Functional magnetic resonance imaging for presurgical evaluation of very young pediatric patients with epilepsy.
OBJECTIVE
The authors describe their experience with functional MR (fMR) imaging in children as young as 5 years of age, or even younger in developmental age equivalent. Functional MR imaging can be useful for identifying eloquent cortex prior to surgical intervention. Most fMR imaging clinical work has been done in adults, and although children as young as 8 years of age have been included in larger clinical series, cases in younger children are rarely reported.


METHODS
The authors reviewed presurgical fMR images in eight patients who were 8 years of age or younger, six of whom were 5 or 6 years of age. Each patient had undergone neuropsychological testing. Three patients functioned at a below-average level, with adaptive functioning age scores of 3 to 4 years. Self-paced finger tapping (with passive movement in one patient) and silent language tasks were used as activation tasks. The language task was modified for younger children, for whom the same (not novel) stimuli were used for extensive practice ahead of time and in the MR imaging unit. Patient preparation involved techniques such as having experienced staff present to work with patients and providing external management during imaging. Six of eight patients had extensive training and practice prior to the procedure. In the two youngest patients, this training included use of a mock MR unit.


RESULTS
All cases yielded successful imaging. Finger tapping in all seven of the patients who could perform it demonstrated focal motor activation in the frontal-parietal region, with expected activation elsewhere, including in the cerebellum. Three of four patients had the expected verb generation task activations, with left-hemisphere dominance, including a 6-year-old child who functioned at the 3-year, 9-month level. The only child (an 8-year-old) who was not prepared prior to the imaging session for the verb generation task failed this task due to movement artifact.


CONCLUSIONS
Despite the challenges of successfully using fMR imaging in very young and clinically involved patients, these studies can be performed successfully in children with a chronological age of 5 or 6 years and a developmental age as young as 3 or 4 years.
Shurtleff
Hillary
H
Department of Neurology, Seattle Children's Hospital, Seattle, Washington, USA.
Warner
Molly
M
Poliakov
Andrew
A
Bournival
Brian
B
Shaw
Dennis W
DW
Ishak
Gisele
G
Yang
Tong
T
Karandikar
Mahesh
M
Saneto
Russell P
RP
Browd
Samuel R
SR
Ojemann
Jeffrey G
JG
D001931:Brain Mapping; D001932:Brain Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004292:Dominance, Cerebral / Q000502:physiology; D004828:Epilepsies, Partial / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D017029:Epilepsy, Complex Partial / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007807:Language Tests; D008279:Magnetic Resonance Imaging; D008297:Male; D009048:Motor Skills / Q000502:physiology; D010100:Oxygen / Q000097:blood; D010364:Pattern Recognition, Visual / Q000502:physiology; D011300:Preoperative Care; D011932:Reading
D010100:Oxygen