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The potential benefits of functional magnetic resonance imaging (MRI) for the investigation of normal development have been limited by difficulties in its use with children. We describe the practical aspects, including failure rates, involved in conducting large-scale functional MRI studies with normal children. Two hundred and nine healthy children between the ages of 5 and 18 years participated in a functional MRI study of language development. Reliable activation maps were obtained across the age range. Younger children had significantly higher failure rates than older children and adolescents. It is concluded that it is feasible to conduct large-scale functional MRI studies of children as young as 5 years old. These findings can be used by other research groups to guide study design and plans for recruitment of young subjects.

Summary:Purpose: The goal of this study was to compare language lateralization between pediatric epilepsy patients and healthy children.Methods: Two groups of subjects were evaluated with functional magnetic resonance imaging (f MRI) by using a silent verb-generation task. The first group included 18 pediatric epilepsy patients, whereas the control group consisted of 18 age/gender/handedness-matched healthy subjects.Results: A significant difference in hemispheric lateralization index (LI) was found between children with epilepsy (mean LI = −0.038) and the age/gender/handedness-matched healthy control subjects (mean LI = 0.257; t = 6.490, p < 0.0001). A dramatic difference also was observed in the percentage of children with epilepsy (77.78%) who had atypical LI (righthemispheric or bilateral, LI < 0.1) when compared with the age/gender/handedness-matched group (11.11%; χ 2 = 16.02, p < 0.001). A linear regression analysis showed a trend toward increasing language lateralization with age in healthy controls (R 2 = 0.152; p = 0.108). This association was not observed in pediatric epilepsy subjects (R 2 = 0.004, p = 0.80). A significant association between language LI and epilepsy duration also was found (R 2 = 0.234, p < 0.05). Conclusions: This study shows that epilepsy during childhood is associated with neuroplasticity and reorganization of language function.

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Summary:Purpose: West syndrome is a rare epileptic syndrome associated with infantile spasms, a specific abnormal electroencephalographic pattern (termed hypsarrhythmia). and mental retardation. Management of this disorder is difficult because current treatment regimens, including many anticonvulsants and hormones, are often ineffective. Topiramate (TPM) is a new antiepileptic drug that may be effective in pediatric epilepsies. We conducted a pilot study to test the effects of rapid TPM dosing in patients with refractory infantile spasms.Methods: Eleven children with refractory infantile spasms were given an initial dose of 25 mg TPM per day in addition to their current therapy. Dosage was increased by 25 mg every 2-3 days until spasms were controlled, the maximal tolerated dose was reached, or the maximal dose of 24 mg/kg/day was achieved. Efficacy was primarily assessed by video EEG and secondarily by parental count of spasm frequency.Results: Five (45%) subjects became spasm free during the study, with absence of infantile spasms and hypsarrhythmia (either classic or modified) proven by video EEG. Nine s u b jects, including the five spasm free, achieved a spasm reduction of 250%. Spasm frequency decreased from 25.6 f 19.3 to 6.9 r 5.9 spasmdday. Sixty-four percent of the subjects were able to achieve TPM monotherapy.Conclusions: Results in this cohort of 1 1 patients with refractory disease show TPM to be a promising new agent for the treatment of infantile spasms.

We used verb generation and story listening tasks during fMRI to study language organization in children (7, 9 and 12 years old) with perinatal left MCA infarctions. Healthy, age-matched comparison children (n = 39) showed activation in left Broca's area during the verb generation task; in contrast, stroke subjects showed activation either bilaterally or in the right hemisphere homologue during both tasks. In Wernicke's area, comparison subjects showed left lateralization (verb generation) and bilateral activation (L > R) (story listening). Stroke subjects instead showed bilateral or right lateralization (verb generation) and bilateral activation (R > L) (story listening). Language is distributed atypically in children with perinatal left hemisphere stroke.

To determine whether the BOLD signal used in fMRI is age dependent in childhood, 332 healthy children (age 4.9-18.9 years) performed tasks in a periodic block design during 3 T fMRI: (1) a verb generation task interleaved with a finger tapping task; (2) a word-picture matching task interleaved with an image discrimination task. Significant correlations between percent signal change in BOLD effect and age occurred in left Broca's, middle frontal, Wernicke's, and inferior parietal regions, and anterior cingulate during the verb generation task; in precentral, postcentral, middle frontal, supplementary motor, and precuneus regions during the finger tapping task; and in bilateral lingula gyri during the word-picture matching task. Thus, BOLD effect increases with age in children during sensorimotor and language tasks.

A significant positive correlation exists between LEV saliva and serum concentrations. The ability to monitor LEV therapy using saliva may provide benefits that include facilitating sample collection and improving the quality of life for persons with epilepsy. Patients with poor venous access, such as children and elderly patients, and persons afraid of needles may particularly benefit from this method.