False lateralization of language cortex on functional MRI after a cluster of focal seizures

Jayakar, Prasanna; Bernal, Byron; Medina, L. Santiago; Altman, Nolan

doi:10.1212/wnl.58.3.490

Cited by 68 publications

(40 citation statements)

References 8 publications

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“…20 There are also case reports of language laterality reversing following successful temporal lobectomy. 21 These data raise the possibility that metabolic perturbations by ictal and interictal activity may dampen the BOLD response on which fMRI measurements are based.…”

Section: Discussionmentioning

confidence: 99%

fMRI language dominance and FDG-PET hypometabolism

et al. 2011

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Section: Discussionmentioning

confidence: 99%

fMRI language dominance and FDG-PET hypometabolism

et al. 2011

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“…Although the IAP has remained the "gold standard" for language lateralization, it has several risks and disadvantages [4][5][6][7][8]. It may be falsely lateralizing [9,10]; the precise pattern of sodium amobarbital perfusion rate is unknown even with angiography showing the intracranial vessels [11]. Performing the procedure may not be possible in patients with complicated vascular anatomy or a known allergy to iodine-based contrast agents or barbiturates.…”

Section: Introductionmentioning

confidence: 99%

Comprehensive presurgical functional MRI language evaluation in adult patients with epilepsy

Szaflarski

Holland

Jacola

et al. 2008

Epilepsy & Behavior

113

137

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Functional magnetic resonance imaging (fMRI) has the potential to replace the intracarotid amobarbital procedure (IAP) in presurgical evaluation of patients with epilepsy patients. In this study, we compared fMRI verb generation (VG) and semantic decision/tone decision (SDTD) tasks and the IAP in their ability to localize language functions in patients with epilepsy undergoing presurgical evaluation. We enrolled 50 healthy controls to establish normal language activation patterns for VG and SDTD tasks at 3 or 4 T, and to design language regions of interest (ROIs) that were later applied to 38 patients with epilepsy (28 of 38 also underwent the IAP). We calculated laterality indices (LIs) for each task for each subject based on the ROIs, and we used general linear modeling to analyze the fMRI data. All healthy and epileptic subjects activated language areas with both fMRI tasks. We found significant correlations in language lateralization between the fMRI tasks (r = 0.495, P ≤ 0.001) and between VG and IAP (r = 0.652, P < 0.001) and SDTD and IAP (r = 0.735, P < 0.001). The differences in LIs between SDTD and VG tasks were small and not affected by age, gender, epilepsy status, handedness, or performance. SDTD and VG tasks combined explained approximately 58.4% in the variability of the IAP/language. In the general linear modeling, only the SDTD task significantly contributed to the determination of language lateralization in patients with epilepsy undergoing presurgical evaluation. Results indicate a moderate convergent validity between both fMRI language tasks and between IAP and fMRI tasks. The results of this study indicate that either of these fMRI tasks can be used for language lateralization in patients with epilepsy undergoing presurgical evaluation, but that the SDTD task is likely to provide more information regarding language lateralization than the VG task.

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“…Despite these good results it shouldn't be forgotten that like any diagnostic test there is always the possibility of false positives and false negatives. For example, Jayakar reported a case of false lateralization of language in a 14-year-old with left-HS who was assessed in the postictal period (Jayakar, 2002). On the other hand, it is necessary to keep in mind the cost of fMRI versus IAP for the assessment of candidates for surgery.…”

Section: Functional Imagementioning

confidence: 99%