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Updated: Jul 5, 2026

Scanning Dos and Don'ts: Using Magnetic Resonance Imaging in Awake Children Aged 3 to 5 Years to Assess Brain Structure and Function
Published on: March 10, 2026
[Structural and functional imaging: particularities in children]
1U663, Inserm, Service de neuropédiatrie, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France. catherine.chiron@nck.aphp.fr
Insights
Advanced imaging techniques aid in the surgical treatment of childhood partial epilepsies by localizing seizure origins and mapping brain function. These methods improve patient selection and surgical planning for better outcomes.
Area of Science:
- Neuroscience
- Medical Imaging
- Pediatric Neurology
Background:
- Childhood partial epilepsies present unique diagnostic challenges.
- Surgical intervention is a key treatment for refractory cases.
- Accurate localization of the epileptogenic zone is crucial for successful surgery.
Purpose of the Study:
- To review the role of advanced neuroimaging in the presurgical evaluation of pediatric partial epilepsies.
- To highlight the benefits of multimodal imaging in improving diagnostic accuracy.
- To discuss the integration of imaging findings with clinical and electrophysiological data.
Main Methods:
- Review of magnetic resonance imaging (MRI) techniques, including advanced sequences for early childhood.
- Discussion of functional imaging modalities such as ictal SPECT and PET.
- Integration of functional MRI (fMRI) for noninvasive cortical mapping of eloquent areas.
- Comparison of noninvasive imaging with invasive methods like SEEG and cortical stimulation.
Main Results:
- Advances in MRI enhance detection of subtle lesions in young children.
- Functional imaging (SPECT, PET) aids in electrode placement and clarifies ambiguous cases.
- Multimodal imaging significantly increases diagnostic sensitivity.
- fMRI provides essential functional mapping in cooperating children aged 5-6 years.
Conclusions:
- Advanced neuroimaging is indispensable for presurgical workup in pediatric epilepsy surgery.
- A multimodal approach combining MRI, functional imaging, and clinical data optimizes patient selection and surgical planning.
- Invasive techniques remain vital for cryptogenic epilepsies or complex cases.
Abstract:
Surgery of partial epilepsies in childhood has largely benefited from the recent advances of imaging techniques, which carry a triple goal: (1) to contribute to the localization of the epilepsy onset zone, (2) to detect and delineate an underlying lesion, and (3) to study the spatial relationship between the epileptogenic zone and the neighboring functional cortex, in order to select patients and plan the resection. This noninvasive presurgical imaging workup must be compared to clinical and electrical data to estimate the postoperative prognosis, while invasive techniques such as SEEG, cortical stimulations, and IAT often remain indispensable in difficult cases, i.e., in cryptogenic epilepsies. As in adults, advances in MRI allow us to detect more and more subtle underlying lesions, but this requires repeating MR studies during early childhood and using adapted sequence parameters to account for ongoing myelination. Ictal SPECT and PET imaging prove especially useful in planning depth electrode placement when video-EEG is not contributive, when MRI looks normal or shows multiple abnormalities, or in cases of discrepant findings. Multimodal imaging greatly enhances the sensitivity of all of these techniques. Finally, functional MRI of motor and language functions provide noninvasive cortical mapping of essential functions, using age-adapted paradigms, in cooperating children from age five to six and from IQs around 60.
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