Abstracts

RATIONALE: Sedation or anesthesia is an established means of obtaining clinical imaging data in children who are otherwise unable to cooperate. However, with sedation 8.7 % of 6-11 year olds experience adverse effects and 23% still fail to complete the studies. In addition, functional MRI and other functional neuroimaging studies such as MRS, SPECT and PET may yield compromised results when sedation or anesthesia is used. Behavioral training programs designed to reduce patient movement and anxiety during scanning can improve patient compliance and comfort, thus increasing the amount of usable data obtained while reducing both the risk of adverse effects of medication and costs. METHODS: Thirty two subjects ranging in age from 6 years old to adult underwent 1-3 practice sessions in a mock scanner with trained personnel who explained the procedure and coached subjects throughout the scans. Practice sessions were tailored to the developmental level and specific needs of each subject and achievable goals were established and linked to a reward. Our methods were based on a modification of Thompson et al (H N Pract 1994:8:59). We assessed the number of scans successfully completed compared to those attempted after implementation of the training project. RESULTS: Thirty two subjects including patients considered candidates for sedation/anesthesia as well as those who were not due to the nature of their scans completed the training. Twenty six then underwent imaging studies; a total of 32 scans (structural and fMRIs) were attempted. Twenty four of 32 (75%) completed the studies successfully. Failed scans include 4 related to anxiety, and 4 to movement. CONCLUSIONS: Sedation and anesthesia are established means of obtaining crucial imaging studies in the pediatric epilepsy population. More than 50% (195/382) of patients between the ages of 6 and 17 years old are sedated or anesthetized prior to MR imaging at our institution. However, in nonemergent cases, the use of a behavioral training program prior to scanning can maximize the amount and quality of data obtained from imaging studies while minimizing the risk, cost and psychological trauma to the patients.