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Study: Brain scans mapping language and memory areas can help guide epilepsy-related surgeries

---Language task fMRI and resting-state fMRI data from a presurgical patient with left temporal lobe epilepsy. Copyright Bradley Goodyear, Einat Liebenthal and Victoria Mosher.

—Lan­guage task fMRI and rest­ing-state fMRI data from a presur­gi­cal patient with left tem­po­ral lobe epilep­sy. Copy­right Bradley Goodyear, Einat Lieben­thal and Vic­to­ria Mosh­er.

Can brain scans help doc­tors nav­i­gate epilep­sy surgery? (UPI)

…When med­ica­tion does­n’t effec­tive­ly con­trol epilep­sy, surgery may be rec­om­mend­ed. Doc­tors can remove the part of the brain that trig­gers seizures or use cer­tain pro­ce­dures to con­trol seizure activ­i­ty.

Before surgery, how­ev­er, the brain must be “mapped” to ensure the regions respon­si­ble for lan­guage and mem­o­ry aren’t dam­aged dur­ing the pro­ce­dure, the study authors explained…

Because fMRI is becom­ing more wide­ly avail­able, we want­ed to see how it com­pares to the Wada test,” said study author Dr. Jerzy Szaflars­ki, of the Uni­ver­si­ty of Alaba­ma at Birmingham…The new guide­lines, pub­lished online Jan. 11 in the jour­nal Neu­rol­o­gy, are based on a sys­tem­at­ic review of exist­ing evi­dence, the study authors said.

The guide­lines’ authors found some evi­dence that fMRI could be an alter­na­tive to the Wada test for peo­ple with spe­cif­ic types of epilep­sy.”

Study: Prac­tice guide­line sum­ma­ry: Use of fMRI in the presur­gi­cal eval­u­a­tion of patients with epilep­sy (Neu­rol­o­gy). From the abstract:

  • Objec­tive: To assess the diag­nos­tic accu­ra­cy and prog­nos­tic val­ue of func­tion­al MRI (fMRI) in deter­min­ing lat­er­al­iza­tion and pre­dict­ing post­sur­gi­cal lan­guage and mem­o­ry out­comes.
  • Results and rec­om­men­da­tions: The use of fMRI may be con­sid­ered an option for lat­er­al­iz­ing lan­guage func­tions in place of intrac­arotid amo­bar­bi­tal pro­ce­dure (IAP) in patients with medi­al tem­po­ral lobe epilep­sy (MTLE; Lev­el C), tem­po­ral epilep­sy in gen­er­al (Lev­el C), or extratem­po­ral epilep­sy (Lev­el C). For patients with tem­po­ral neo­cor­ti­cal epilep­sy or tem­po­ral tumors, the evi­dence is insuf­fi­cient (Lev­el U). fMRI may be con­sid­ered to pre­dict post­sur­gi­cal lan­guage deficits after ante­ri­or tem­po­ral lobe resec­tion (Lev­el C). The use of fMRI may be con­sid­ered for lat­er­al­iz­ing mem­o­ry func­tions in place of IAP in patients with MTLE (Lev­el C) but is of unclear util­i­ty in oth­er epilep­sy types (Lev­el U). fMRI of ver­bal mem­o­ry or lan­guage encod­ing should be con­sid­ered for pre­dict­ing ver­bal mem­o­ry out­come (Lev­el B). fMRI using non­ver­bal mem­o­ry encod­ing may be con­sid­ered for pre­dict­ing visu­ospa­tial mem­o­ry out­comes (Lev­el C). Presur­gi­cal fMRI could be an ade­quate alter­na­tive to IAP mem­o­ry test­ing for pre­dict­ing ver­bal mem­o­ry out­come (Lev­el C). Clin­i­cians should care­ful­ly advise patients of the risks and ben­e­fits of fMRI vs IAP dur­ing dis­cus­sions con­cern­ing choice of spe­cif­ic modal­i­ty in each case.

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