Influence of motor functional magnetic resonance imaging on the surgical management of children and adolescents with symptomatic focal epilepsy.
OBJECTIVE
To determine the clinical value of motor functional magnetic resonance imaging (fMRI) in the presurgical evaluation of a large group of children and adolescents with epilepsy caused by lesions close to the central sulcus.


METHODS
Forty-three patients (19 males; mean age, 13 years) with lesional focal epilepsy underwent motor fMRI as part of a multidisciplinary standardized presurgical evaluation between 2000 and 2006. fMRI data were analyzed using statistical parametric mapping (SPM2) and screened for the presence of movement-related artifacts. The ways in which the results of motor fMRI influenced the decision-making process were reviewed.


RESULTS
The success rate of motor fMRI was 93% and data were of high quality in 67.5% of the patients. Together with other clinical considerations, motor fMRI results contributed to the surgical management of 32 patients (74%). They helped 1) to determine the type of surgery in 23 patients (72%; 12 cases with and 11 cases without invasive functional mapping), 2) to indicate a reduced benefit-risk ratio with the consequence that surgery was not further considered in 5 patients (16%), and 3) to indicate that surgery was not an appropriate option because of the high risk of motor function deficit in 4 patients (12%).


CONCLUSIONS
Motor fMRI can be performed with a high degree of success and good data quality in this population of patients. It has an important additive role in the discussion of the feasibility of resective surgery contributing to the decision-making process for children with epilepsy caused by brain lesions close to the central sulcus.
De Tiège
Xavier
X
Neurosciences Unit, University College London Institute of Child Health, London, United Kingdom. xdetiege@ulb.ac.be
Connelly
Alan
A
Liégeois
Frédérique
F
Harkness
William
W
Clark
Chris A
CA
Chong
Wui K
WK
Gadian
David G
DG
Cross
J Helen
JH
D000293:Adolescent; D001931:Brain Mapping; D002648:Child; D004828:Epilepsies, Partial / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D009044:Motor Cortex / Q000098:blood supply* / Q000503:physiopathology / Q000601:surgery; D009068:Movement / Q000502:physiology*; D010100:Oxygen / Q000097:blood; D012189:Retrospective Studies; D016896:Treatment Outcome
D010100:Oxygen