.V., Avakyan G.G. Recommendations of the Russian League Against Epilepsy (RLAE) on the use of magnetic resonance imaging in the diagnosis of epilepsy. Epilepsy and paroxysmal conditions. 2019;11(3):208-232. (In Russ.)

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