Pediatric Epilepsy: Neurology, Functional Imaging, and Neurosurgery James M. Mountz, MD, PhD, * Christina M. Patterson, MD, † and Mandeep S. Tamber, MD, PhD ‡ In this chapter we provide a comprehensive review of the current role that functional imaging can have in the care of the pediatric epilepsy patient from the perspective of the epilepsy neurologist and the epilepsy neurosurgeon. In the neurology section, the diagnosis and classi fication of epilepsy adapted by the International League Against Epilepsy as well as the etiology and incidence of the disease is presented. The neuroimaging section describes how advanced nuclear medicine imaging methods can be synergized to provide a maximum opportunity to localize an epileptogenic focus. This section described the value of FDG-PET and regional cerebral blood flow SPECT in the identification of an epileptogenic focus. The imaging section also emphasizes the importance on developing a dedicated epilepsy management team, comprised of an epilepsy imaging specialist, epilepsy neurologist and epilepsy neurosurgeon, to provide the maximum benefit to each child with epilepsy. An emphasis is placed on preparation for ictal SPECT injection procedures, including the critical role of an automated injector well as the use of state-of-the-art dedicated nuclear medicine imaging and analysis protocols to correctly localize the epileptogenic focus location. In the final section, surgical options, approaches and expected outcomes for the different classes of epilepsy is presented. Semin Nucl Med ] :]]]-]]] C 2016 Elsevier Inc. All rights reserved. Neurology of Pediatric Epilepsy Introduction Epilepsy is a neurologic disease affecting all ages of the population with significant effect in children and adoles- cents in quality of life, burden to families and society, and medical cost. The incidence of epilepsy in childhood is approximately 50-100 cases per 100,000 persons per year with the highest incidence in the first year of life. 1 Annual estimated associated cost is approximately $12.5 billion. 2 Mortality rates in patients with epilepsy are three times higher than the expected age- and sex-adjusted mortality in the general population with most deaths directly related to seizures. 3 Comorbidities with epilepsy are high, with some diseases being eight times more common in these patients. 4 A wide range of mental health issues can also affect quality of life, and patients with epilepsy can experience significant negative effects on self-image, family, and peer relationships. Treatment with antiepileptic drugs can be effective in most patients, but up to 30% would continue to have uncontrolled seizures despite medical therapy. 5 In some patients who do not respond to drug therapy, surgery to remove and epileptic focus can be a promising alternative, with potential for improving seizure frequency, severity, and quality of life. Diagnosis Definitions An epileptic seizure can be defined as a transient occurrence of signs and symptoms resulting from abnormal excessive or synchronous neuronal activity in the brain. 6 In 2014, the International League Against Epilepsy (ILAE) updated an operational definition of epilepsy as a disease of the brain http://dx.doi.org/10.1053/j.semnuclmed.2016.10.003 1 0001-2998/& 2016 Elsevier Inc. All rights reserved. *Department of Radiology, University of Pittsburgh, Pittsburgh, PA. †Department of Pediatrics, Children’ s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA. ‡Department of Neurosurgery, University of Pittsburgh School of Medicine, Children’ s Hospital of Pittsburgh of UPMC, Pittsburgh, PA. Address reprint requests to James M. Mountz, MD, PhD, Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213. E-mail: mountzjm@upmc.edu