title: Language functional MRI and direct cortical stimulation in epilepsy preoperative planning.
abstract: OBJECTIVE
  Presurgical language assessment can help minimize damage to eloquent cortex during resective epilepsy surgery. Two methods for presurgical language mapping are functional MRI (fMRI) and direct cortical stimulation (DCS) of implanted subdural electrodes. We compared fMRI results to DCS to help optimize noninvasive language localization and assess its validity.
  
  
  METHODS
  We studied 19 patients referred for presurgical evaluation of drug-resistant epilepsy. Patients completed four language tasks during preoperative fMRI. After subdural electrode implantation, we used DCS to localize language areas. For each stimulation site, we determined whether language positive electrode pairs intersected with significant fMRI activity clusters for language tasks.
  
  
  RESULTS
  Sensitivity and specificity depended on electrode region of interest radii and statistical thresholding. For patients with at least one language positive stimulation site, an auditory description decision task provided the best trade-off between sensitivity and specificity. For patients with no language positive stimulation sites, fMRI was a dependable method of excluding eloquent language processing.
  
  
  CONCLUSIONS
  Language fMRI is an effective tool for determining language lateralization before electrode implantation and is especially useful for excluding unexpected critical language areas. It can help guide subdural electrode implantation and narrow the search for eloquent cortical areas by DCS. Ann Neurol 2017;81:526-537.
authors.affiliation: Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD.
authors.forename: Alison
authors.initials: A
authors.lastname: Austermuehle
authors.affiliation: Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, MD.
authors.forename: John
authors.initials: J
authors.lastname: Cocjin
authors.affiliation: Scientific and Statistical Computing Core, National Institute of Mental Health, Bethesda, MD.
authors.forename: Richard
authors.initials: R
authors.lastname: Reynolds
authors.affiliation: Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD.
authors.forename: Shubhi
authors.initials: S
authors.lastname: Agrawal
authors.affiliation: Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD.
authors.forename: Leigh
authors.initials: L
authors.lastname: Sepeta
authors.affiliation: Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD.
authors.forename: William D
authors.initials: WD
authors.lastname: Gaillard
authors.affiliation: Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, MD.
authors.forename: Kareem A
authors.initials: KA
authors.lastname: Zaghloul
authors.affiliation: Electroencephalography Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD.
authors.forename: Sara
authors.initials: S
authors.lastname: Inati
authors.affiliation: Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD.
authors.forename: William H
authors.initials: WH
authors.lastname: Theodore
mesh_terms: D000328:Adult; D001931:Brain Mapping / Q000379:methods* / Q000592:standards; D002540:Cerebral Cortex / Q000502:physiology*; D000069279:Drug Resistant Epilepsy / Q000601:surgery*; D004558:Electric Stimulation / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D007802:Language; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D012680:Sensitivity and Specificity; D055815:Young Adult