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

Benjamin, Christopher F A, Li, Alexa X, Blumenfeld, Hal, Constable, R Todd, Alkawadri, Rafeed, Bickel, Stephan, Helmstaedter, Christoph, Meletti, Stefano, Bronen, Richard, Warfield, Simon K, Peters, Jurriaan M, Reutens, David, Połczyńska, Monika, Spencer, Dennis D and Hirsch, Lawrence J (2018) Presurgical language fMRI: Clinical practices and patient outcomes in epilepsy surgical planning. Human brain mapping, . doi:10.1002/hbm.24039

Author Benjamin, Christopher F A
Li, Alexa X
Blumenfeld, Hal
Constable, R Todd
Alkawadri, Rafeed
Bickel, Stephan
Helmstaedter, Christoph
Meletti, Stefano
Bronen, Richard
Warfield, Simon K
Peters, Jurriaan M
Reutens, David
Połczyńska, Monika
Spencer, Dennis D
Hirsch, Lawrence J
Title Presurgical language fMRI: Clinical practices and patient outcomes in epilepsy surgical planning
Journal name Human brain mapping   Check publisher's open access policy
ISSN 1097-0193
Publication date 2018-03-12
Sub-type Article (original research)
DOI 10.1002/hbm.24039
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.
Keyword epilepsy
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: Pubmed Import
Version Filter Type
Citation counts: Google Scholar Search Google Scholar
Created: Wed, 14 Mar 2018, 10:01:07 EST