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4. Optimising EEG-fMRI for Localisation of Focal Epilepsy in Children

Author

Centeno Maria, Tierney Tim M, Perani Suejen, Shamshiri Elhum A, StPier Kelly, Wilkinson Charlotte, Konn Daniel, Banks Tina, Vulliemoz Serge, Lemieux Louis, Pressler Ronit M, Clark Christopher A, Cross J Helen, and Carmichael David W

Subjects
Male, Physiology, lcsh:Medicine, Pathology and Laboratory Medicine, Pediatrics, Diagnostic Radiology, Families, Functional Magnetic Resonance Imaging, Medicine and Health Sciences, Attention, lcsh:Science, Child, Children, Clinical Neurophysiology, Brain Mapping, Radiology and Imaging, Electroencephalography, Magnetic Resonance Imaging, Quality Improvement, Electrophysiology, Bioassays and Physiological Analysis, Neurology, Brain Electrophysiology, Sedation, Female, Research Article, Adolescent, Imaging Techniques, Movement, Neurophysiology, Neuroimaging, Research and Analysis Methods, Immobilization, Signs and Symptoms, Diagnostic Medicine, Brain Mapping/methods, Humans, Epilepsies, Partial/diagnosis/physiopathology, Pharmacology, Epilepsy, Electrophysiological Techniques, lcsh:R, Biology and Life Sciences, ddc:616.8, Age Groups, Case-Control Studies, People and Places, Population Groupings, lcsh:Q, Epilepsies, Partial, Atrophy, Photic Stimulation, Neuroscience
Abstract

BACKGROUND: Early surgical intervention in children with drug resistant epilepsy has benefits but requires using tolerable and minimally invasive tests. EEG-fMRI studies have demonstrated good sensitivity for the localization of epileptic focus but a poor yield although the reasons for this have not been systematically addressed. While adults EEG-fMRI studies are performed in the "resting state"; children are commonly sedated however, this has associated risks and potential confounds. In this study, we assessed the impact of the following factors on the tolerability and results of EEG-fMRI in children: viewing a movie inside the scanner; movement; occurrence of interictal epileptiform discharges (IED); scan duration and design efficiency. This work's motivation is to optimize EEG-fMRI parameters to make this test widely available to paediatric population. METHODS: Forty-six children with focal epilepsy and 20 controls (6-18) underwent EEG-fMRI. For two 10 minutes sessions subjects were told to lie still with eyes closed, as it is classically performed in adult studies ("rest sessions"), for another two sessions, subjects watched a child friendly stimulation i.e. movie ("movie sessions"). IED were mapped with EEG-fMRI for each session and across sessions. The resulting maps were classified as concordant/discordant with the presumed epileptogenic focus for each subject. FINDINGS: Movement increased with scan duration, but the movie reduced movement by ~40% when played within the first 20 minutes. There was no effect of movie on the occurrence of IED, nor in the concordance of the test. Ability of EEG-fMRI to map the epileptogenic region was similar for the 20 and 40 minute scan durations. Design efficiency was predictive of concordance. CONCLUSIONS: A child friendly natural stimulus improves the tolerability of EEG-fMRI and reduces in-scanner movement without having an effect on IED occurrence and quality of EEG-fMRI maps. This allowed us to scan children as young as 6 and obtain localising information without sedation. Our data suggest that ~20 minutes is the optimal length of scanning for EEG-fMRI studies in children with frequent IED. The efficiency of the fMRI design derived from spontaneous IED generation is an important factor for producing concordant results.

Published
2016

5. Optimising EEG-fMRI for Localisation of Focal Epilepsy in Children.

Author

Centeno M, Tierney TM, Perani S, Shamshiri EA, StPier K, Wilkinson C, Konn D, Banks T, Vulliemoz S, Lemieux L, Pressler RM, Clark CA, Cross JH, and Carmichael DW

Subjects
Adolescent, Attention, Brain Mapping methods, Case-Control Studies, Child, Electroencephalography, Epilepsies, Partial physiopathology, Female, Humans, Immobilization, Magnetic Resonance Imaging, Male, Movement, Photic Stimulation, Quality Improvement, Epilepsies, Partial diagnosis
Abstract

Background: Early surgical intervention in children with drug resistant epilepsy has benefits but requires using tolerable and minimally invasive tests. EEG-fMRI studies have demonstrated good sensitivity for the localization of epileptic focus but a poor yield although the reasons for this have not been systematically addressed. While adults EEG-fMRI studies are performed in the "resting state"; children are commonly sedated however, this has associated risks and potential confounds. In this study, we assessed the impact of the following factors on the tolerability and results of EEG-fMRI in children: viewing a movie inside the scanner; movement; occurrence of interictal epileptiform discharges (IED); scan duration and design efficiency. This work's motivation is to optimize EEG-fMRI parameters to make this test widely available to paediatric population., Methods: Forty-six children with focal epilepsy and 20 controls (6-18) underwent EEG-fMRI. For two 10 minutes sessions subjects were told to lie still with eyes closed, as it is classically performed in adult studies ("rest sessions"), for another two sessions, subjects watched a child friendly stimulation i.e. movie ("movie sessions"). IED were mapped with EEG-fMRI for each session and across sessions. The resulting maps were classified as concordant/discordant with the presumed epileptogenic focus for each subject., Findings: Movement increased with scan duration, but the movie reduced movement by ~40% when played within the first 20 minutes. There was no effect of movie on the occurrence of IED, nor in the concordance of the test. Ability of EEG-fMRI to map the epileptogenic region was similar for the 20 and 40 minute scan durations. Design efficiency was predictive of concordance., Conclusions: A child friendly natural stimulus improves the tolerability of EEG-fMRI and reduces in-scanner movement without having an effect on IED occurrence and quality of EEG-fMRI maps. This allowed us to scan children as young as 6 and obtain localising information without sedation. Our data suggest that ~20 minutes is the optimal length of scanning for EEG-fMRI studies in children with frequent IED. The efficiency of the fMRI design derived from spontaneous IED generation is an important factor for producing concordant results.

Published
2016
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