Seizures are a symptom of an underlying brain disorder. The accurate identification of the nature of the disease generating the seizures facilitates treatment and can prevent further brain damage. The understanding of the physiopathology underlying the seizures has been greatly enhanced by the possibility to examine these patients with advanced forms of neuroimaging. Among different forms of investigation, neuroimaging techniques play a major role in diagnosis and decision-making in the care of patients with epilepsy. We review the contributions of current methods of imaging in the investigation of patients with single seizures, febrile seizures or refractory seizures, assessing the practical aspects, benefits, and operational costs of various neuroimaging techniques. The focus is on MRI, which is the imaging modality of choice for outpatient investigation. We also assessed the benefits from CT scans, which remain the first option for emergency seizure assessment. The aim was to evaluate how the structural, functional and metabolic information provided by modern techniques of neuroimaging decreases the need for additional investigation and speeds the management of these epileptic disorders. This makes it possible to accurately define the location and the nature of the epileptogenic lesions related to seizures.103RA40RA46Browne, T.R., Holmes, G.L., Epilepsy (2001) N Engl J Med, 344, pp. 1145-1151King, M.A., Newton, M.R., Jackson, G.D., Epileptology of the first-seizure presentation: A clinical, electroencephalographic, and magnetic resonance imaging study of 300 consecutive patients (1998) Lancet, 352, pp. 1007-1011Hauser, W.A., Annegers, J.F., Kurland, L.T., Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935-1984 (1993) Epilepsia, 34, pp. 453-468Forsgren, L., Bucht, G., Eriksson, S., Bergmark, L., Incidence and clinical characterization of unprovoked seizures in adults: A prospective population-based study (1996) Epilepsia, 37, pp. 224-229Wright, J., Pickard, N., Whitfield, A., Hakin, N., A population-based study of the prevalence, clinical characteristics and effect of ethnicity in epilepsy (2000) Seizure, 9, pp. 309-313Practice parameter: Neuroimaging in the emergency patient presenting with seizure-summary statement (1996) Neurology, 47, pp. 288-291. , Quality Standards Sub-committee of the American Academy of Neurology in cooperation with American College of Emergency Physicians, American Association of Neurological Surgeons, and American Society of NeuroradiologyEngel Jr., J., (1989) Seizures and Epilepsy, , Philadelphia: F.A. DavisProposal for revised classification of epilepsies and epileptic syndromes (1989) Epilepsia, 30, pp. 389-399. , Commission on Classification and Terminology of the International League Against EpilepsyGreenberg, M.K., Barsan, W.G., Starkman, S., Neuroimaging in the emergency patient presenting with seizure (1996) Neurology, 47, pp. 26-32Fernandez, G., Effenberger, O., Vinz, B., Hippocampal malformation as a cause of familial febrile convulsions and subsequent hippocampal sclerosis (1998) Neurology, 57, pp. S13-S21Brown, L.W., Febrile seizures (2000) Curr Treat Options Neurol, 2, pp. 553-558VanLandingham, K.E., Heinz, E.R., Cavazos, J.E., Lewis, D.V., Magnetic resonance imaging evidence of hippocampal injury after prolonged focal febrile convulsions (1998) Ann Neurol, 43, pp. 413-426Berger, H., Über das Elektrenkephalogram des Menschen (1929) Arch Psychiatr Nervenkr, 87, pp. 527-570Engel Jr., J., (1987) Surgical Treatment of the Epilepsies, , New York: Raven PressLi, L.M., Fish, D.R., Sisodiya, S.M., High resolution magnetic resonance imaging in adults with partial or secondary generalised epilepsy attending a tertiary referral unit (1995) J Neurol Neurosurg Psychiatry, 59, pp. 384-387Cendes, F., Leproux, F., Melanson, D., MRI of amygdala and hippocampus in temporal lobe epilepsy (1993) J Comput Assist Tomogr, 17, pp. 206-210Cendes, F., Andermann, F., Gloor, P., MRI volumetric measurements of amygdala and hippocampus in temporal lobe epilepsy (1993) Neurology, 43, pp. 719-725Cendes, F., Dubeau, F., Andermann, F., Significance of mesial temporal atrophy in relation to intracranial ictal and interictal stereo EEG abnormalities (1996) Brain, 119, pp. 1317-1326Arruda, F., Cendes, F., Andermann, F., Mesial atrophy and outcome after amygdalohippocampectomy or temporal lobe removal (1996) Ann Neurol, 40, pp. 446-450Bernasconi, N., Bernasconi, A., Caramanos, Z., Entorhinal cortex atrophy in epilepsy patients exhibiting normal hippocampal volumes (2001) Neurology, 56, pp. 1335-1339Bernasconi, N., Bernasconi, A., Andermann, F., Entorhinal cortex in temporal lobe epilepsy: A quantitative MRI study (1999) Neurology, 52, pp. 1870-1876Jack Jr., C.R., Hippocampal T2 relaxometry in epilepsy: Past, present, and future (1996) AJNR Am J Neuroradiol, 17, pp. 1811-1814Van Paesschen, W., Sisodiya, S., Connelly, A., Quantitative hippocampal MRI and intractable temporal lobe epilepsy (1995) Neurology, 45, pp. 2233-2240Van Paesschen, W., Revesz, T., Duncan, J.S., Quantitative neuropathology and quantitative magnetic resonance imaging of the hippocampus in temporal lobe epilepsy (1997) Ann Neurol, 42, pp. 756-766Cendes, F., Andermann, F., Dubeau, F., Arnold, D.L., Proton magnetic resonance spectroscopic images and MRI volumetric studies for lateralization of temporal lobe epilepsy (1995) Magn Reson Imaging, 13, pp. 1187-1191Connelly, A., Jackson, G.D., Duncan, J.S., Magnetic resonance spectroscopy in temporal lobe epilepsy (1994) Neurology, 44, pp. 1411-1417Duc, C.O., Trabesinger, A.H., Weber, O.M., Quantitative 1H MRS in the evaluation of mesial temporal lobe epilepsy in vivo (1998) Magn Reson Imaging, 16, pp. 969-979Kuzniecky, R., Hugg, J.W., Hetherington, H., Relative utility of 1H spectroscopic imaging and hippocampal volumetry in the lateralization of mesial temporal lobe epilepsy (1998) Neurology, 51, pp. 66-71Li, L.M., Cendes, F., Andermann, F., Prognostic value of proton MR spectroscopic imaging for surgical outcome in patients with intractable temporal lobe epilepsy and bilateral hippocampal atrophy (2000) Ann Neurol, 47, pp. 195-200Li, L.M., Caramanos, Z., Cendes, F., Lateralization of temporal lobe epilepsy (TLE) and discrimination of TLE from extra-TLE using pattern analysis of magnetic resonance spectroscopic and volumetric data (2000) Epilepsia, 41, pp. 832-842Li, L.M., Dubeau, F., Andermann, F., Arnold, D.L., Proton magnetic resonance spectroscopic imaging studies in patients with newly diagnosed partial epilepsy (2000) Epilepsia, 41, pp. 825-831Li, L.M., Cendes, F., Andermann, F., Spatial extent of neuronal metabolic dysfunction measured by proton MR spectroscopic imaging in patients with localization-related epilepsy (2000) Epilepsia, 41, pp. 666-674Li, L.M., Cendes, F., Antel, S.B., Prognostic value of proton magnetic resonance spectroscopic imaging for surgical outcome in patients with intractable temporal lobe epilepsy and bilateral hippocampal atrophy (2000) Ann Neurol, 47, pp. 195-200Taylor, D.C., Falconer, M.A., Bruton, C.J., Corsellis, J.A., Focal dysplasia of the cerebral cortex in epilepsy (1971) J Neurol Neurosurg Psychiat, 34, pp. 369-387Falconer, M.A., Serafetinides, E.A., Corselis, J.A.N., Etiology and pathogenesis of temporal lobe epilepsy (1964) Arch Neurol, 10, pp. 233-248Gambardella, A., Palmini, A., Andermann, F., Usefulness of focal rhythmic discharges on scalp EEG of patients with focal cortical dysplasia and intractable epilepsy (1996) Eletroencephalogr Clin Neurophysiol, 98, pp. 243-249Palmini, A., Gambardella, A., Andermann, F., Operative strategies for patients with cortical dysplastic lesions and intractable epilepsy (1994) Epilepsia, 35 (SUPPL. 6), pp. S57-S71Dobyns, W.B., Andermann, E., Andermann, F., X-linked malformations of neuronal migration (1996) Neurology, 47, pp. 331-339Ferrie, C.D., Jackson, G.D., Giannakodimos, S., Panayiotopoulos, C.P., Posterior agyria-pachygyria with polymicrogyria: Evidence for an inherited neuronal migration disorder (1995) Neurology, 45, pp. 150-153Guerreiro, M.M., Andermann, E., Guerrini, R., Familial perisylvian polymicrogyria: A new familial syndrome of cortical maldevelopment (2000) Ann Neurol, 48, pp. 39-48Montenegro, M.A., Guerreiro, M.M., Lopes-Cendes, S., Relevance of genetic and prenatal events in different forms of malformations of cortical development (2001) Neurology, 56 (8), pp. A135Grant, P.E., Barkovich, A.J., Wald, L.L., High-resolution surface-coil MR of cortical lesions in medically refractory epilepsy: A prospective study (1997) AJNR Am J Neuroradiol, 18, pp. 291-301Bernasconi, A., Antel, S.B., Collins, D.L., Texture analysis and morphological processing of magnetic resonance imaging assist detection of focal cortical dysplasia in extra-temporal partial epilepsy (2001) Ann Neurol, 49, pp. 770-775Bastos, A.C., Korah, I.P., Cendes, F., Curvilinear reconstruction of 3D magnetic resonance imaging in patients with partial epilepsy: A pilot study (1995) Magn Reson Imaging, 13, pp. 1107-1112Montenegro, M.A., Li, L.M., Guerreiro, M.M., Focal cortical dysplasia: Improving diagnosis and localization with magnetic resonance imaging multiplanar and curvilinear reconstruction (2002) J Neuroimaging, 12, pp. 224-230Cendes, F., Li, L.M., Watson, C., Is ictal recording mandatory in temporal lobe epilepsy? Not when the interictal electroencephalogram and hippocampal atrophy coincide (2000) Arch Neurol, 57, pp. 497-500Olivier, A., Surgery of epilepsy: Methods (1988) Acta Neurol Scand (Suppl), 117, pp. 103-113. , ReviewJackson, G.D., New techniques in magnetic resonance and epilepsy (1994) Epilepsia, 35 (SUPPL. 6), pp. S2-S13. , Review