Abstract

Objective

Postoperative resting state functional MRI in children with intractable epilepsy has not been quantified in relation to seizure outcome. Therefore, its value as a biomarker for epileptogenic pathology is not well understood.

Methods

In a sample of children with intractable epilepsy who underwent prospective resting state guided epilepsy surgery, post‐operative resting state functional MRI was performed 6 to 12 months later. Graded normalization of the post‐operative resting state seizure onset zone was compared to seizure outcomes, patient, surgery, and anatomical MRI characteristics.

Results

A total of 64 cases were evaluated. Post‐operative rs‐fMRI normalization was significantly (p‐value <0.001) correlated with seizure reduction, with Spearman rank correlation coefficient of 0.83. Of 39 cases with post‐operative resting state seizure onset zone normalization, 38 (97%) became completely seizure free. In contrast, of the 25 cases without complete rs‐fMRI SOZ normalization, only 3 (5%) become seizure free. The accuracy of rs‐fMRI as a biomarker predicting seizure freedom is 94%, with 96% sensitivity and 93% specificity.

Interpretation

Among seizure localization techniques in pediatric epilepsy, post‐operative rs‐fMRI normalization has high correlation with seizure freedom. This study shows that pre‐operative resting state functional MRI abnormalities can be used as a biomarker of the epileptogenic zone and the post‐operative rs‐fMRI normalization is a biomarker for seizure onset zone quiescence.

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