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Clin Exp Pediatr > Accepted Articles
DOI: https://doi.org/10.3345/kjp.2019.00871    [Accepted]
Published online November 8, 2019.
Advanced neuroimaging techniques in the evaluation of pediatric epilepsy
Yun Jeong Lee 
Department of Pediatrics, Kyungpook National University, School of Medicine, Kyungpook National University Hospital, Daegu, South Korea
Correspondence: 
Yun Jeong Lee, Tel: +82-53-200-5704, Fax: +82-53-200-2029, Email: oilily1103@hanmail.net
Received: 28 July 2019   • Revised: 3 November 2019   • Accepted: 6 November 2019
Abstract
Accurate localization of the seizure onset zone is important for better seizure outcome and preventing deficits following epilepsy surgery. Recent advances in neuroimaging techniques have increased the understanding of the underlying etiology and improved the ability to identify the seizure onset zone noninvasively. With epilepsy-specific magnetic resonance imaging (MRI) protocols, structural MRI allows a better detection of the seizure onset zone, particularly when it is interpreted by experienced neuroradiologists. Ultra-high-field imaging and post-processing analysis with automated machine learning algorithms can detect subtle structural abnormalities in MRI-negative patients. Tractography derived from diffusion tensor imaging can delineate white matter connections associated with epilepsy or eloquent function, thus preventing deficits after epilepsy surgery. Arterial spin labeling perfusion MRI, simultaneous electroencephalography-functional MRI (EEG-fMRI), and magnetoencephalography (MEG) are non-invasive imaging modalities that can be used to localize the epileptogenic foci and assist in planning epilepsy surgery with positron emission tomography, ictal single-photon emission computed tomography, and intracranial EEG monitoring. fMRI and MEG can localize and lateralize the area of the cortex essential for language, motor, and memory function and identify its relationship with planned surgical resection sites to reduce the risk of neurological impairment. All these advanced structural and functional imaging modalities can be combined with post-processing methods to better understand the epileptic network and obtain valuable clinical information for predicting long-term outcome in pediatric epilepsy.
Key Words: Children, Epilepsy, Neuroimaging, Diffusion tensor imaging, Functional magnetic resonance imaging




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