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I need an MRI scan. What is it like?

Most people with epilepsy need an MRI scan. When someone starts to experience seizures, it’s important to visualise the brain to rule out any progressive brain abnormalities that may need immediate attention. The truth is, the majority of people who start to experience seizures and are first diagnosed with epilepsy have a normal MRI scan. There are no brain ‘lesions’ that a neuroradiologist can see. A lesion is some kind of structural abnormality in the brain and a neuroradiologist is a specialist doctor who interprets brain imaging scans. So, the cause and location of the origin of the seizures remain a mystery for the majority of people with epilepsy. 

Some people with epilepsy do have a brain lesion. The lesion may be very small, like a small scar. When you look at large groups of people with epilepsy, there is a tendency for people with lesions to be more likely to continue to experience seizures despite being treated with anti-seizure medications. However, many people with lesions also have very well controlled seizures. If the seizures significantly impact on a person’s life despite taking anti-seizure medications, alternative treatment options may be considered. One of them is surgery. Epilepsy surgery is a safe procedure and for the vast majority of people will lead to a significant reduction or elimination of their seizures. The chance of being seizure free after surgery is highest when a person has an MRI-identified brain lesion and supporting EEG data localising the onset of the seizures to where the lesion is.

So it is clear why MRI scans are important for people with epilepsy from the point of diagnosis right through to surgery. But what is an MRI scan like?

A nice simple overview of what it is like to have an MRI scan is provided by the NHS here

MRI scanning is safe. You will not be exposed to any radiation. There are some occasions when it’s not safe to have an MRI scan. These are covered in the NHS link above, and include having a pacemaker or any internal metal (e.g. clips from previous surgery). As an outpatient, you will attend a department of radiology (or neuroradiology in brain specialising hospitals and centres), register at reception and complete a short questionnaire. The questionnaire contains questions about your health and general suitability for MRI scanning. A radiographer, who is the person who performs the MRI scan, will sit with you before the scan and go through the questionnaire to make sure that you’re fine for scanning. The majority of people are suitable. 

Given that the MRI scanner is a very powerful magnetic, it is important to make sure that you do not enter the MRI scanning room with metal on you. So you will be asked to change into some hospital clothing and leave your own clothes in a locker. The radiographer will then take you into the scanning room and position you on a table that extends into the MRI scanner. The radiographer will make sure that you’re comfortable and make you aware of any safety features that you need to know about (e.g. if you feel uncomfortable at any point, you have the opportunity to squeeze a button. The radiographer can then bring you out of the scanner if you feel that this is necessary). 

The MRI scanner is a cylindrical tube. Some people find this unsettling if they have a fear of closed-in spaces (i.e. are claustrophobic). For the majority of people, this is not a problem. Once you are comfortable, the scanning may commence. You will hear a series of noises that the MRI scanner generates during scanning. This can be quite loud, so you will be provided with earbuds or headphones. Through the scanning, the radiographer will speak to you through a microphone and you will be able to speak back. The scanning may take 20-30 minutes for a brain scan performed at a hospital. Sometimes the scan may be longer, for example for research purposes or when specialised scans are being performed before epilepsy surgery. Once the scan is completed you will be able to get changed back into your clothes and return home.

The results of your scan won’t be available straight away. The scans have to be imported to a system where the neuroradiologist can review them. The neuroradiologist will usually have a backlog of scans to report on, that report needs to be written up, and all this information needs to be communicated to your referring clinician. The duration of this process can be different between hospitals and doctors and depends on many factors. Normally, you will get the results within 2-3 weeks, potentially earlier. 

I am writing this as someone who has administered, analysed and reported thousands of MRI scans. I have also been scanned as part of research – 70 times and counting! MRI scanning is very safe and extremely useful for doctors treating people with epilepsy. 

Dr Simon Keller

 

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