Neuroimaging in the evaluation of children and adolescents with intractable epilepsy: II. Neuroimaging and pediatric epilepsy surgery.
The costs of epilepsy encompass all aspects of life, including medical, educational, and psychosocial. Adults with intractable epilepsy who undergo epilepsy surgery and have seizure-free outcomes still have significant barriers in the attainment of improved quality of life. For this reason, there is increasing interest in the recognition of children and adolescents with intractable epilepsy who might be epilepsy surgery candidates. This is Part II of an article on the role of neuroimaging in the evaluation of children and adolescents with intractable epilepsy. Part I addressed the role of MRI in detecting the substrates of epilepsy (Pediatr Neurol 1997;17: 19-26); Part II elaborates on the selection process of pediatric patients who might benefit from epilepsy surgery. Although EEG remains the cornerstone of the evaluation process, MRI, SPECT, and PET can play a pivotal role in the identification of the underlying epileptogenic focus and minimize the need for invasive EEG monitoring. Magnetic resonance spectroscopy and magnetoencephalography are also innovative, noninvasive techniques which may aid in the localization of the epileptogenic focus. Functional MRI scans may soon replace invasive technologies in the identification of eloquent cortex that should not be a part of the surgical resection.
Zupanc
M L
ML
Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA.
D000293:Adolescent; D000328:Adult; D001921:Brain / Q000473:pathology; D001927:Brain Diseases / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D002648:Child; D003952:Diagnostic Imaging; D004827:Epilepsy / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted; D011379:Prognosis