en Clinical Neuroscience Clinical Neuroscience Original Original <div style="text-align: justify;"><span style="font-size:14px;"><span style="font-family:Tahoma;"><span style="line-height:2;"><b>Background</b>: Approximately 30&ndash;40% of drug-resistant epilepsy (DRE) cases are MRI-negative, showing no visible lesions on conventional magnetic resonance imaging. This presents a significant challenge in localizing epileptic foci. However, recent evidence indicates that neuroinflammation plays a crucial role in epileptogenesis, offering potential biomarkers for more precise localization.<br> <b>Purpose of the study</b>: To evaluate whether multi-parametric quantitative MRI can detect neuroinflammation in the seizure-generating regions of patients with MRI-negative, drug-resistant epilepsy.<br> <b>Methods: </b>This study included twenty-one MRI-negative, drug-resistant epilepsy patients (mean age: 31.3 years) All participants underwent multi-parametric MRI at 1.5T, which included magnetization transfer imaging (MTI) and magnetic resonance spectroscopy (MRS). Regions of interest in epileptic patients were defined based on long-term video-EEG monitoring. Metabolite values from MRS and magnetization transfer ratios were analyzed using t-tests (p < 0.05) to compare normal and epileptic brain lobes in the patients.<br> <b>Results</b>: the analysis revealed significant metabolic and physiological alterations in epileptic regions. The magnetization transfer ratio (MTR) was significantly reduced in epileptic white matter (0.5718 &plusmn; 0.0141 vs. 0.5943 &plusmn; 0.0141, p < 0.05). Additionally, the myo-inositol to creatine ratio (mIns/Cr) was significantly elevated in epileptic areas (2.3581 &plusmn; 0.8257 vs. 1.7062 &plusmn; 0.4134, p < 0.05).<br> <b>Conclusions</b>: For patients with MRI-negative, drug-resistant epilepsy, multiparametric quantitative MRI provides a crucial tool for detecting neuroinflammation-related changes. By combining reduced magnetization transfer ratio (MTR) with increased myo-inositol to creatine (mIns/Cr) ratios, could provide helpful methods to localize epileptic focus and improve treatment in MRI-negative DRE.</span></span></span></div> Drug-resistant epilepsy, neuroinflammation, magnetization transfer imaging, magnetic resonance spectroscopy, MRI-negative epilepsy 0 0 http://bcn.iums.ac.ir/browse.php?a_code=A-10-8464-1&slc_lang=en&sid=1 Asieh Fatemidokht a_fatemidokht@yahoo.com 13700319475328460058185 13700319475328460058185 Yes Department of Radiology, Faculty of Allied Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran Keyvan Hassanzadeh k1.hassanzadeh@gmail.com 13700319475328460058186 13700319475328460058186 No Mojtaba Asadi Non-Profit Institute, Rafsanjan, Iran Mohammad Hossein Harirchian harirchn@hotmail.com 13700319475328460058187 13700319475328460058187 No Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran Mohammad Ali Oghabian Oghabian@sina.tums.ac.ir 13700319475328460058188 13700319475328460058188 No Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran. Abbas Tafakhori abbas.tafakhori@gmail.com 13700319475328460058189 13700319475328460058189 No Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran