Presurgical language fMRI: Clinical practices and patient outcomes in epilepsy surgical planning.

Abstract:

:The goal of this study was to document current clinical practice and report patient outcomes in presurgical language functional MRI (fMRI) for epilepsy surgery. Epilepsy surgical programs worldwide were surveyed as to the utility, implementation, and efficacy of language fMRI in the clinic; 82 programs responded. Respondents were predominantly US (61%) academic programs (85%), and evaluated adults (44%), adults and children (40%), or children only (16%). Nearly all (96%) reported using language fMRI. Surprisingly, fMRI is used to guide surgical margins (44% of programs) as well as lateralize language (100%). Sites using fMRI for localization most often use a distance margin around activation of 10mm. While considered useful, 56% of programs reported at least one instance of disagreement with other measures. Direct brain stimulation typically confirmed fMRI findings (74%) when guiding margins, but instances of unpredicted decline were reported by 17% of programs and 54% reported unexpected preservation of function. Programs reporting unexpected decline did not clearly differ from those which did not. Clinicians using fMRI to guide surgical margins do not typically map known language-critical areas beyond Broca's and Wernicke's. This initial data shows many clinical teams are confident using fMRI not only for language lateralization but also to guide surgical margins. Reported cases of unexpected language preservation when fMRI activation is resected, and cases of language decline when it is not, emphasize a critical need for further validation. Comprehensive studies comparing commonly-used fMRI paradigms to predict stimulation mapping and post-surgical language decline remain of high importance.

journal_name

Hum Brain Mapp

journal_title

Human brain mapping

authors

Benjamin CFA,Li AX,Blumenfeld H,Constable RT,Alkawadri R,Bickel S,Helmstaedter C,Meletti S,Bronen R,Warfield SK,Peters JM,Reutens D,Połczyńska M,Spencer DD,Hirsch LJ

doi

10.1002/hbm.24039

subject

Has Abstract

pub_date

2018-07-01 00:00:00

pages

2777-2785

issue

7

eissn

1065-9471

issn

1097-0193

journal_volume

39

pub_type

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