Open AccessPresurgical language fMRI: Clinical practices and patient outcomes in epilepsy surgical planning
Author(s) -
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.
Publication year - 2018
Publication title -
human brain mapping
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.005
H-Index - 191
eISSN - 1097-0193
pISSN - 1065-9471
DOI - 10.1002/hbm.24039
Subject(s) - epilepsy surgery , language function , epilepsy , margin (machine learning) , lateralization of brain function , psychology , medicine , audiology , neuroscience , natural language processing , computer science , machine learning
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.