European Journal of Molecular & Clinical Medicine

Accurate localization of the seizure onset zone is important for better seizure outcomes and preventing
deficits following epilepsy surgery. Recent advances in neuroimaging techniques have increased our
understanding of the underlying etiology and improved our ability to noninvasively identify the seizure
onset zone. Using epilepsy-specific magnetic resonance imaging (MRI) protocols, structural MRI allows
better detection of the seizure onset zone, particularly when it is interpreted by experienced
neuroradiologists. Ultra-high-field imaging and postprocessing analysis with automated machine learning
algorithms can detect subtle structural abnormalities in MRI-negative patients. Tractography derived from
diffusion tensor imaging can delineate white matter connections associated with epilepsy or eloquent
function, thus, preventing deficits after epilepsy surgery. Arterial spin-labeling perfusion MRI,
simultaneous electroencephalography (EEG)-functional MRI (fMRI), and magnetoencephalography
(MEG) are noninvasive imaging modalities that can be used to localize the epileptogenic foci and assist in
planning epilepsy surgery with positron emission tomography, ictal single-photon emission computed
tomography, and intracranial EEG monitoring. These advanced structural and functional imaging
modalities can be combined with postprocessing methods to better understand the epileptic network and
obtain valuable clinical information for predicting long-term outcomes in pediatric epilepsy.