Pediatric Epilepsy: Neurology, Functional Imaging, and Neurosurgery

https://doi.org/10.1053/j.semnuclmed.2016.10.003Get rights and content

In this chapter we provide a comprehensive review of the current role that functional imaging can have in the care of the pediatric epilepsy patient from the perspective of the epilepsy neurologist and the epilepsy neurosurgeon. In the neurology section, the diagnosis and classification of epilepsy adapted by the International League Against Epilepsy as well as the etiology and incidence of the disease is presented. The neuroimaging section describes how advanced nuclear medicine imaging methods can be synergized to provide a maximum opportunity to localize an epileptogenic focus. This section described the value of FDG-PET and regional cerebral blood flow SPECT in the identification of an epileptogenic focus. The imaging section also emphasizes the importance on developing a dedicated epilepsy management team, comprised of an epilepsy imaging specialist, epilepsy neurologist and epilepsy neurosurgeon, to provide the maximum benefit to each child with epilepsy. An emphasis is placed on preparation for ictal SPECT injection procedures, including the critical role of an automated injector well as the use of state-of-the-art dedicated nuclear medicine imaging and analysis protocols to correctly localize the epileptogenic focus location. In the final section, surgical options, approaches and expected outcomes for the different classes of epilepsy is presented.

Section snippets

18F-FDG-PET Imaging in Epilepsy

18F-FDG-PET is a tracer capable of measuring brain glucose metabolism and is actively transported across the blood-brain barrier into brain cells for subsequent phosphorylation. The relatively long half-life of 18F of 109 minutes permits transport from one cyclotron production facility to several sites within 2-4 hours of travel distance. A normal FDG-PET scan in coronal section is shown in Figure 2.

Rationale for Intracranial EEG Monitoring

The next step in the workup of a potential patient for epilepsy surgery is a comprehensive and multidisciplinary review of all noninvasive clinical, radiological, and electrophysiological data. In most instances, the results of the noninvasive assessment are sufficient to arrive at a resective surgical plan. Within the realm of pediatric epilepsy surgery, however, numerous scenarios arise where information from chronic invasive intracranial EEG recordings is required to formulate an optimal

References (46)

  • R.S. Fisher et al.

    ILAE Official Report: A practical clinical definition of epilepsy

    Epilepsia

    (2014)
  • A.T. Berg et al.

    Revised terminology and concepts for organization of seizures and epilepsies: Report of the ILAE Commission on Classification and Terminology, 2005-2009

    Epilepsia

    (2010)
  • J.C. Edwards et al.

    Seizure outcome after surgery for epilepsy due to malformation of cortical development

    Neurology

    (2000)
  • B.S. Schoenberg et al.

    Cerebrovascular-disease in infants and children—Study of incidence, and clinical features, and survival

    Neurology

    (1978)
  • R.C. Knowlton et al.

    Magnetic source imaging versus intracranial electroencephalogram in epilepsy surgery: A prospective study

    Ann Neurol

    (2006)
  • J.H. Cross et al.

    Proposed criteria for referral and evaluation of children for epilepsy surgery: Recommendations of the subcommission for pediatric epilepsy surgery

    Epilepsia

    (2006)
  • W.H. Theodore et al.

    Hippocampal atrophy, epilepsy duration, and febrile seizures in patients with partial seizures

    Neurology

    (1999)
  • M. Hajek et al.

    Preoperative and postoperative glucose consumption in mesiobasal and lateral temporal lobe epilepsy

    Neurology

    (1994)
  • J.R. Tenney et al.

    Cerebral glucose hypometabolism is associated with mitochondrial dysfunction in patients with intractable epilepsy and cortical dysplasia

    Epilepsia

    (2014)
  • J.G. Burneo et al.

    The utility of positron emission tomography in epilepsy

    Can J Neurol Sci

    (2015)
  • L. Bansal et al.

    PET hypermetabolism in medically resistant childhood epilepsy: Incidence, associations, and surgical outcome

    Epilepsia

    (2016)
  • D. Delbeke et al.

    Postsurgical outcome of patients with uncontrolled complex partial seizures and temporal lobe hypometabolism on 18FDG-positron emission tomography

    Invest Radiol

    (1996)
  • W.H. Theodore et al.

    FDG-positron emission tomography and invasive EEG: Seizure focus detection and surgical outcome

    Epilepsia

    (1997)
  • Cited by (12)

    • FOXD3 inhibits SCN2A gene transcription in intractable epilepsy cell models

      2018, Experimental Neurology
      Citation Excerpt :

      Moreover, epilepsy has become one of the most common diseases of the nervous system (Dossi et al., 2017; Srinivas and Shah, 2017). The pathogenesis of epilepsy is very complex and involves a series of physiological, biochemical, immune, and genetic changes (Dubey et al., 2017; Mountz et al., 2017; Nass et al., 2017). Recent studies have found that many cases of epilepsy are caused by mutations in genes that code for ion channel proteins (Kingston and Schwedt, 2017; Kumar and Chugani, 2017a, 2017b).

    • Letter From the Guest Editor

      2017, Seminars in Nuclear Medicine
    • Challenging Cases in Paediatric Radiology

      2022, Challenging Cases in Paediatric Radiology
    • Evaluation of the Pediatric Patient with Seizures

      2022, Handbook of Pediatric Epilepsy
    View all citing articles on Scopus
    View full text