fMRI Has Added Value in Predicting Naming After Epilepsy Surgery

Task functional MRI (tfMRI) is a technique for mapping the location of important cognitive functions such as memory and language in the brain. At many epilepsy surgical centers, because of its superior regional specificity and improved safety profile, tfMRI has supplanted the intracarotid sodium amobarbital procedure (also known as the Wada test) as the preferred method for determining hemispheric language dominance and identifying functionally eloquent brain areas that might be at risk with planned surgical interventions (e.g., anterior temporal lobectomy, thermal ablation). A recent review by the American Academy of Neurology Guideline Development, Dissemination, and Implementation Subcommittee addressed the quality and external validity of presurgical tfMRI for predicting postsurgical cognitive outcomes.1 They found that for patients undergoing anterior temporal lobectomy (ATL), tfMRI could be of possible benefit in the prediction of language outcome (Level C evidence) and of probable benefit to forecasting verbal memory outcomes (Level B evidence). Subsequent efforts to quantitatively synthesize the relevant literature have been unsuccessful.2

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