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Connectomics 2.0: Connected or Not, is this the Question?

Commentary It is a major understatement to say that MRI has revolutionized our approach to the evaluation and diagnosis of patients with epilepsy. Our patients are fortunate to live in times when techniques like pneumoencephalography have long been replaced by MRI and its derivatives, including magnetic resonance spectroscopy (MRS) or diffusion tensor imaging (DTI), and that these techniques can be used to predict epilepsy course and/ or outcome of epilepsy surgery. It is clear that high-quality imaging provides important information that is invaluable to patients with new-onset and chronic epilepsy alike (1). Modern imaging techniques, frequently supplemented by methods that are sophisticated and difficult to replicate without lengthy training in mathematics and statistics data processing methods, provide new or additional information that may inform us about epilepsy pathophysiology and/or change the approach to evaluating the patient or predicting the outcome An example of this is the study by Keller that used DTI to examine how this technique contributed to epilepsy surgery outcome prediction. There is a growing body of studies in which the investigators have applied DTI alone or in combination with other techniques to evaluate patients with focal and generalized epilepsies, including temporal lobe epilepsy (TLE). As a technique, DTI provides information regarding the intrinsic properties of the white matter and its architecture as well as Preoperative Automated Fibre Quantification Predicts Postoperative Seizure Outcome in Temporal Lobe Epilepsy.