Clinical applications of functional MRI in epilepsy

Area of Science:

• Neuroimaging
• Epilepsy diagnostics
• Functional Magnetic Resonance Imaging (fMRI)

Background:

• Intractable epilepsy requires precise presurgical evaluation.
• Traditional methods like intraoperative cortical stimulation and Wada testing have limitations.
• Real-time fMRI offers a noninvasive alternative for crucial pre-surgical assessments.

Purpose of the Study:

• To review the role and methodology of functional MRI (fMRI) in presurgical epilepsy evaluation.
• To discuss the biophysical basis and clinical application of blood-oxygen-level-dependent (BOLD) fMRI.
• To highlight the impact of fMRI on diagnostic and therapeutic decisions in epilepsy management.

Main Methods:

• Description of the biophysical basis of BOLD fMRI.
• Overview of fMRI methodology: study design, paradigms, setup, and data analysis.
• Inclusion of illustrative case studies demonstrating fMRI's influence on clinical decisions.

Main Results:

• fMRI is increasingly recognized for eloquent cortex mapping and language lateralization.
• fMRI shows promise in predicting postsurgical memory outcomes.
• fMRI aids in localizing ictal activity in epilepsy patients.

Conclusions:

• Real-time fMRI is a practical and noninvasive technique for epilepsy presurgical evaluation.
• fMRI influences diagnostic and therapeutic strategies, improving patient care.
• Addressing challenges in clinical fMRI is crucial for its wider adoption.