title: Practice guideline summary: Use of fMRI in the presurgical evaluation of patients with epilepsy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology.
abstract: OBJECTIVE
  To assess the diagnostic accuracy and prognostic value of functional MRI (fMRI) in determining lateralization and predicting postsurgical language and memory outcomes.
  
  
  METHODS
  An 11-member panel evaluated and rated available evidence according to the 2004 American Academy of Neurology process. At least 2 panelists reviewed the full text of 172 articles and selected 37 for data extraction. Case reports, reports with <15 cases, meta-analyses, and editorials were excluded.
  
  
  CONCLUSIONS
  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.
authors.affiliation: From the Department of Neurology (J.P.S.), University of Alabama at Birmingham; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (J.R.B., S.J.S.), Medical College of Wisconsin, Milwaukee; Children's National Medical Center (W.D.G.), George Washington University, Washington, DC; Departments of Neurosurgery and Radiology (A.J.G.), Brigham and Women's Hospital, Boston, MA; Cincinnati Children's Hospital Research Foundation (S.K.H.), OH; Department of Neurosurgery (J.O.), Seattle Children's Hospital, WA; Department of Neurology (D.C.S.), Oregon Health & Science University, Portland; Department of Neurology (J.A.F.), New York University, New York; and Clinical Epilepsy Section (W.H.T.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD.
authors.forename: Jerzy P
authors.initials: JP
authors.lastname: Szaflarski
authors.affiliation: From the Department of Neurology (J.P.S.), University of Alabama at Birmingham; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (J.R.B., S.J.S.), Medical College of Wisconsin, Milwaukee; Children's National Medical Center (W.D.G.), George Washington University, Washington, DC; Departments of Neurosurgery and Radiology (A.J.G.), Brigham and Women's Hospital, Boston, MA; Cincinnati Children's Hospital Research Foundation (S.K.H.), OH; Department of Neurosurgery (J.O.), Seattle Children's Hospital, WA; Department of Neurology (D.C.S.), Oregon Health & Science University, Portland; Department of Neurology (J.A.F.), New York University, New York; and Clinical Epilepsy Section (W.H.T.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD.
authors.forename: David
authors.initials: D
authors.lastname: Gloss
authors.affiliation: From the Department of Neurology (J.P.S.), University of Alabama at Birmingham; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (J.R.B., S.J.S.), Medical College of Wisconsin, Milwaukee; Children's National Medical Center (W.D.G.), George Washington University, Washington, DC; Departments of Neurosurgery and Radiology (A.J.G.), Brigham and Women's Hospital, Boston, MA; Cincinnati Children's Hospital Research Foundation (S.K.H.), OH; Department of Neurosurgery (J.O.), Seattle Children's Hospital, WA; Department of Neurology (D.C.S.), Oregon Health & Science University, Portland; Department of Neurology (J.A.F.), New York University, New York; and Clinical Epilepsy Section (W.H.T.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Binder
authors.affiliation: From the Department of Neurology (J.P.S.), University of Alabama at Birmingham; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (J.R.B., S.J.S.), Medical College of Wisconsin, Milwaukee; Children's National Medical Center (W.D.G.), George Washington University, Washington, DC; Departments of Neurosurgery and Radiology (A.J.G.), Brigham and Women's Hospital, Boston, MA; Cincinnati Children's Hospital Research Foundation (S.K.H.), OH; Department of Neurosurgery (J.O.), Seattle Children's Hospital, WA; Department of Neurology (D.C.S.), Oregon Health & Science University, Portland; Department of Neurology (J.A.F.), New York University, New York; and Clinical Epilepsy Section (W.H.T.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD.
authors.forename: William D
authors.initials: WD
authors.lastname: Gaillard
authors.affiliation: From the Department of Neurology (J.P.S.), University of Alabama at Birmingham; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (J.R.B., S.J.S.), Medical College of Wisconsin, Milwaukee; Children's National Medical Center (W.D.G.), George Washington University, Washington, DC; Departments of Neurosurgery and Radiology (A.J.G.), Brigham and Women's Hospital, Boston, MA; Cincinnati Children's Hospital Research Foundation (S.K.H.), OH; Department of Neurosurgery (J.O.), Seattle Children's Hospital, WA; Department of Neurology (D.C.S.), Oregon Health & Science University, Portland; Department of Neurology (J.A.F.), New York University, New York; and Clinical Epilepsy Section (W.H.T.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD.
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Golby
authors.affiliation: From the Department of Neurology (J.P.S.), University of Alabama at Birmingham; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (J.R.B., S.J.S.), Medical College of Wisconsin, Milwaukee; Children's National Medical Center (W.D.G.), George Washington University, Washington, DC; Departments of Neurosurgery and Radiology (A.J.G.), Brigham and Women's Hospital, Boston, MA; Cincinnati Children's Hospital Research Foundation (S.K.H.), OH; Department of Neurosurgery (J.O.), Seattle Children's Hospital, WA; Department of Neurology (D.C.S.), Oregon Health & Science University, Portland; Department of Neurology (J.A.F.), New York University, New York; and Clinical Epilepsy Section (W.H.T.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD.
authors.forename: Scott K
authors.initials: SK
authors.lastname: Holland
authors.affiliation: From the Department of Neurology (J.P.S.), University of Alabama at Birmingham; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (J.R.B., S.J.S.), Medical College of Wisconsin, Milwaukee; Children's National Medical Center (W.D.G.), George Washington University, Washington, DC; Departments of Neurosurgery and Radiology (A.J.G.), Brigham and Women's Hospital, Boston, MA; Cincinnati Children's Hospital Research Foundation (S.K.H.), OH; Department of Neurosurgery (J.O.), Seattle Children's Hospital, WA; Department of Neurology (D.C.S.), Oregon Health & Science University, Portland; Department of Neurology (J.A.F.), New York University, New York; and Clinical Epilepsy Section (W.H.T.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Ojemann
authors.affiliation: From the Department of Neurology (J.P.S.), University of Alabama at Birmingham; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (J.R.B., S.J.S.), Medical College of Wisconsin, Milwaukee; Children's National Medical Center (W.D.G.), George Washington University, Washington, DC; Departments of Neurosurgery and Radiology (A.J.G.), Brigham and Women's Hospital, Boston, MA; Cincinnati Children's Hospital Research Foundation (S.K.H.), OH; Department of Neurosurgery (J.O.), Seattle Children's Hospital, WA; Department of Neurology (D.C.S.), Oregon Health & Science University, Portland; Department of Neurology (J.A.F.), New York University, New York; and Clinical Epilepsy Section (W.H.T.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD.
authors.forename: David C
authors.initials: DC
authors.lastname: Spencer
authors.affiliation: From the Department of Neurology (J.P.S.), University of Alabama at Birmingham; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (J.R.B., S.J.S.), Medical College of Wisconsin, Milwaukee; Children's National Medical Center (W.D.G.), George Washington University, Washington, DC; Departments of Neurosurgery and Radiology (A.J.G.), Brigham and Women's Hospital, Boston, MA; Cincinnati Children's Hospital Research Foundation (S.K.H.), OH; Department of Neurosurgery (J.O.), Seattle Children's Hospital, WA; Department of Neurology (D.C.S.), Oregon Health & Science University, Portland; Department of Neurology (J.A.F.), New York University, New York; and Clinical Epilepsy Section (W.H.T.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Swanson
authors.affiliation: From the Department of Neurology (J.P.S.), University of Alabama at Birmingham; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (J.R.B., S.J.S.), Medical College of Wisconsin, Milwaukee; Children's National Medical Center (W.D.G.), George Washington University, Washington, DC; Departments of Neurosurgery and Radiology (A.J.G.), Brigham and Women's Hospital, Boston, MA; Cincinnati Children's Hospital Research Foundation (S.K.H.), OH; Department of Neurosurgery (J.O.), Seattle Children's Hospital, WA; Department of Neurology (D.C.S.), Oregon Health & Science University, Portland; Department of Neurology (J.A.F.), New York University, New York; and Clinical Epilepsy Section (W.H.T.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD.
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: French
authors.affiliation: From the Department of Neurology (J.P.S.), University of Alabama at Birmingham; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (J.R.B., S.J.S.), Medical College of Wisconsin, Milwaukee; Children's National Medical Center (W.D.G.), George Washington University, Washington, DC; Departments of Neurosurgery and Radiology (A.J.G.), Brigham and Women's Hospital, Boston, MA; Cincinnati Children's Hospital Research Foundation (S.K.H.), OH; Department of Neurosurgery (J.O.), Seattle Children's Hospital, WA; Department of Neurology (D.C.S.), Oregon Health & Science University, Portland; Department of Neurology (J.A.F.), New York University, New York; and Clinical Epilepsy Section (W.H.T.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD.
authors.forename: William H
authors.initials: WH
authors.lastname: Theodore
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging* / Q000601:surgery*; D001931:Brain Mapping / Q000379:methods; D004827:Epilepsy / Q000000981:diagnostic imaging* / Q000523:psychology / Q000601:surgery*; D007839:Functional Laterality; D006801:Humans; D007802:Language; D008279:Magnetic Resonance Imaging; D008568:Memory; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care