A review of magnetoencephalography use in pediatric epilepsy: an update on best practice
Hiroshi Otsubo1, Hiroshi Ogawa1, Elizabeth Pang1,2
1Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada.
Insights
Magnetoencephalography (MEG) aids in presurgical evaluation for children with drug-resistant epilepsy (DRE). This noninvasive technique improves localization of the epileptogenic zone, potentially increasing epilepsy surgery candidacy.
Area of Science:
- Neuroscience
- Medical Imaging
- Epileptology
Background:
- Magnetoencephalography (MEG) is a noninvasive neuroimaging technique.
- It is utilized for the presurgical evaluation of pediatric patients diagnosed with drug-resistant epilepsy (DRE).
Purpose of the Study:
- To discuss the contributions of MEG in localizing the epileptogenic zone in pediatric DRE.
- To review MEG's role in mapping eloquent cortex and its clinical applications and challenges.
Main Methods:
- Review of current evidence on MEG's application in pediatric epilepsy surgery evaluation.
- Analysis of MEG's performance in localizing the epileptogenic zone, particularly in extra-temporal lobe epilepsy, focal cortical dysplasia, and operculo-insular epilepsy.
Main Results:
- MEG is valuable for localizing the epileptogenic zone in various pediatric epilepsy types.
- Evidence supports MEG's utility in mapping eloquent cortex for surgical planning.
Conclusions:
- MEG can significantly alter clinical management of pediatric DRE by guiding intracranial electrode placement and enhancing surgical yield.
- Improved epileptogenic zone identification via MEG may increase patient suitability for epilepsy surgery and its overall utilization.
Abstract:
Introduction: Magnetoencephalography (MEG) is a noninvasive technique that is used for presurgical evaluation of children with drug-resistant epilepsy (DRE).Areas covered: The contributions of MEG for localizing the epileptogenic zone are discussed, in particular in extra-temporal lobe epilepsy and focal cortical dysplasia, which are common in children, as well as in difficult to localize epilepsy such as operculo-insular epilepsy. Further, the authors review current evidence on MEG for mapping eloquent cortex, its performance, application in clinical practice, and potential challenges.Expert opinion: MEG could change the clinical management of children with DRE by directing placement of intracranial electrodes thereby enhancing their yield. With improved identification of a circumscribed epileptogenic zone, MEG could render more patients as suitable candidates for epilepsy surgery and increase utilization of surgery.
