Functional MRI and the Wada test provide complementary information for predicting post-operative seizure control.
Prediction of post-surgical seizure relief and potential cognitive deficits secondary to anterior temporal lobectomy (ATL) are important to pre-surgical planning. Although the intracarotid amobarbital test (IAT) is predictive of post-ATL seizure outcome, development of non-invasive and more precise means for determining post-ATL seizure relief are needed. We previously reported on a technique utilizing functional MRI (fMRI) to evaluate the relative functional adequacy of mesial temporal lobe structures in preparation for ATL. In the present study, we report follow-up outcome data on eight temporal lobe epilepsy (TLE) patients 1-year post-ATL who were evaluated pre-surgically using IAT and fMRI. Functional memory lateralization using fMRI predicted post-ATL seizure outcome as effectively as the IAT. In general, asymmetry of functional mTL activation favouring the non-epileptic hemisphere was associated with seizure-free status at 1-year follow-up. Moreover, when combined, fMRI and IAT provided complementary data that resulted in improved prediction of post-operative seizure control compared with either procedure alone.
Killgore
W D
WD
Department of Neurology, University of Pennsylvania Medical Center, USA.
Glosser
G
G
Casasanto
D J
DJ
French
J A
JA
Alsop
D C
DC
Detre
J A
JA
D000293:Adolescent; D000328:Adult; D000654:Amobarbital / Q000008:administration & dosage / Q000493:pharmacokinetics; D003072:Cognition Disorders / Q000175:diagnosis / Q000517:prevention & control; D004333:Drug Administration Routes; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000517:prevention & control / Q000601:surgery; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D018757:GABA Modulators / Q000008:administration & dosage / Q000493:pharmacokinetics; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008568:Memory / Q000502:physiology; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011612:Psychosurgery / Q000379:methods*; D013702:Temporal Lobe / Q000601:surgery*
D018757:GABA Modulators; D000654:Amobarbital