title: Lessons for neuropsychology from functional MRI in patients with epilepsy.
abstract: This contribution aims to review the major findings of pre- and postsurgical functional magnetic resonance imaging (fMRI) in patients with refractory epilepsy from a neuropsychological perspective. We compared the contribution of fMRI with the intracarotid amytal procedure (IAP) with respect to functional mapping of language and memory in patients with therapy-resistant epilepsy. We conclude that using comprehensive language paradigms, fMRI has been able (1) to provide estimates of the degree of language lateralization including the degree of involvement of the nondominant hemisphere, (2) to provide information on the location of its activated network during expressive and receptive language, and (3) to help delineate eloquent language regions in the vicinity of the surgical target, thus preventing postoperative complications. The contribution of the frequently observed nondominant hemisphere activation to language should be explored and its clinical relevance determined. Evidence from fMRI studies is accumulating that reorganization of cognitive and motor function favors the activation of contralateral homotopic areas, although this process is far from understood. The exact functional contribution of atypical areas of activation should be investigated critically. In the presurgical evaluation process, detailed and reliable localization of language and memory functions of the individual patient is mandatory and should be the ultimate goal in the development of comprehensive clinical fMRI protocols.
authors.affiliation: Laboratory for Neuropsychology, Ghent University, De Pintelaan 185, B-9000 Ghent, Belgium. guy.vingerhoets@ugent.be
authors.forename: Guy
authors.initials: G
authors.lastname: Vingerhoets
authors.forename: Karel
authors.initials: K
authors.lastname: Deblaere
authors.forename: Walter H
authors.initials: WH
authors.lastname: Backes
authors.forename: Eric
authors.initials: E
authors.lastname: Achten
authors.forename: Paul
authors.initials: P
authors.lastname: Boon
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Boon
authors.forename: Paul
authors.initials: P
authors.lastname: Hofman
authors.forename: Jan
authors.initials: J
authors.lastname: Vermeulen
authors.forename: Kristl
authors.initials: K
authors.lastname: Vonck
authors.forename: Jan
authors.initials: J
authors.lastname: Wilmink
authors.forename: Albert P
authors.initials: AP
authors.lastname: Aldenkamp
mesh_terms: D000654:Amobarbital; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000503:physiopathology; D003072:Cognition Disorders / Q000503:physiopathology* / Q000523:psychology*; D004292:Dominance, Cerebral / Q000502:physiology; D004827:Epilepsy / Q000503:physiopathology* / Q000523:psychology* / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008568:Memory / Q000502:physiology; D009473:Neuronal Plasticity / Q000502:physiology; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000503:physiopathology / Q000523:psychology; D011379:Prognosis; D011597:Psychomotor Performance / Q000502:physiology; D013060:Speech / Q000502:physiology
chemical_list: D000654:Amobarbital