title: Multimodality imaging in the surgical treatment of children with nonlesional epilepsy.
abstract: OBJECTIVE
  To evaluate the diagnostic value of individual noninvasive presurgical modalities and to study their role in surgical management of nonlesional pediatric epilepsy patients.
  
  
  METHODS
  We retrospectively studied 14 children (3-18 years) with nonlesional intractable focal epilepsy. Clinical characteristics, surgical outcome, localizing features on 3 presurgical diagnostic tests (subtraction peri-ictal SPECT coregistered to MRI [SISCOM], statistical parametric mapping [SPM] analysis of [18F] FDG-PET, magnetoencephalography [MEG]), and intracranial EEG (iEEG) were reviewed. The localization of each individual test was determined for lobar location by visual inspection. Concordance of localization between each test and iEEG was scored as follows: 2=lobar concordance; 1=hemispheric concordance; 0=discordance or nonlocalization. Total concordance score in each patient was measured by the summation of concordance scores for all 3 tests.
  
  
  RESULTS
  Seven (50%) of 14 patients were seizure-free for at least 12 months after surgery. One (7%) had only rare seizures and 6 (43%) had persistent seizures. MEG (79%, 11/14) and SISCOM (79%, 11/14) showed greater lobar concordance with iEEG than SPM-PET (13%, 3/14) (p<0.05). SPM-PET provided hemispheric lateralization (71%, 10/14) more often than lobar localization. Total concordance score tended to be greater for seizure-free patients (4.7) than for non-seizure-free patients (3.9).
  
  
  CONCLUSIONS
  Our data suggest that MEG and SISCOM are better tools for lobar localization than SPM analysis of FDG-PET in children with nonlesional epilepsy. A multimodality approach may improve surgical outcome as well as selection of surgical candidates in patients without MRI abnormalities.
authors.affiliation: Division of Pediatric Neurology, Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229-3339, USA.
authors.forename: J H
authors.initials: JH
authors.lastname: Seo
authors.forename: K
authors.initials: K
authors.lastname: Holland
authors.forename: D
authors.initials: D
authors.lastname: Rose
authors.forename: L
authors.initials: L
authors.lastname: Rozhkov
authors.forename: H
authors.initials: H
authors.lastname: Fujiwara
authors.forename: A
authors.initials: A
authors.lastname: Byars
authors.forename: T
authors.initials: T
authors.lastname: Arthur
authors.forename: T
authors.initials: T
authors.lastname: DeGrauw
authors.forename: J L
authors.initials: JL
authors.lastname: Leach
authors.forename: M J
authors.initials: MJ
authors.lastname: Gelfand
authors.forename: L
authors.initials: L
authors.lastname: Miles
authors.forename: F T
authors.initials: FT
authors.lastname: Mangano
authors.forename: P
authors.initials: P
authors.lastname: Horn
authors.forename: K H
authors.initials: KH
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D001921:Brain / Q000473:pathology* / Q000601:surgery; D001931:Brain Mapping; D002648:Child; D003952:Diagnostic Imaging / Q000379:methods*; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007091:Image Processing, Computer-Assisted; D015225:Magnetoencephalography / Q000379:methods; D008297:Male; D009483:Neuropsychological Tests; D012189:Retrospective Studies; D014741:Video Recording
chemical_list: D019788:Fluorodeoxyglucose F18