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Clinical applications of functional MRI in epilepsy.

Kesavadas C, Thomas B - Indian J Radiol Imaging (2008)

Bottom Line: It has become a noninvasive alternative to intraoperative cortical stimulation and the Wada test for eloquent cortex mapping and language lateralization, respectively.Its role in predicting postsurgical memory outcome and in localizing the ictal activity is being recognized.Illustrative cases have been discussed, wherein the fMRI results influenced the seizure team's decisions with regard to diagnosis and therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum - 695 011, India.

ABSTRACT
The role of functional MRI (fMRI) in the presurgical evaluation of patients with intractable epilepsy is being increasingly recognized. Real-time fMRI is an easily performable diagnostic technique in the clinical setting. It has become a noninvasive alternative to intraoperative cortical stimulation and the Wada test for eloquent cortex mapping and language lateralization, respectively. Its role in predicting postsurgical memory outcome and in localizing the ictal activity is being recognized. This review article describes the biophysical basis of blood-oxygen-level-dependent (BOLD) fMRI and the methodology adopted, including the design, paradigms, the fMRI setup, and data analysis. Illustrative cases have been discussed, wherein the fMRI results influenced the seizure team's decisions with regard to diagnosis and therapy. Finally, the special issues involved in fMRI of epilepsy patients and the various challenges of clinical fMRI are detailed.

No MeSH data available.


Related in: MedlinePlus

Three patients with intractable seizures due to a mass lesion close to the sensorimotor cortex. Presurgical mapping of the motor cortex was performed using bilateral finger tapping vs rest, in all the three patients. MRI (axial FLAIR) and fMRI (inline BOLD coregistered on FLAIR) images (A, B) of the first patient show that the lesion is posterior to the right postcentral gyrus. Since the lesion was placed well away from the motor cortex it was decided to proceed with surgery. MRI and fMRI in the second patient (C, D) show the mass lesion to be abutting the right hand area. The postsurgical risk of developing limb weakness was explained to the patient. MRI and fMRI images of the third patient (E, F) show that the lesion is placed in the motor cortex lateral to the right hand area. Fortunately the seizures in this patient could be controlled with antiepileptic medication. It was decided to postpone the surgery and keep the patient on regular follow-up
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Figure 0007: Three patients with intractable seizures due to a mass lesion close to the sensorimotor cortex. Presurgical mapping of the motor cortex was performed using bilateral finger tapping vs rest, in all the three patients. MRI (axial FLAIR) and fMRI (inline BOLD coregistered on FLAIR) images (A, B) of the first patient show that the lesion is posterior to the right postcentral gyrus. Since the lesion was placed well away from the motor cortex it was decided to proceed with surgery. MRI and fMRI in the second patient (C, D) show the mass lesion to be abutting the right hand area. The postsurgical risk of developing limb weakness was explained to the patient. MRI and fMRI images of the third patient (E, F) show that the lesion is placed in the motor cortex lateral to the right hand area. Fortunately the seizures in this patient could be controlled with antiepileptic medication. It was decided to postpone the surgery and keep the patient on regular follow-up


Clinical applications of functional MRI in epilepsy.

Kesavadas C, Thomas B - Indian J Radiol Imaging (2008)

Three patients with intractable seizures due to a mass lesion close to the sensorimotor cortex. Presurgical mapping of the motor cortex was performed using bilateral finger tapping vs rest, in all the three patients. MRI (axial FLAIR) and fMRI (inline BOLD coregistered on FLAIR) images (A, B) of the first patient show that the lesion is posterior to the right postcentral gyrus. Since the lesion was placed well away from the motor cortex it was decided to proceed with surgery. MRI and fMRI in the second patient (C, D) show the mass lesion to be abutting the right hand area. The postsurgical risk of developing limb weakness was explained to the patient. MRI and fMRI images of the third patient (E, F) show that the lesion is placed in the motor cortex lateral to the right hand area. Fortunately the seizures in this patient could be controlled with antiepileptic medication. It was decided to postpone the surgery and keep the patient on regular follow-up
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2747426&req=5

Figure 0007: Three patients with intractable seizures due to a mass lesion close to the sensorimotor cortex. Presurgical mapping of the motor cortex was performed using bilateral finger tapping vs rest, in all the three patients. MRI (axial FLAIR) and fMRI (inline BOLD coregistered on FLAIR) images (A, B) of the first patient show that the lesion is posterior to the right postcentral gyrus. Since the lesion was placed well away from the motor cortex it was decided to proceed with surgery. MRI and fMRI in the second patient (C, D) show the mass lesion to be abutting the right hand area. The postsurgical risk of developing limb weakness was explained to the patient. MRI and fMRI images of the third patient (E, F) show that the lesion is placed in the motor cortex lateral to the right hand area. Fortunately the seizures in this patient could be controlled with antiepileptic medication. It was decided to postpone the surgery and keep the patient on regular follow-up
Bottom Line: It has become a noninvasive alternative to intraoperative cortical stimulation and the Wada test for eloquent cortex mapping and language lateralization, respectively.Its role in predicting postsurgical memory outcome and in localizing the ictal activity is being recognized.Illustrative cases have been discussed, wherein the fMRI results influenced the seizure team's decisions with regard to diagnosis and therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum - 695 011, India.

ABSTRACT
The role of functional MRI (fMRI) in the presurgical evaluation of patients with intractable epilepsy is being increasingly recognized. Real-time fMRI is an easily performable diagnostic technique in the clinical setting. It has become a noninvasive alternative to intraoperative cortical stimulation and the Wada test for eloquent cortex mapping and language lateralization, respectively. Its role in predicting postsurgical memory outcome and in localizing the ictal activity is being recognized. This review article describes the biophysical basis of blood-oxygen-level-dependent (BOLD) fMRI and the methodology adopted, including the design, paradigms, the fMRI setup, and data analysis. Illustrative cases have been discussed, wherein the fMRI results influenced the seizure team's decisions with regard to diagnosis and therapy. Finally, the special issues involved in fMRI of epilepsy patients and the various challenges of clinical fMRI are detailed.

No MeSH data available.


Related in: MedlinePlus