Advanced neuroimaging techniques for evaluating pediatric epilepsy

Abstract

Accurate localization of the seizure onset zone is important for better seizure outcomes and preventing deficits following epilepsy surgery. Recent advances in neuroimaging techniques have increased our understanding of the underlying etiology and improved our ability to noninvasively identify the seizure onset zone. Using epilepsy-specific magnetic resonance imaging (MRI) protocols, structural MRI allows better detection of the seizure onset zone, particularly when it is interpreted by experienced neuroradiologists. Ultra-high-field imaging and postprocessing analysis with automated machine learning algorithms can detect subtle structural abnormalities in MRI-negative patients. Tractography derived from diffusion tensor imaging can delineate white matter connections associated with epilepsy or eloquent function, thus, preventing deficits after epilepsy surgery. Arterial spin-labeling perfusion MRI, simultaneous electroencephalography (EEG)-functional MRI (fMRI), and magnetoencephalography (MEG) are noinvasive imaging modalities that can be used to localize the epileptogenic foci and assist in planning epilepsy surgery with positron emission tomography, ictal single-photon emission computed tomography, and intracranial EEG monitoring. MEG and fMRI can localize and lateralize the area of the cortex that is essential for language, motor, and memory function and identify its relationship with planned surgical resection sites to reduce the risk of neurological impairments. These advanced structural and functional imaging modalities can be combined with postprocessing methods to better understand the epileptic network and obtain valuable clinical information for predicting long-term outcomes in pediatric epilepsy.

Magnetic Resonance Imaging Findings in Childhood Epilepsy at a Tertiary Hospital in Kenya

“…MRI is fundamentally important and has become increasingly relevant in the evaluation and management of childhood epilepsy: supporting elucidation of etiology, syndrome description, prognostication, and determination of opportunities for definitive interventions (9). Identification of focal brain lesions on MRI has supported the scale-up of surgical interventions, delivering favorable outcomes for epilepsy conditions that were hitherto associated with refractory seizures and poor outcomes (9,10,15). In infectious pathologies, it is useful in discerning etiological agents and supporting targeted and adequate microbial care.…”

The Noninvasive Evaluation for Minimally Invasive Pediatric Epilepsy Surgery (MIPES): A Multimodal Exploration of the Localization-Based Hypothesis

“…2) and a brain magnetic resonance imaging (MRI) is generally recommended as the primary initial neuroimaging modality. [26][27][28] MRI magnetic field strength of 3 tesla (3T) provides superior imaging quality over 1.5T and is preferred in the epilepsy work-up. It has been established that 3T phased array MRI can detect new lesions in patients with previously "normal" 1.5T studies, particularly in the case of focal cortical dysplasias (FCDs).…”

Rare Neurovascular Diseases in Korea: Classification and Related Genetic Variants

“…Since RNVD is rare, obtaining the diagnosis based on imaging studies can often be difficult, and knowing which diseases can involve the neurovascular system can be of great help in the diagnosis. Advanced neuroimaging techniques, which are useful in diagnosing various neurologic diseases, are also expected to play an essential role in the evaluation of RNVDs [ 104 105 106 ]. For example, four-dimensional magnetic resonance angiography and arterial spin labeling are useful non-invasive imaging modalities in the detection, evaluation, and follow-up of intracranial shunt diseases ( Figs.…”