Automated MRI-based atrophy patterns to improve the diagnosis of generalized epilepsies in outpatient care

Misdiagnosing focal versus generalized epilepsies can have severe consequences, and Brain MRI can be misleading (e.g.focal incidental findings in generalized epilepsy, or subtle undetected lesions in focal epilepsies) A simple pattern of atrophy (bilateral and symmetrical atrophy of frontothalamic networks) detected with an automated, commercially available software strongly suggests generalized epilepsy in our cohort. An ipsilateral lobar and thalamic atrophy failed to diagnose focal epilepsy, but may help in focusing the area of detection. This represents a first translation of connectome science in an outpatient, individual-level, diagnostic tool, and a potential imaging biomarker of generalized epilepsy.