Neuroimaging Techniques in Pediatric Epilepsy

Neuroimaging techniques in paediatric epilepsy have evolved from conventional structural imaging to advanced modalities that offer insights into both anatomical and functional aberrations underpinning epileptogenesis in children. Structural MRI, employing high-resolution T1- and T2-weighted sequences alongside volumetric techniques, remains the cornerstone for detecting malformations of cortical development, mesial temporal sclerosis and acquired lesions such as hypoxic-ischaemic injury. Diffusion tensor imaging augments conventional MRI by characterising microstructural white matter integrity and connectivity disruptions that may underlie seizure propagation pathways. Functional imaging modalities—including functional MRI, positron emission tomography and single-photon emission computed tomography—provide metabolic and haemodynamic profiles of epileptogenic zones and network reorganisation, enabling focus localisation in non-invasive presurgical evaluation. Concurrent electrophysiological mapping with electroencephalography and magnetoencephalography refines spatio-temporal resolution of ictal and interictal activity, often co-registered to anatomical scans for comprehensive surgical planning. Emerging techniques such as resting-state fMRI connectivity analysis and multimodal integration using advanced post-processing pipelines are delineating functional networks and improving localisation accuracy in drug-resistant paediatric cases. Overall, these complementary modalities have transformed diagnostic algorithms, guiding both medical and surgical management in children with epilepsy.

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Neuroimaging Techniques in Pediatric Epilepsy publication trend

The graph below shows the total number of articles in neuroimaging techniques in pediatric epilepsy across all publications each year (not limited to Nature Index journals).

Technical terms

Magnetic resonance imaging (MRI): A non-invasive imaging modality utilising magnetic fields and radiofrequency pulses to generate high-resolution anatomical images of brain structures.

Diffusion tensor imaging (DTI): An MRI-based technique that maps the diffusion of water molecules within white matter tracts, providing measures of microstructural integrity and connectivity.

Functional MRI (fMRI): A modality that detects haemodynamic changes related to neural activity, often used to localise functional networks and eloquent cortex.

Positron emission tomography (PET): A nuclear imaging technique that visualises metabolic activity by detecting gamma photons emitted from radiotracers, useful for identifying hypometabolic epileptogenic regions.

Single-photon emission computed tomography (SPECT): A nuclear imaging modality that maps cerebral perfusion by capturing gamma photons from single-photon radiotracers, applied in ictal and interictal studies.

Electroencephalography (EEG): A method of recording electrical activity of the brain via scalp electrodes, essential for characterising seizure types and interictal epileptiform discharges.

Magnetoencephalography (MEG): A technique that measures magnetic fields produced by neuronal currents, offering precise temporal resolution for localising epileptiform activity.

References

1. When Should a Brain MRI Be Performed in Children with New-Onset Seizures? Results of a Large Prospective Trial. American Journal of Neuroradiology (2021).
2. Predictors of abnormal electroencephalogram and neuroimaging in children presenting to the emergency department with new-onset afebrile seizures. BMC Pediatrics (2022).
3. The Agreement Between Long-Term Monitoring by Electroencephalography and Magnetic Resonance Imaging in Paediatric Seizure. Iranian Journal of Pediatrics (2023).