⚡ Expert-Reviewed by Epileptologist

Your MRI Holds Answers.
Let's Find Them.

Up to 50% of epilepsy lesions are missed on standard MRI. The right protocol changes everything.

🎯 Learn About HARNESS Protocol 📋 Prepare for Your MRI
30% More lesions detected with 3T HARNESS
1mm Isotropic resolution for subtle findings
7+ Specialized sequences
❌

Standard Brain MRI

  • 1.5T field strength
  • Generic brain protocol
  • 5mm slice thickness
  • Wrong angulation for hippocampus
  • Missing key sequences
Misses up to 50% of lesions
✅

3T HARNESS Protocol

  • 3 Tesla field strength
  • Epilepsy-specific sequences
  • 1mm isotropic resolution
  • Perpendicular to hippocampus
  • Complete sequence set
Gold standard for detection
⭐ Featured Protocol

3T MRI Brain HARNESS Protocol

Harmonized Neuroimaging of Epilepsy Structural Sequences — The ILAE-recommended gold standard

Why HARNESS?

Standard MRI protocols were designed for strokes, tumors, and general pathology — not for the subtle lesions that cause epilepsy. HARNESS was developed specifically to detect:

  • Hippocampal sclerosis (MTS)
  • Focal cortical dysplasia (FCD)
  • Bottom-of-sulcus dysplasia
  • Small cavernomas
  • Subtle developmental anomalies
3T Required

Required Sequences

Sequence Plane Resolution Purpose
3D T1 MPRAGE Isotropic 1mm Anatomy, volumetry, gray-white contrast
3D FLAIR Isotropic 1mm Cortical signal abnormalities, FCD
Coronal T2 TSE ⊥ to hippocampus 3mm Hippocampal internal structure
Coronal FLAIR ⊥ to hippocampus 3mm MTS signal change
Axial T2 Axial 3mm Overview, extra-temporal
SWI / GRE Axial 3mm Hemosiderin, cavernomas, calcification
DWI Axial 3mm Acute changes, cytotoxic edema
📄 Download Protocol Card (PDF)

Print and share with your MRI center

👤 For Patients & Families

Understanding Your Epilepsy MRI

What to expect, how to prepare, and what your results mean

📋

Before Your MRI

  • Remove all metal (jewelry, watches, hair clips)
  • Wear comfortable clothes without metal
  • Inform staff of any implants or devices
  • You may be asked to sleep less the night before
  • Scan takes 45-60 minutes — stay still
🔊

During the Scan

  • The machine is loud — you'll get earplugs
  • You can communicate via intercom
  • Try to relax — anxiety is normal
  • Close your eyes if it helps
  • Movement blurs images — stay as still as possible
❓

What If My MRI Is "Normal"?

  • ~30% of epilepsy patients have normal MRI
  • Ask: Was it done on 3T with HARNESS protocol?
  • A "normal" standard MRI may need repeating
  • Advanced post-processing can reveal subtle lesions
  • Normal MRI doesn't mean surgery isn't possible

🗣️ Ask Your Doctor

"Was my MRI done on a 3T machine?"
"Was an epilepsy-specific protocol used?"
"Should I repeat the MRI with HARNESS protocol?"
"Can the images be reviewed by an epilepsy specialist?"
🩺 For Clinicians

Systematic MRI Interpretation

A structured approach to reading epilepsy MRI

🔍 Hippocampal Checklist

  • Size asymmetry (compare L vs R)
  • T2/FLAIR signal increase
  • Loss of internal structure
  • Loss of digitations
  • Atrophy of collateral white matter
  • Temporal horn dilation (ipsilateral)
  • Fornix/mammillary body atrophy

🔍 FCD Checklist

  • Cortical thickening
  • Gray-white blurring
  • T2/FLAIR hyperintensity
  • Transmantle sign
  • Bottom-of-sulcus location
  • Abnormal gyration pattern
  • Subtle — compare both hemispheres

🔍 Red Flags

  • New lesion in known epilepsy → tumor?
  • Ring enhancement → infection/tumor
  • Rapid change → progressive pathology
  • Bilateral hippocampal changes → autoimmune?
  • Hemorrhage pattern → cavernoma
💡

Key Principle

Always correlate with semiology and EEG. The MRI finding must make sense with the clinical picture. A right temporal lesion doesn't explain left arm clonic seizures.

📚 Findings Atlas

Common Epileptogenic Lesions

Key imaging features of lesions that cause seizures

🧠

Hippocampal Sclerosis (MTS)

Most common finding in temporal lobe epilepsy

  • Hippocampal atrophy
  • T2/FLAIR hyperintensity
  • Loss of internal architecture
  • Often unilateral
Excellent surgical outcome if correctly identified
🔬

Focal Cortical Dysplasia

Developmental malformation — neurons in wrong place/orientation

  • Type I: Subtle, often MRI-negative
  • Type II: Cortical thickening, transmantle sign
  • Gray-white blurring
  • Bottom-of-sulcus common
May require 3T + post-processing to detect
🩸

Cavernoma

Vascular malformation with hemosiderin rim

  • "Popcorn" or "mulberry" appearance
  • Hemosiderin ring on SWI/GRE
  • May be multiple
  • Can grow or bleed
SWI sequence essential for detection
🎯

Low-Grade Tumors

DNET, Ganglioglioma — often temporal

  • Well-circumscribed
  • Minimal/no enhancement
  • May have cystic component
  • Cortically based
Excellent prognosis with resection
📥 Resources

Downloadable Tools

Print-ready materials for patients and clinicians

📄

HARNESS Protocol Card

One-page protocol specification for your MRI center

Download PDF
✅

Patient Prep Checklist

What to do before your epilepsy MRI

Download PDF
❓

Questions for Your Doctor

Key questions to ask about your MRI

Download PDF

Had an MRI But Still Have Seizures?

A "normal" MRI on standard protocol doesn't mean there's no lesion. Consider evaluation at a comprehensive epilepsy center with 3T HARNESS protocol imaging.

Learn About Proper Imaging

About This Resource

EpilepsyMRI.com is created and maintained by Dr. Abhishek Gohel, Epileptologist at Gujarat Epilepsy & Neuro Clinic and KD Hospital, Ahmedabad.

Specializing in drug-refractory epilepsy, LTVEEG, and pre-surgical evaluation.

FirstSeizure.com