Epilepsy is a common neurologic disorder with diverse etiologies. Appropriate MRI investigation has an important role in the assessment of epilepsy. Specific protocols are required for recognition of epileptogenic lesions, particularly for recognition of subtle lesions. In patients with refractory epilepsy and “normal MRI,” multimodal imaging techniques are crucial in the definition of epilepsy etiology, including those that combine metabolic and functional investigation, such as fluorodeoxyglucose positron emission tomography (FDG-PET), single-photonemission computed tomography (SPECT), diffusion MRI and magnetic resonance spectroscopy (MRS). Familiarity with various protocols of imaging studies is required for optimized investigation of seizure etiology. Main features found in MRIs of patients with focal epilepsies are discussed in the present review, as are alternative protocols and techniques of imaging that may optimize neuroimaging investigation in patients with epilepsy. The findings described have a direct impact on treatment and prognosis counseling of patients with focal epilepsies.

Keywords: Focal epilepsies, neuroimaging