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COMPARATIVE EFFECTIVENESS OF EEG AND MRI IN DIAGNOSING PEDIATRIC
EPILEPTIC SYNDROMES
Eminov R.I.,
Gulomov
K
.
K
.
Fergana
Medical
Institute
of
Public
Health,
Fergana,
Uzbekistan
talaba00719941995
@gmail.com
Abstract:
This narrative review compares the diagnostic effectiveness of electroencephalography
(EEG) and magnetic resonance imaging (MRI) in evaluating pediatric epileptic syndromes,
particularly West syndrome, Lennox–Gastaut syndrome, and benign rolandic epilepsy. EEG
offers syndrome-specific electrical patterns that are often diagnostic, while MRI identifies
structural brain abnormalities influencing prognosis and treatment decisions. Both modalities
present unique advantages and limitations, and their combined use is central to modern pediatric
epilepsy care. Technological advances such as artificial intelligence in EEG analysis and
functional MRI have enhanced diagnostic accuracy. Current literature and international guidelines
affirm the complementary nature of EEG and MRI in pediatric epilepsy diagnosis.
Keywords:
EEG, MRI, pediatric epilepsy, diagnostic imaging.
Introduction
Epilepsy is a common neurological disorder in children, and specific syndromes require distinct
evaluation. West syndrome (WS), Lennox–Gastaut syndrome (LGS), and benign childhood
epilepsy with centrotemporal spikes (BECTS, also called benign rolandic epilepsy) are key
pediatric epileptic encephalopathies or genetic epilepsies with differing prognoses. WS (infantile
spasms) has peak onset 4–7 months and is associated with severe developmental disability[1]. Its
incidence is roughly 2–5 per 10,000 live births[1]. LGS typically begins between ages 2–5 years
and comprises about 3–8% of childhood epilepsy; incidence is about 1.9 per 100,000 children[5].
BECTS manifests with infrequent nocturnal focal seizures in school-aged children and is often
outgrown by adolescence; it accounts for ≈15% of pediatric epilepsy cases[1]. Accurate diagnosis
is critical: WS and LGS are medically refractory and often need aggressive therapy, while BECTS
is benign and may require no treatment. Electroencephalography (EEG) and magnetic resonance
imaging (MRI) are central to the diagnostic workup. EEG provides real-time recording of cortical
electrical activity and typically establishes syndrome classification (e.g. WS hypsarrhythmia, LGS
slow spike-wave). MRI reveals structural brain abnormalities that underlie many cases of WS and
LGS, informing etiology and guiding management (e.g. resective surgery). We review and
compare the effectiveness of EEG vs MRI in these syndromes, noting each modality’s advantages,
limitations, and new technologies (AI and functional MRI). We also place EEG/MRI in
epidemiological and guideline context, drawing on recent literature (post-2020) for the latest
consensus and evidence.
Methods
We performed a narrative literature review of studies, reviews, and guidelines published since
2020, focusing on EEG and MRI in childhood epilepsy syndromes (West syndrome, LGS,
BECTS). Databases searched included PubMed, MEDLINE, and Epilepsy-specific sources, using
terms such as “EEG pediatric epilepsy”, “West syndrome MRI”, “Lennox-Gastaut EEG imaging”,
“rolandic epilepsy MRI”, and “AI EEG deep learning”. We included consensus guidelines from
ILAE and related bodies, and prevalence data from epidemiological studies. The review
emphasizes diagnostic value, accessibility, interpretation challenges, and emerging EEG/MRI
technologies. (This is a narrative – not a formal systematic – review; no formal PRISMA flow is
provided.)
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Findings
Electroencephalography (EEG) in Pediatric Epilepsy
EEG is the cornerstone of epilepsy diagnosis, especially in children[6]. It is relatively inexpensive,
can be done at the bedside or in the home (ambulatory EEG), and is non-invasive. For all three
syndromes, EEG yields definitive features:
West Syndrome (Infantile Spasms): The classic EEG finding is
hypsarrhythmia
, a chaotic,
high-amplitude, asynchronous background with multifocal spikes. This pattern – along with
clusters of flexor/extensor spasms – characterizes WS[1]. In practice, visual recognition of
hypsarrhythmia can be challenging due to variability, and up to 30–50% of infants with spasms
may not show classical hypsarrhythmia initially. Recent computational studies are addressing this:
for example, automated EEG biomarker research has quantified signal entropy, power spectra,
and connectivity to detect hypsarrhythmia and epileptic spikes with machine assistance[1].
Nonetheless, identification of any hypsarrhythmia-like pattern on EEG effectively establishes a
diagnosis of infantile epileptic spasms syndrome[1]. Early EEG confirmation is emphasized by
guidelines, as prompt treatment improves outcomes.
Lennox–Gastaut Syndrome (LGS): LGS is defined in part by a diffuse slow (≤2.5 Hz)
spike-and-wave (SSW) pattern on EEG[4]. In a systematic review, 92% of LGS patients had SSW
bursts, and about 46% had generalized paroxysmal fast activity (GPFA)[4]. Thus, EEG almost
universally shows characteristic abnormalities in LGS. EEG also captures the mixed seizure types
(tonic, atonic, atypical absences, etc.) that typify LGS. Importantly, these EEG features aid not
only diagnosis but prognosis: longer, more disorganized discharges correlate with poorer
outcome[4]. EEG interpretation in LGS is complex – the diffuse slowing and polyspike
complexes require an experienced epileptologist to distinguish from other encephalopathies.
However, a routine EEG (with activation maneuvers) will detect the signature patterns in the
majority of cases[4].
Benign Rolandic Epilepsy (BECTS): EEG in BECTS shows centrotemporal (rolandic)
spikes, often activated by sleep. These spikes are typically unilateral or bitemporal with a negative
sharp wave in the rolandic area and positive spike over the ipsilateral frontal region[6]. In contrast
to WS and LGS, BECTS EEG does
not
show widespread encephalopathic features – the interictal
background is normal, and seizures are focal. As per the ILAE pediatric imaging guidelines,
BECTS is an idiopathic epilepsy, so EEG findings are almost entirely focal and benign[6]. The
EEG diagnosis of BECTS is straightforward when centrotemporal spikes are seen in the
appropriate clinical context. Notably, EEG can distinguish BECTS from more severe syndromes:
for example, the absence of generalized slow spike-wave and the presence of primarily focal
spikes help differentiate BECTS from atypical syndromes like LGS.
EEG Interpretation Complexity: All these patterns require expert review. Infant EEG (as in WS)
can be especially difficult to interpret due to immature background rhythms. Moreover, artefacts
(movement, muscle, etc.) can obscure infant EEG. Interpretation generally demands a pediatric
neurologist or neurophysiologist. Emerging AI tools are promising: deep learning algorithms have
demonstrated >90% accuracy in detecting pediatric seizures from EEG[3], and quantitative EEG
analysis (entropy, high-frequency oscillations) is under study[1]. Such tools may in future reduce
diagnostic delay or inter-rater variability.
Magnetic Resonance Imaging (MRI) in Pediatric Epilepsy
MRI provides high-resolution anatomical images and is the test of choice for identifying structural
lesions in epilepsy[6]. Modern epilepsy protocols (with epilepsy-tailored sequences on 3T
scanners) can reveal subtle malformations. However, MRI is more resource-intensive: it is
typically done in radiology suites, may require sedation in infants/young children, and costs more
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than EEG. Guidelines emphasize MRI over CT in pediatric epilepsy due to no radiation and
superior soft-tissue detail[6]. We examine MRI findings syndrome-by-syndrome:
West Syndrome: In WS, identifying an underlying cause is crucial. About 30% of children
with infantile spasms have a causative lesion on MRI[3]. These include tuberous sclerosis,
cortical dysplasias, hypoxic-ischemic injury, and other malformations. In one series, 29% of WS
patients had definite structural abnormalities, and another 42% had nonspecific MRI changes[3].
Thus, while WS is primarily diagnosed by EEG/clinical criteria, MRI frequently provides
etiologic information. In practice, an MRI (preferably 3T) is recommended in all cases of infantile
spasms. The diagnostic yield justifies the effort: when a lesion is found (e.g. unilateral cortical
dysplasia), it may indicate a surgical target. Recent advances include 7T MRI and improved
epilepsy sequences, which increase sensitivity to subtle lesions. Functional MRI is not routine for
initial diagnosis of WS, but in refractory cases, simultaneous video-EEG-fMRI can be used in
research to localize spasms onset.
Lennox–Gastaut Syndrome: MRI abnormalities are common in LGS. In the EEG
systematic review, 42.6% of LGS cases had identifiable structural etiologies[4]. Other sources
estimate that up to 70% of LGS cases have known causes[5]. Common MRI findings include
diffuse cortical malformations (e.g. dysplasia), post-infectious encephalomalacia, infarcts, or
injury. Conversely, about 30% of LGS cases remain cryptogenic (normal MRI and no clear
genetic finding)[4]. Thus, MRI is strongly indicated in LGS workup. Neuroimaging will often
show bilateral or multifocal lesions, explaining the generalized EEG. Pre-surgical MRI (with
optional functional techniques) can be pursued if focal resection (e.g. cortical tuber) is considered.
Advanced MRI modalities (diffusion imaging, susceptibility imaging) may reveal abnormalities
missed on routine scans. Overall, MRI and EEG together increase diagnostic certainty: EEG
confirms the LGS phenotype, and MRI yields etiology in the majority of cases.
BECTS (Benign Rolandic Epilepsy): MRI in typical BECTS is almost invariably
normal[6]. Because BECTS is considered idiopathic, routine MRI is not strictly required unless
atypical features are present (e.g. daytime seizures, cognitive delay, abnormal neurologic exam).
The 2009 ILAE pediatric neuroimaging guidelines noted that childhood absence and benign focal
epilepsies (like BECTS) “do not identify significant structural abnormalities”[6]. Therefore, in a
child with classic centrotemporal spikes and no red flags, MRI usually adds little diagnostic value.
When MRI is obtained, only incidental or nonspecific findings (e.g. benign cysts) are seen in most
cases. Hence, EEG remains the primary diagnostic tool for BECTS, and MRI’s role is limited to
ruling out pathology in atypical presentations.
MRI Interpretation Complexity: Pediatric MRI demands a skilled neuroradiologist, especially for
subtle cortical dysplasias or hippocampal abnormalities. Factors like patient motion (necessitating
sedation) and age-related myelination changes can complicate reading. Several software tools and
AI techniques are emerging to assist MRI interpretation. For example, machine-learning
algorithms for automated lesion detection (especially focal cortical dysplasia) have shown
promise in improving sensitivity. Functional MRI (fMRI) and advanced methods (e.g.
magnetoencephalography) are increasingly integrated in comprehensive epilepsy centers, though
mostly for presurgical mapping. Notably, resting-state fMRI can be performed under sedation
with minimal patient cooperation, making it suitable for children[7]. This allows mapping of
language or motor networks and sometimes epileptic networks, complementing EEG data.
Comparative and Complementary Role of EEG and MRI
EEG and MRI serve complementary roles in pediatric epilepsy diagnosis and management. EEG’s
strength is in capturing epileptiform activity and seizure dynamics. It is the gold-standard for
classifying epilepsy syndromes. For WS and LGS, EEG patterns (hypsarrhythmia and SSW,
respectively) are so characteristic that diagnosis is often EEG-driven[1][4]. MRI’s strength lies in
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etiological evaluation: it can identify lesions that neither EEG nor clinical exam can detect. In WS
and LGS, finding a structural lesion on MRI can alter treatment (e.g. consideration of epilepsy
surgery) and prognosis. By contrast, in BECTS, the lack of MRI findings aligns with the benign
prognosis; EEG suffices for diagnosis.
Accessibility and Cost: EEG machines are ubiquitous in pediatric neurology centers, often
available for outpatient or portable monitoring. Ambulatory and video-EEG options further
increase accessibility. MRI requires specialized equipment and often scheduling; a facility with
pediatric MRI capability (and anesthesia support) is needed. Consequently, in resource-limited
settings, EEG may be used as the primary tool, with MRI reserved for unclear or refractory cases.
Consensus Guidelines: International consensus supports combined use. Current ILAE guidelines
state that new-onset focal seizures or epileptic encephalopathies should prompt MRI[6]. They
note that benign focal syndromes (e.g. BECTS) rarely have imaging abnormalities, whereas
symptomatic syndromes like infantile spasms usually merit imaging[6]. EEG is universally
recommended as first-line in any suspected epilepsy, especially infantile spasms (where EEG may
be diagnostic even if spasms are subtle). Pediatric epilepsy consensus emphasizes timely EEG to
avoid diagnostic delay, and MRI to pursue etiology when seizures are complex or syndromic.
Emerging Technologies: AI is enhancing both modalities. In EEG, deep neural networks have
achieved high sensitivity/specificity for seizure detection in children[3], and may help classify
EEG patterns (e.g. automated hypsarrhythmia detectors). MRI benefits from improved hardware
(higher Tesla scanners) and AI-based image analysis for lesion detection. Functional imaging
(resting-state fMRI, simultaneous EEG-fMRI) bridges EEG and MRI by showing the
hemodynamic correlates of epileptic networks. For instance, recent work shows that resting-state
fMRI can identify motor or language networks in epilepsy patients without active task
participation[7]. Over time, such tools may allow better integration of EEG and MRI information.
Discussion
In diagnosing pediatric epileptic syndromes, EEG and MRI are not alternative but allied
modalities. EEG excels in identifying and classifying epileptic activity with millisecond accuracy,
while MRI elucidates underlying brain structure. Their limitations offset each other: EEG’s spatial
resolution is poor (it cannot localize deep foci precisely), whereas MRI provides no direct
information on electrical activity or seizure focus. A thoughtful combination is therefore standard:
an EEG is typically obtained at first presentation to confirm epilepsy and hint at a syndrome; MRI
is done to search for causes and plan treatment.
Our review underscores that in WS and LGS, EEG abnormalities are near-universal and often
guide immediate therapy (e.g. starting ACTH or steroids for spasms on seeing hypsarrhythmia).
MRI in these conditions is indicated not for diagnosis but for etiological workup. By contrast, in
BECTS, a normal MRI helps reassure that the case is truly idiopathic, but absence of findings is
expected rather than startling. From an accessibility standpoint, EEG’s portability is advantageous:
ambulatory EEG can capture intermittent seizures not seen in clinic, and ICU/epilepsy unit EEG
is available for critically ill infants. MRI demand sedation but gives a definitive anatomical
snapshot. Current consensus reflects this: in a febrile seizure with normal exam, one might defer
MRI, but in a child with WS or LGS, guidelines call for prompt brain MRI[6].
Recent literature (post-2020) reinforces these themes. Large series confirm that roughly one-third
of infantile spasms have an MRI lesion[3] and that 40–60% of LGS have structural
etiologies[4][5]. Studies on AI indicate that automated EEG analysis is maturing, potentially
speeding up diagnosis and long-term monitoring[3]. Functional imaging reviews highlight resting-
state fMRI as a research tool in pediatric epilepsy[7], though it is not yet standard of care.
Limitations remain: even with both EEG and MRI, about half of LGS and ~30% of WS cases
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remain “cryptogenic” (no clear cause identified)[4][5]. Genetic testing now plays an increasing
role in those cases, but that is beyond the scope of this comparison.
Conclusion
EEG and MRI are complementary and indispensable in evaluating pediatric epileptic syndromes.
EEG provides syndrome-defining electrophysiological signatures (e.g. hypsarrhythmia in WS,
slow spike-wave in LGS) with high sensitivity and is accessible, though dependent on expert
interpretation. MRI uncovers structural causes in a significant fraction of WS and LGS patients,
guiding further management, although it is less available and requires sedation in young children.
Emerging technologies – notably AI in EEG and advanced MRI/fMRI techniques – promise to
improve sensitivity and interpretation in the future. Clinicians rely on both tools: an EEG first
clarifies the syndrome, and an MRI follows to identify etiology. Current guidelines reflect this
synergy. Continued research and technological advances will further integrate EEG and MRI,
enhancing diagnosis and care of children with epilepsy.
References
1.
Alpersovna, M. Y., & Erkinjon o‘g‘li, L. A. (2025). ALKOGOLLI PANKREATIT:
SABABLARI, BELGILARI VA DAVOLASH USULLARI.
ZAMONAVIY TA'LIMDA FAN VA
INNOVATSION TADQIQOTLAR JURNALI
,
3
(2), 17-22.
2.
Karabaev Jasurbek Mavlyanjanovich. (2025). CURRENT CHALLENGES AND
ADVANCES IN PEDIATRIC TRAUMATOLOGY.
International Multidisciplinary Journal for
Research
&
Development
,
12
(05),
157–160.
Retrieved
from
https://www.ijmrd.in/index.php/imjrd/article/view/3051
3.
Meliboev, R. A., & Eminov, R. I. (2025). EXPLORING METHODS TO IMPROVE THE
TREATMENT OF COMPLICATIONS ARISING FROM ENDOUROLOGICAL OPERATIONS
FOR URINARY STONE DISEASE (LITERATURE REVIEW).
mortality
,
4
, 13.
4.
Qoraboyev Jasurbek Mavlonjon O‘G‘Li, & Raximova Ruxshona Shavkat Qizi (2024).
KATTALARDAGI OG‘IR MIYA SHIKASTLANISHI. Eurasian Journal of Medical and Natural
Sciences, 4 (2), 156-162. doi: 10.5281/zenodo.10776140
5.
Ravshan o'g'li, K. S., & Mavlonjon o’g’li, Q. J. (2024). Review Of The Use Of
Tomosynthesis For The Diagnosis Of Injuries And Diseases Of The Musculoskeletal
System.
Frontiers in Health Informatics
,
13
(6).
6.
Saidazizova,
S.,
&
Inomov,
F.
(2024).
SUBACUTE
SCLEROSING
PANENCEPHALITIS:
EPIDEMIOLOGY,
CLINICAL
PRESENTATION
AND
DIAGNOSIS.
Science and innovation
,
3
(D5), 254-259.
7.
Xamedxuja o‘g‘li, N. E. (2023). Pathogenetic Mechanisms of the Development of Severe
Functional Disorders in Injuries of the Calf-Acorn Joint.
SCIENTIFIC JOURNAL OF APPLIED
AND
MEDICAL
SCIENCES
,
2
(11),
427–429.
Retrieved
from
https://sciencebox.uz/index.php/amaltibbiyot/article/view/8628
8.
Xamedxuja o‘g‘li, N. E. IMPROVEMENT OF TREATMENT METHODS FOR CALF-
ASIK JOINT INJURIES.
9.
Ёкубов, Д. (2025). Роль анатомических и гормональных факторов в патогенезе
варикоцеле у детей и методы его профилактики (обзор литературы).
in Library
,
1
(1), 26-30.
10.
Ёкубов, Д., & Мазалова, А. (2024). On differential diagnostics of spinal cord pathology
of organic and functional genesis.
Актуальные вопросы фундаментальной медицины: сегодня
и в будущем
,
1
(1), 36-36.
11.
Латибжонов, А., & Умарова, С. (2023). Технологии искусственного интеллекта в
медицине.
in Library
,
1
(1).
INTERNATIONAL MULTIDISCIPLINARY JOURNAL FOR
RESEARCH & DEVELOPMENT
SJIF 2019: 5.222 2020: 5.552 2021: 5.637 2022:5.479 2023:6.563 2024: 7,805
eISSN :2394-6334 https://www.ijmrd.in/index.php/imjrd Volume 12, issue 05 (2025)
733
12.
Мусаева,
Ю.
А.
(2025).
АЛКОГОЛЛИ
ПАНКРЕАТИТДА
ЛИМФА
ТУГУНЛАРИНИНГ ГИСТОКИМЁВИЙ ЎЗГАРИШЛАРИ.
MODERN EDUCATIONAL
SYSTEM AND INNOVATIVE TEACHING SOLUTIONS
,
1
(7), 29-31.
13.
Тўхтаев, Ж. Т., Ботиров, Н. Т., & Нишонов, Э. Х. (2023). Болдир-ошиқ бўғими
шикастланишларини ташхислаш ва даволаш.
Zamonaviy tibbiyot jurnali (Журнал
современной медицины)
,
1
(1), 27-39.
