Role of Brain Magnetic Resonance Imaging in the Evaluation of Seizure Disorders at a Tertiary Care Centre in Rajasthan, India: A Descriptive Observational Study

BackgroundMagnetic resonance imaging (MRI) with a dedicated epilepsy protocol is the most sensitive non-invasive tool for identifying structural epileptogenic substrates, yet contemporary regional data from Rajasthan are scarce. ObjectiveTo describe the spectrum, anatomical distribution, and management impact of MRI brain abnormalities in patients with seizure disorders presenting to a tertiary care centre in Rajasthan. MethodsA hospital-based, descriptive observational cross-sectional study enrolled 90 consecutive patients of any age referred for MRI brain after a clinical diagnosis of seizure disorder.All examinations were performed on a 1.5-Tesla scanner using a dedicated epilepsy protocol aligned with the Harmonised Neuroimaging of Epilepsy Structural Sequences (HARNESS-MRI) framework with axial T1, T2, fluid-attenuated inversion recovery, and diffusion-weighted sequences plus high-resolution coronal T1-and T2-weighted images perpendicular to the long axis of the hippocampus; gadolinium was used when indicated.Two neuroradiologists independently interpreted the images.Demographic, clinical, and management data were summarised descriptively. ResultsMean age was 27.07 ± 22.46 years (median 23.00, IQR 7.25-39.75);62 of 90 patients (68.89%) were men, and generalised seizures predominated in 74 of 90 patients (82.22%).Any structural or signal abnormality was identified on MRI in 64 of 90 patients (71.11%; 95% CI 61.7-80.5);aetiologically relevant findings were present in 56 of 90 patients (62.22%).Mesial temporal sclerosis, tumours, and peri-ictal or post-ictal changes were the most common specific findings (eight patients each; 8.89%), followed by vascular and congenital lesions (seven patients each; 7.78%).Mesial temporal sclerosis was exclusively identified in patients with focal seizures with secondary generalisation (8 of 11 patients; 72.73%).The parietal lobe was the most frequent anatomical site (22 of 64 patients; 34.38%).Targeted medical therapy was initiated in 37 of 90 patients (41.11%), surgical lesionectomy recommended in 5 of 90 patients (5.56%), and management was changed in 48 of 90 patients (53.33%) overall.Conventional sequences disclosed abnormalities in 34 patients; addition of high-resolution coronal hippocampal sequences and contrast-enhanced imaging identified lesions in a further 30 patients. ConclusionDedicated epilepsy-protocol MRI revealed structural abnormalities in over 70% of patients and altered management in the majority.Routine high-resolution MRI is justified in the initial evaluation of seizure disorders in this region.