Functional magnetic resonance imaging for presurgical evaluation of very young pediatric patients with epilepsy
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Published on: September 20, 2024
Hillary Shurtleff1, Molly Warner, Andrew Poliakov
1Department of Neurology, Seattle Children's Hospital, Seattle, Washington, USA.
Insights
Functional MRI (fMRI) can successfully image children as young as 5 years old, even those with developmental ages as low as 3-4 years. This neuroimaging technique aids in identifying critical brain areas before surgery in pediatric patients.
Area of Science:
- Pediatric Neuroimaging
- Functional Magnetic Resonance Imaging (fMRI)
- Neurodevelopmental Disorders
Background:
- Functional MRI (fMRI) is crucial for pre-surgical mapping of eloquent cortex.
- Clinical fMRI data in children, especially those younger than 8 years, is limited.
- This study explores fMRI feasibility in very young pediatric patients.
Observation:
- Eight pediatric patients aged 8 years or younger underwent fMRI.
- Six patients were 5 or 6 years old, with three functioning at a 3-4 year developmental level.
- Specialized preparation, including mock MRI sessions, was employed for younger children.
Findings:
- Successful fMRI was achieved in all cases.
- Finger tapping tasks showed expected motor activation in the frontal-parietal region.
- Language tasks demonstrated expected left-hemisphere dominance in most children, including one with a 3-year developmental age.
Implications:
- fMRI is a viable tool for pre-surgical planning in children aged 5-6 years with developmental ages as low as 3-4 years.
- Adapted preparation techniques enhance the success rate of fMRI in young pediatric populations.
- This research expands the application of fMRI in pediatric neurosurgery and neurology.
Object:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
