Purpose or Case Report: To evaluate the relationship between cortical venous signal and electrographic activity in children with seizure using magnetic resonance imaging with susceptibility weighted imaging (SWI) and electroencephalogrphy (EEG).

Methods & Materials: Children presented with seizures, who underwent both SWI and EEG within 12 hours after seizure onset were retrospectively reviewed. An increased signal of cortical veins (SWI+) was assessed using SWI, while abnormal activities such as slowing or epileptiform discharges (EEG+) were investigated on EEG. We defined three groups of patients in accordance to the topographic correlation between SWI+ and EEG+: (A) no increased venous flow and no abnormal discharges, (B) discordant finding between the SWI+ and EEG+ area, (C) concordant distribution between the SWI+ and EEG+ area.

Results: We identified 297 children (194 in group-A, 76 in group-B, and 27 in group-C). The mean age among the three groups was similar (group-A =3.5±4.5 years; group-B = 3.1±3.5 years; group-C = 5.2±5.4 years, p=0.079). Multiple seizures were revealed more frequently in group-C (51.9%) than in group-A (23.7%) or group-B (39.5%, p=0.002). The incidence of newly-diagnosed epilepsy was significantly higher in group-C (20/27, 74.1%, p=0.001) than in group-A (45/194, 23.2%) or group-B (17/76, 22.4%). By contrast, there were no significant differences in seizure duration and seizure types among the three groups.
Conclusions: Patients with concordant distribution of the findings between SWI and EEG had significantly frequent multiple or epileptic seizures. SWI may be helpful to discover the epileptic focus localization in children with acute seizures.