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Abstract Epilepsy is a common brain disease that affects both adults and pediatrics. The main role of neuroimaging in epilepsy patients is to identify underlying structural abnormalities. MRI has excellent spatial resolution, soft tissue contrast and multiplanar capabilities making it the modality of choice in investigating patients with epilepsy. The aim of this study was to evaluate the different MRI brain findings in epilepsy This study was conducted at the MRI Unit, Radiodiagnosis Department at Menoufia University Hospitals from October 2019 to September 2021 with the approval of the Menoufia review board and performed after obtaining consent from all patients or, in the case of children, their parent or guardian. Patients were referred/recruited and subjected to MRI imaging. The included patients were diagnosed as having epilepsy according to 2014 criteria of ILAE. The study included 100 patients (49 % adults, 53 % males, median age 23.87 years). The MRI was normal in 31 patients (31 %) while abnormal in 69 patients (69 %) with a wide diffuse range of abnormalities. Most common abnormalities were congenital/ developmental lesions (27 %) followed by brain tumors (26 %). The abnormal MRIs were more common with increased age (median age 33 years, p < 0.001), in adults than pediatrics (p < 0.001) and in chronic/recurrent seizures than new-onset seizures (p < 0.001). MRI brain assessment of patients with clinically diagnosed epilepsy showed a high prevalence of MRI abnormalities with a wide Summary 131 diffuse range of etiologies with significant relation |