Resting-state functional MRI in pediatric epilepsy: a narrative review

The role of connectivity in the function and development of the human brain has been intensely studied over the last two decades. These findings have begun to be translated to the clinical setting, particularly in the context of epilepsy. Determining connectivity in the epileptic brain can be challenging and is even more difficult in the pediatric patient. In pediatric epilepsy, resting-state functional magnetic resonance imaging (rs-fMRI) has emerged as a powerful method for determining connectivity. Resting-state fMRI is a non-invasive method of determining correlated activity (functional connectivity) between brain regions in a task-free manner. This modality is especially useful in the pediatric population as it can be done under sedation and requires minimal cooperation from the patient. Over the last decade, rs-fMRI has been increasingly used and studied in pediatric epilepsy. In this article, we review this recent work and discuss the current state of rs-fMRI in the diagnosis and management of the different pediatric epilepsy syndromes. We first provide an overview of rs-fMRI in practice, including the different methods of analysis. We then describe the connectivity findings in pediatric epilepsy that have been revealed by rs-fMRI and the current state of rs-fMRI use in practice. Finally, we discuss what rs-fMRI has revealed about postoperative changes in connectivity and provide several recommendations for future research.