Advanced

AJNR - American Journal of Neuroradiology

Published ahead of print on February 13, 2008
doi: 10.3174/ajnr.A1029

This Article Figures Only Full Text Full Text (PDF) Supplemental Online Table All Versions of this Article: ajnr.A1029v1 29/5/832    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Schwartz, E.S. Articles by Roberts, T.P.L. Search for Related Content PubMed PubMed Citation Articles by Schwartz, E.S. Articles by Roberts, T.P.L.

American Journal of Neuroradiology 29:832-837, May 2008
© 2008 American Society of Neuroradiology

Review Article

Magnetoencephalography for Pediatric Epilepsy: How We Do It

E.S. Schwartz^a, D.J. Dlugos^b, P.B. Storm^c, J. Dell^a, R. Magee^a, T.P. Flynn^d, D.M. Zarnow^a, R.A. Zimmerman^a and T.P.L. Roberts^a

^a Divisions of Neuroradiology, The Children's Hospital of Philadelphia, Philadelphia, Pa
^b Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pa
^c Neurosurgery, The Children's Hospital of Philadelphia, Philadelphia, Pa
^d Department of Psychology, The Children's Hospital of Philadelphia, Philadelphia, Pa

Please address correspondence to Timothy P.L. Roberts, PhD, CHOP Radiology, Suite 2115, Wood Building, 324 S 34th St, Philadelphia, PA 19104-4399; e-mail: robertstim{at}email.chop.edu

SUMMARY: Magnetoencephalography (MEG) is increasingly being used in the preoperative evaluation of pediatric patients with epilepsy. The ability to noninvasively localize ictal onset zones (IOZ) and their relationships to eloquent functional cortex allows the pediatric epilepsy team to more accurately assess the likelihood of postoperative seizure freedom, while more precisely prognosticating the potential functional deficits that may be expected from resective surgery. Confirmation of clinically suggested multifocality may result in a recommendation against resective surgery because the probability of seizure freedom will be low. Current paradigms for motor and somatosensory testing are robust. Paradigms allowing localization of those regions necessary for competent language function, though promising, are under continuous optimization. MR imaging white matter trajectory data, created from diffusion tensor imaging obtained in the same setting as the localization brain MR imaging, provide ancillary information regarding connectivity of the IOZ to sites of rapid secondary spread and the spatial relationship of the IOZ to functionally important white matter bundles, such as the corticospinal tracts. A collaborative effort between neuroradiology, neurology, neurosurgery, neuropsychology, technology, and physics ensures successful implementation of MEG within a pediatric epilepsy program.