Use of preoperative functional neuroimaging to predict language deficits from epilepsy surgery

Sabsevitz, David S.; Swanson, Sara J.; Hammeke, Thomas A.; Spanaki, Marianna V.; Possing, Edward T.; Morris, George L.; Mueller, Wade; Binder, Jeffrey R.

doi:10.1212/01.wnl.0000068022.05644.01

Cited by 286 publications

(256 citation statements)

References 28 publications

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“…Correct localization and lateralization of language functions in patients undergoing surgical treatment of epilepsy is of utmost importance, as patients who undergo surgery in the language-dominant hemisphere are known to suffer from word finding deficits. The possibility of such deficits may be predicted by fMRI with the SDTD task [26,48]. These and our results confirm the utility of fMRI in presurgical evaluation of patients with pharmacoresistant epilepsy and add to the growing body of evidence that fMRI can be used for presurgical language localization.…”

Section: Discussionsupporting

confidence: 83%

“…Some of the more recent studies used a combination of fMRI tasks for evaluation of language functions in patients with epilepsy, and at least one study proposed using fMRI instead of the IAP [33,49]. Furthermore, one fMRI study using the SDTD task in patients with left temporal lobe epilepsy has already shown 100% sensitivity and 73% specificity in predicting significant naming decline after epilepsy surgery when language was lateralized to the left hemisphere, confirming the clinical utility of this fMRI task in presurgical evaluation of epilepsy surgery patients [26]. We extended the results of the preceding studies by adding a comparison of the two most frequently used fMRI tasks and by demonstrating the excellent ability of both tasks in language localization and a strong correlation between fMRI and the IAP.…”

Section: Discussionmentioning

confidence: 87%

“…These and other authors used various language fMRI tasks including semantic decision [14,16,21,[25][26][27], verb generation/verbal fluency [13,19,20,23,[28][29][30], word generation [15,18,22,24], and sentence reading [17,31]. Some studies have also reported the use of more than one fMRI paradigm for language localization and lateralization [10,12,13,29,32,33], but the results of these studies have been mixed, with some tasks showing good and some poor correlation with the results of IAP.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

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Comprehensive presurgical functional MRI language evaluation in adult patients with epilepsy

Szaflarski

Holland

Jacola

et al. 2008

Epilepsy & Behavior

113

137

View full text Add to dashboard Cite

show abstract

“…With this protocol, a key study found decline of more than two standard deviations in naming skill (relative to controls) could be predicted with 100% sensitivity and 73% specificity, with prediction superior to that using Wada (92% and 45%, respectively) [Sabsevitz et al, 2003]. Overall, 41% of variance in post-operative language skill was predicted by fMRI and the positive predictive value was 81% for fMRI and 67% for Wada.…”

Section: 1 Introductionmentioning

confidence: 99%

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

Benjamin

Blumenfeld

et al. 2018

Human Brain Mapping

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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 from the 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 language lateralization (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 unexpected preservation of function by 54%. 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.

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“…Language functional magnetic resonance imaging (fMRI) is an imaging method and neurocognitive assessment validated for predicting language decline after temporal lobe surgery (Bonelli et al, 2012; Sabsevitz et al, 2003). The demonstration of its equivalence or superiority to the Wada test (Intracarotid Amobarbital Testing; IAT) with certain protocols (Janecek et al, 2013), and its noninvasive nature, has led to its widespread adoption in neurosurgical planning.…”

Section: Introductionmentioning

confidence: 99%

Presurgical language fMRI: Technical practices in epilepsy surgical planning

Benjamin¹,

Dhingra²,

et al. 2018

Human Brain Mapping

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Little is known about how language functional MRI (fMRI) is executed in clinical practice in spite of its widespread use. Here we comprehensively documented its execution in surgical planning in epilepsy. A questionnaire focusing on cognitive design, image acquisition, analysis and interpretation, and practical considerations was developed. Individuals responsible for collecting, analyzing, and interpreting clinical language fMRI data at 63 epilepsy surgical programs responded. The central finding was of marked heterogeneity in all aspects of fMRI. Most programs use multiple tasks, with a fifth routinely using 2, 3, 4, or 5 tasks with a modal run duration of 5 min. Variants of over 15 protocols are in routine use with forms of noun–verb generation, verbal fluency, and semantic decision‐making used most often. Nearly all aspects of data acquisition and analysis vary markedly. Neither of the two best‐validated protocols was used by more than 10% of respondents. Preprocessing steps are broadly consistent across sites, language‐related blood flow is most often identified using general linear modeling (76% of respondents), and statistical thresholding typically varies by patient (79%). The software SPM is most often used. fMRI programs inconsistently include input from experts with all required skills (imaging, cognitive assessment, MR physics, statistical analysis, and brain–behavior relationships). These data highlight marked gaps between the evidence supporting fMRI and its clinical application. Teams performing language fMRI may benefit from evaluating practice with reference to the best‐validated protocols to date and ensuring individuals trained in all aspects of fMRI are involved to optimize patient care.

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Use of preoperative functional neuroimaging to predict language deficits from epilepsy surgery

Abstract: Preoperative fMRI predicted naming decline in patients undergoing left anterior temporal lobectomy surgery.

Cited by 286 publications

References 28 publications

Comprehensive presurgical functional MRI language evaluation in adult patients with epilepsy

Comprehensive presurgical functional MRI language evaluation in adult patients with epilepsy

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

Presurgical language fMRI: Technical practices in epilepsy surgical planning

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