Functional magnetic resonance imaging for presurgical evaluation of very young pediatric patients with epilepsy

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The authors describe their experience with functional MR (fMR) imaging in children as young as 5 years of age, or even younger in developmental age equivalent. Functional MR imaging can be useful for identifying eloquent cortex prior to surgical intervention. Most fMR imaging clinical work has been done in adults, and although children as young as 8 years of age have been included in larger clinical series, cases in younger children are rarely reported.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors reviewed presurgical fMR images in eight patients who were 8 years of age or younger, six of whom were 5 or 6 years of age. Each patient had undergone neuropsychological testing. Three patients functioned at a below-average level, with adaptive functioning age scores of 3 to 4 years. Self-paced finger tapping (with passive movement in one patient) and silent language tasks were used as activation tasks. The language task was modified for younger children, for whom the same (not novel) stimuli were used for extensive practice ahead of time and in the MR imaging unit. Patient preparation involved techniques such as having experienced staff present to work with patients and providing external management during imaging. Six of eight patients had extensive training and practice prior to the procedure. In the two youngest patients, this training included use of a mock MR unit.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>All cases yielded successful imaging. Finger tapping in all seven of the patients who could perform it demonstrated focal motor activation in the frontal-parietal region, with expected activation elsewhere, including in the cerebellum. Three of four patients had the expected verb generation task activations, with left-hemisphere dominance, including a 6-year-old child who functioned at the 3-year, 9-month level. The only child (an 8-year-old) who was not prepared prior to the imaging session for the verb generation task failed this task due to movement artifact.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Despite the challenges of successfully using fMR imaging in very young and clinically involved patients, these studies can be performed successfully in children with a chronological age of 5 or 6 years and a developmental age as young as 3 or 4 years.</jats:p></jats:sec>

Evolution of the curve patterns during brace treatment for adolescent idiopathic scoliosis

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Resting-state functional magnetic resonance imaging for surgical planning in pediatric patients: a preliminary experience

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“…The perceptron can generalize to multiple outputs, and it is used in this case to classify several canonical RSNs. These networks include the dorsal attention network (DAN), 5 ventral attention network (VAN), 5 sensorimotor network (SMN), 17 visual network (VIS), 28 frontoparietal control network (FPC), 6 language network (LAN), 25 and default mode network (DMN). 7 The MLP was previously trained from a large collection of functional MRI data using seeds obtained from meta-analysis.…”

Corticospinal tract atrophy and motor fMRI predict motor preservation after functional cerebral hemispherectomy

“…34 The fact that many patients were cognitively impaired adds to the risk that our fMRI results may be partially obscured by motion artifacts. The DTI protocol we routinely use in the clinical setting is basic, utilizing at first 10 and then later 30 directions that are repeated 2-4 times.…”

“…34 Motor tasks alternated between left-and right-hand movements (visually cued, self-paced, tapping of the thumb and fingers together). Studies used a conventional block design (ABABAB paradigm) and were repeated at least twice.…”