White Matter Integrity in Diffusion Tensor Imaging Utilizing Fractional Anisotropy and Mean Diffusivity in Patients with and without Epilepsy in a Tertiary Care Hospital

Abstract

Background
Epilepsy is a common neurological disorder characterized by recurrent seizures due to abnormal neuronal discharges. Microstructural alterations in white matter play a crucial role in its pathophysiology. Diffusion Tensor Imaging (DTI), a non-invasive MRI technique, enables assessment of white matter integrity using Fractional Anisotropy (FA) and Mean Diffusivity (MD).
Methods
A comparative analytical study was conducted in the Department of Radiology, Tribhuvan University Teaching Hospital, Nepal, from September 2025 to February 2026 after ethical approval from the Institutional Review Committee. A total of 14 cases with seizures and 28 controls (normal) were included. Diffusion Tensor Imaging parameters were measured in the different regions of deep white matter of the cerebral hemisphere. Data were analyzed using independent t-test and Spearman’s correlation coefficient. The level of statistical significance was set at p<0.05. 
Results
Cases demonstrated reduced FA and MD values in several white matter regions compared to controls. Statistically significant reductions in FA were observed in the bilateral anterior limbs of the internal capsule, while significant decreases in MD were noted in the bilateral posterior limbs of the internal capsule and right posterior corpus callosum. Other regions showed variable but non-significant differences. A negative correlation was found between FA values and duration of seizure, particularly in the right external capsule and posterior corpus callosum.
Conclusions
Epilepsy is associated with measurable microstructural white matter alterations on DTI. Reduced FA and MD values indicate axonal disorganization and structural damage, highlighting the potential role of DTI as a biomarker for assessing the disease.