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Functional neuroimaging in the preoperative evaluation of children with drug-resistant epilepsy

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Abstract

Functional neuroimaging

Although the primary imaging modality in the management of epilepsy is magnetic resonance imaging MRI, functional neuroimaging with positron-emission tomography (PET) and single photon emission computed tomography (SPECT) often provides complementary information and, in a number of situations, provides unique information that cannot be obtained with MRI. The most commonly used PET tracers used for epilepsy evaluation are 2-deoxy-2-[18F]fluoro-d-glucose (FDG) and [11C]flumazenil (FMZ). Recently, interictal PET with alpha-[11C]methyl-l-tryptophan was found to be highly specific for the epileptic focus and can differentiate between epileptogenic and nonepileptogenic lesions in the same patient (e.g., in patients with tuberous sclerosis).

Discussion

In this review, we discuss clinical applications of these three PET tracers in drug-resistant temporal and extratemporal lobe epilepsy, selected epilepsy syndromes of childhood, lesional and nonlesional epilepsy, and the challenges of imaging secondary epileptic foci. A brief discussion of SPECT applications in epilepsy is also included. With further development of new tracers highly sensitive and specific for epileptogenic brain regions, the presurgical evaluation of refractory epilepsy will be greatly facilitated. Approximately 0.5 to 1.0% of the population suffer from epilepsy, of which 15–20% are intractable. Infants and children, whose seizures have a focal onset are refractory to anticonvulsants and are prolonged, tend to have the worst cognitive outcome [Meador KJ, Neurology 58 (Suppl 5):S21–S26, 2002]. Seizures themselves affect the developing brain and contribute to an adverse neurologic outcome (Holmes, Pediatric Neurology 33:1–110, 2005).

Conclusion

Therefore, in treating children with intractable epilepsy, it is important to consider seizure control and to give allowance for normal cognitive development.

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Authors and Affiliations

  1. Department of Neurosurgery, Children’s Hospital of Michigan, Wayne State University, Detroit, MI, USA

    Sandeep Sood

  2. Carman and Ann Adams Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University, Detroit, MI, USA

    Harry T. Chugani

  3. Department of Neurology, Children’s Hospital of Michigan, Wayne State University, Detroit, MI, USA

    Harry T. Chugani

  4. Department of Radiology, Children’s Hospital of Michigan, Wayne State University, Detroit, MI, USA

    Harry T. Chugani

  5. Pediatric Neurology/PET Center, Children’s Hospital of Michigan, 3901 Beaubien Blvd., Detroit, MI, 48201, USA

    Harry T. Chugani

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  1. Sandeep Sood
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Correspondence to Harry T. Chugani.

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Sood, S., Chugani, H.T. Functional neuroimaging in the preoperative evaluation of children with drug-resistant epilepsy. Childs Nerv Syst 22, 810–820 (2006). https://doi.org/10.1007/s00381-006-0137-0

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