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Imaging modalities have evolved over the last century and different modalities, such as plain X-ray, air or contrast ventriculography, pneumo-encephalography, cerebral angiography, CT scan, MRI, SPECT and PET scanning all have significantly contributed to the diagnosis and management of epilepsy. Whereas some of the initial imaging modalities, such as X-ray, ventriculography and conventional nuclear medicine imaging have become almost redundant and obsolete, the advent and evolution of various high-resolution tomographic neuroimaging during the past several decades has had a significant impact on the understanding, classification and treatment of patients with epilepsy. Cerebral imaging became almost routine following the development and widespread availability of CT scanning, which quickly became the standard of care in the evaluation of patients with epilepsy until outperformed by much higher resolution and greater structural details of MRI. This chapter briefly reviews the historical aspects and evolution of neuroimaging in epilepsy.

In 2008, Takabuti was taken to Manchester Royal Infirmary where radiography and CT-scanning were performed; recent analysis has revealed several unexpected and unusual features. Initially, the scans indicated that she was around 25-35 years of age at death; there were no signs of disease and her cause of death remained unidentified. Current research on the CT-scans has revealed that the only organ tissue returned to the body after evisceration was the heart which, as the locus of the owner’s personality, was usually afforded special treatment. Endoscopy was used to take samples to identify any traces of disease. Partial visual examination of her teeth, together with the CT scans, enabled Takabuti’s dental state to be determined: all her teeth were present, there is no evidence of tooth decay and little indication of gum disease, in contrast to many ancient Egyptians who suffered from worn, sensitive and abscessed teeth. Stable carbon and isotope analysis undertaken on a sample of Takabuti’s hair has demonstrated that she probably ate a diet lacking cereals but rich in food derived from trees and shrubs as well as legumes, beans and pods. The lack of cereals is unusual in an ancient Egyptian diet.

Twenty percent to 30% of all Sjögren’s patients have some form of pulmonary symptoms. The most common ones involve dry trachea, pleuritic discomfort, cough, and shortness of breath (dyspnea). Over time, approximately 10% of patients develop interstitial changes that may progress to scarring, increased pulmonary pressure, and bronchiectasis. A variety of interstitial lung disease (ILD) have been identified in the context of Sjögren’s. Infrequently, some Sjögren’s patients present with vasculitis or thromboembolic or lymphoproliferative changes. Evaluating the lungs in Sjögren’s includes pulmonary function testing, high-resolution CT scanning, 2-D echocardiography, and sleep studies. Supportive measures such as humidification are useful. If there is evidence for systemic inflammation, disease-modifying agents such as cyclophosphamide, mycophenolate mofetil, antifibrotic agents, or azathioprine are prescribed.

As we have seen, ECT involves modest discomfort, minimal risk, and almost no contraindications to its use. Headache, backache, nausea, and vomiting are the most frequent immediate complaints. These are relieved by mild analgesics and occasionally by the choice of anesthetic. Spine fractures were a complicating risk of the early treatments, but they are now prevented by muscle relaxation. In the past, seizures were sometimes prolonged and did not end promptly. Prolonged seizures are now avoided by precise energy dosing and attention to anesthesia related to the patient’s age. When a prolonged seizure does occur, it is readily recognized and treated. The risk of death during ECT is very low, less than that of women delivering spontaneous births. It is surprising that death is so rare since half of the patients are elderly, many ill with severe systemic infirmities or critical illnesses. The low mortality rate reflects the inherent safety of modern procedures. Indeed, some reports find that the lifetime death rates for hospitalized psychiatric patients who have received ECT are lower than the rates of those who have not. The mortality rate from natural causes is lower for those treated with ECT than for those who have not. Suicide rates are higher, however. The common memory loss associated with ECT is the main hurdle patients and their families face in accepting the treatment. Images of a patient losing the memory of his past life, his work skills, the names of his children and friends, and the ability to care for himself, much like a patient with Alzheimer’s disease, are so prevalent that doctors hesitate to recommend the treatment and many patients refuse permission even when it may be their principal lifesaving option. Such images are false. The fear of memory loss is based largely on reports by patients who were treated without anesthesia or ventilation with oxygen in the first decades of the treatment’s use. Such treatments were accompanied by severe, and often persistent, impairments in memory. Clinical practice changed and our treatments are no longer associated with these devastating problems, as careful attention is now paid to oxygenation throughout the procedure and to technical features that minimize the impact of the stimulus, anesthesia, and the seizure on memory.