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Structural and functional imaging in children with partial epilepsy
1Department of Neurology, Children's National Medical Center, The George Washington University School of Medicine, Washington, DC 20010, USA. wgaillar@cnmc.org
Insights
Advanced imaging techniques like MRI and PET scans are crucial for diagnosing pediatric complex partial seizures. These methods reveal structural and functional brain changes, aiding in understanding epilepsy
Area of Science:
- Neurology
- Pediatric Epilepsy
- Neuroimaging
Background:
- Partial epilepsy, particularly temporal lobe epilepsy, frequently originates in childhood.
- Imaging is essential for evaluating children with complex partial seizures.
Purpose of the Study:
- To highlight the role of neuroimaging in diagnosing pediatric complex partial seizures.
- To explore how imaging identifies seizure etiology and brain changes.
Main Methods:
- High-resolution structural MRI to detect underlying causes.
- FDG-PET scans to assess regional glucose metabolism.
- Functional MRI (fMRI) to map language areas.
Main Results:
- MRI reveals structural abnormalities and progressive hippocampal volume loss in some epilepsy cases.
- FDG-PET shows reduced glucose metabolism in seizure origin zones, often more widespread than the focus.
- fMRI effectively identifies language dominance and localization in pediatric epilepsy patients.
Conclusions:
- Neuroimaging, including MRI and fMRI, is vital for understanding pediatric epilepsy.
- Imaging aids in identifying seizure causes, assessing neuronal injury, and planning epilepsy surgery.
- fMRI is a valuable tool for mapping language networks during development in children with epilepsy.
Abstract:
Imaging plays an increasingly important role in the evaluation of children with complex partial seizures. Most partial epilepsy, especially of temporal lobe origin, begins during childhood. Structural imaging with high-resolution MRI can help identify the etiology of partial seizure disorders in many children. MRI studies also show the more widespread effect of seizures on brain structure. Progressive volume loss of the hippocampal formation in some patients with temporal lobe epilepsy provides evidence that continued seizures may be associated with progressive neuronal injury. FDG-PET studies show regional decreases in glucose consumption in the cortical zone from which seizures arise. Functional abnormalities often are more extensive than the seizure focus. Studies in children with recent-onset epilepsy show that metabolic abnormalities are considerably less common than in adults with partial epilepsy, supporting the notion that in some patients there may be progressive metabolic changes that occur with continued seizures. Functional MRI may be used to identify language areas in children with partial epilepsy. fMRI language tasks reliably identify the dominant hemisphere for language dominance when compared to the intracarotid amytal procedure. Tests of verbal fluency and semantic decision identify frontal lobe language areas, while reading text paradigms and auditory passage paradigms are better for identifying temporal language areas. A panel of paradigms is best used to identify language areas in children being considered for epilepsy surgery. fMRI is a valuable tool for elucidating the impact of chronic neurologic disease states on the functional organization of language networks during development.