[Neuroimaging in pediatric epilepsy]

Area of Science:

• Neurology
• Pediatric Neurology
• Neuroradiology

Context:

• Epilepsy in children stems from various causes including cortical malformations, phakomatosis, perinatal insults, and tumors.
• A significant portion (25%) of pediatric epilepsy cases are pharmacoresistant, necessitating alternative treatment strategies.
• Magnetic Resonance Imaging (MRI) is vital for identifying potential epileptogenic lesions and considering surgical interventions.

Purpose:

• To illustrate the diverse etiologies of pediatric epilepsy through a comprehensive review of MRI findings.
• To aid clinicians in recognizing characteristic and subtle MRI features associated with different epilepsy causes.
• To highlight the role of advanced imaging techniques beyond conventional MRI in diagnosing pediatric epilepsy.

Summary:

• Common pediatric epilepsy causes include cortical malformations (e.g., hemimegalencephaly, cortical dysplasia) and phakomatoses (e.g., tuberous sclerosis, neurofibromatosis).
• Standard MRI protocols involve multiplanar sequences (T1, T2, Flair, T1 inversion-recovery, post-contrast T1) to detect epileptogenic lesions.
• Subtle malformations and certain pathologies may require advanced MRI techniques like spectroscopy and diffusion imaging for accurate diagnosis.

Impact:

• Improved recognition of MRI findings can lead to earlier and more accurate diagnoses of pediatric epilepsy.
• Enhanced understanding of imaging characteristics aids in selecting appropriate patients for epilepsy surgery.
• Integration of advanced imaging modalities can improve diagnostic yield in complex pediatric epilepsy cases.