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[Functional neuroimaging in children].

C Chiron1

  • 1Service de Neurologie et Métabolisme, Hôpital Necker-Enfants Malades, INSERM U29, 149 rue des Sèvres, 75743 Paris cedex 15, France. pcchiron@wanadoo.fr

Revue Neurologique
|August 28, 2004
PubMed
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Functional brain imaging, including SPECT and PET scans, aids in pinpointing seizure origins and mapping critical brain areas in children with drug-resistant epilepsy. These techniques are valuable for surgical planning and understanding brain plasticity.

Area of Science:

  • Neuroimaging
  • Epilepsy Research
  • Pediatric Neurology

Background:

  • Pharmacoresistant partial epilepsy (PRPE) in children presents challenges in localizing the epileptogenic zone.
  • Accurate localization is crucial for surgical intervention and improving patient outcomes.
  • Functional neuroimaging modalities offer non-invasive methods to assess brain function.

Purpose of the Study:

  • To evaluate the utility of functional cerebral imaging techniques in the presurgical work-up of pediatric PRPE.
  • To assess the sensitivity and applicability of SPECT, PET, and functional MRI in identifying seizure foci and functional brain areas.
  • To determine the role of these imaging modalities in surgical planning and understanding brain plasticity.

Main Methods:

  • Review of Single Photon Emission Computed Tomography (SPECT) including ictal and interictal scans with subtraction processing.

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  • Evaluation of Positron Emission Tomography (PET) using tracers like 18FDG, 11C-flumazenil, and 11C-alpha-methyl-tryptophane.
  • Assessment of functional Magnetic Resonance Imaging (fMRI) for motor and language cortex mapping, including its potential for assessing plasticity.

    • Main Results:

    • Ictal SPECT demonstrates acceptable sensitivity (80%) for epileptogenic zone localization, especially with interictal SPECT and subtraction processing.
    • PET sensitivity requires further validation against intracranial EEG, but both SPECT and PET aid in intracranial electrode placement decisions.
    • Functional MRI offers a non-invasive method for language lateralization in cooperative children and can track network plasticity post-lesion or surgery.

    Conclusions:

    • Functional imaging techniques, particularly ictal SPECT and fMRI, provide valuable complementary information for presurgical evaluation in pediatric PRPE.
    • These methods assist in localizing the epileptogenic zone and mapping functional cortices, guiding surgical planning.
    • Functional MRI shows promise for non-invasive language mapping and assessing brain plasticity in pediatric epilepsy patients.