Prospective detection of cortical dysplasia on clinical MRI in pediatric intractable epilepsy

Abstract

Awareness of current classification schemes of cortical dysplasia and image review in the context of a multidisciplinary conference can lead to improved MRI detection of cortical dysplasia in children.

Patient management conference: Correlating pre-surgical data

“…The patient's clinical history and seizure semiology are presented along with clinically validated tools of video EEG, MRI, PET, and ictal SPECT [8]. Multiple pediatric studies have reported that degree of concordance among the studies correlates with postoperative outcomes [9][10][11]. From the available data, hypotheses of involved networks and spread patterns are generated.…”

“…In some cases, surgery may be recommended to patients initially not thought to be surgical candidates (case example 1). Radhakrishnan et al analyzed the benefit of retrospective unblinded review of reportedly normal preoperative MRIs of children with medically intractable epilepsy and histopathology consistent with cortical dysplasia [9]. In their study, 18/78 children had overlooked MRI findings, and 72% of these (13/18) were identified prospectively at PMC.…”

“…In another study, See et al reported 28% (17/60) of patients with extratemporal epilepsy and reportedly normal MRI were found to have a lesion when presented at PMC [12]. One perceived limitation is that this approach may introduce observer bias [8,9] T further high resolution images, such as 7 T MRI. Co-registration of noninvasive data or 3D reconstruction are also being utilized at many centers [3].…”

Morphometric analysis program: Detection of epileptic foci in young children using an adult normative database: Initial experience

“…Magnetic resonance imaging (MRI) detection of FCD is fundamental for surgical planning and leads to better outcomes 3,4 . Unfortunately, a significant number of FCDs may be overlooked by MRI 5–8 . MAP is a voxel‐based morphometric analysis program that quantifies interindividual variability on T1‐ and T2‐weighted volumetric MRI.…”

“…3,4 Unfortunately, a significant number of FCDs may be overlooked by MRI. [5][6][7][8] MAP is a voxel-based morphometric analysis program that quantifies interindividual variability on T1-and T2-weighted volumetric MRI. Wang et al recently published a study emphasizing the importance of MAP in presurgical evaluation of drug-resistant focal epilepsy in children with apparently normal MRI using an agespecific template created with controls as young as 3 years of age.…”