Altered neurostructural development in magnetic resonance imaging‐negative pediatric epilepsy: A large‐scale multicenter study of 1919 children

Our findings indicate that pediatric epilepsy is a disorder of aberrant neurodevelopment with two distinct signatures. First, we identify a critical 4-9-year vulnerability window characterized by profound but transient deviations, including atypical cortical maturation, increased WMH burden, and widespread morphological delays. These delays appeared to normalize after age 10 years, a finding that requires longitudinal validation. Second, we uncover a progressive, potentially persistent alteration: a hierarchical expansion of gray matter initiating in the limbic system and later involving the thalamus. These signatures provide distinct biomarkers to differentiate transient disruption from ongoing network reorganization, offering new targets for timed interventions.