Determination of hemispheric language dominance in the surgical epilepsy patient diagnostic properties of functional magnetic resonance imaging

Scott D. Spritzer, Matthew T. Hoerth, Richard S. Zimmerman, Aaron Shmookler, Charlene R. Hoffman-Snyder, Kay E. Wellik, Bart M Demaerschalk, Dean Marko Wingerchuk

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Presurgical evaluation for refractory epilepsy typically includes assessment of cognitive and language functions. The reference standard for determination of hemispheric language dominance has been the intracarotid amobarbital test (IAT) but functional magnetic resonance imaging (fMRI) is increasingly used. Objective: To critically assess current evidence regarding the diagnostic properties of fMRI in comparison with the IAT for determination of hemispheric language dominance. Methods: The objective was addressed through the development of a structured critically appraised topic. This included a clinical scenario, structured question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and content experts in the fields of epilepsy and neurosurgery. Results: A systematic review and meta-analysis that compared the sensitivity and specificity of fMRI to IAT-determined language lateralization was selected for critical appraisal. The review included data from 23 articles (n = 442); study methodology varied widely. fMRI was 83.5% sensitive and 88.1% specific for detection of hemispheric language dominance. Conclusions: There are insufficient data to support routine use of fMRI for the purpose of determining hemispheric language dominance in patients with intractable epilepsy. Larger, well-designed studies of fMRI for language and other cognitive outcomes as part of the presurgical and postsurgical evaluation of epilepsy patients are necessary.

Original languageEnglish (US)
Pages (from-to)329-331
Number of pages3
JournalNeurologist
Volume18
Issue number5
DOIs
StatePublished - Sep 2012

Fingerprint

Epilepsy
Language
Magnetic Resonance Imaging
Amobarbital
Librarians
Language Tests
Neurosurgery
Consultants
Cognition
Meta-Analysis
Sensitivity and Specificity

Keywords

  • Cerebral dominance
  • Diagnosis
  • Epilepsy
  • Evidence-based medicine
  • Functional laterality
  • Language
  • Magnetic resonance imaging
  • Neurosurgical procedures
  • Wada

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Determination of hemispheric language dominance in the surgical epilepsy patient diagnostic properties of functional magnetic resonance imaging. / Spritzer, Scott D.; Hoerth, Matthew T.; Zimmerman, Richard S.; Shmookler, Aaron; Hoffman-Snyder, Charlene R.; Wellik, Kay E.; Demaerschalk, Bart M; Wingerchuk, Dean Marko.

In: Neurologist, Vol. 18, No. 5, 09.2012, p. 329-331.

Research output: Contribution to journalArticle

Spritzer, Scott D. ; Hoerth, Matthew T. ; Zimmerman, Richard S. ; Shmookler, Aaron ; Hoffman-Snyder, Charlene R. ; Wellik, Kay E. ; Demaerschalk, Bart M ; Wingerchuk, Dean Marko. / Determination of hemispheric language dominance in the surgical epilepsy patient diagnostic properties of functional magnetic resonance imaging. In: Neurologist. 2012 ; Vol. 18, No. 5. pp. 329-331.
@article{2e33fa43e13d4a0f8c6298d0f45250b6,
title = "Determination of hemispheric language dominance in the surgical epilepsy patient diagnostic properties of functional magnetic resonance imaging",
abstract = "Background: Presurgical evaluation for refractory epilepsy typically includes assessment of cognitive and language functions. The reference standard for determination of hemispheric language dominance has been the intracarotid amobarbital test (IAT) but functional magnetic resonance imaging (fMRI) is increasingly used. Objective: To critically assess current evidence regarding the diagnostic properties of fMRI in comparison with the IAT for determination of hemispheric language dominance. Methods: The objective was addressed through the development of a structured critically appraised topic. This included a clinical scenario, structured question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and content experts in the fields of epilepsy and neurosurgery. Results: A systematic review and meta-analysis that compared the sensitivity and specificity of fMRI to IAT-determined language lateralization was selected for critical appraisal. The review included data from 23 articles (n = 442); study methodology varied widely. fMRI was 83.5{\%} sensitive and 88.1{\%} specific for detection of hemispheric language dominance. Conclusions: There are insufficient data to support routine use of fMRI for the purpose of determining hemispheric language dominance in patients with intractable epilepsy. Larger, well-designed studies of fMRI for language and other cognitive outcomes as part of the presurgical and postsurgical evaluation of epilepsy patients are necessary.",
keywords = "Cerebral dominance, Diagnosis, Epilepsy, Evidence-based medicine, Functional laterality, Language, Magnetic resonance imaging, Neurosurgical procedures, Wada",
author = "Spritzer, {Scott D.} and Hoerth, {Matthew T.} and Zimmerman, {Richard S.} and Aaron Shmookler and Hoffman-Snyder, {Charlene R.} and Wellik, {Kay E.} and Demaerschalk, {Bart M} and Wingerchuk, {Dean Marko}",
year = "2012",
month = "9",
doi = "10.1097/NRL.0b013e31826ac675",
language = "English (US)",
volume = "18",
pages = "329--331",
journal = "Neurologist",
issn = "1074-7931",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Determination of hemispheric language dominance in the surgical epilepsy patient diagnostic properties of functional magnetic resonance imaging

AU - Spritzer, Scott D.

AU - Hoerth, Matthew T.

AU - Zimmerman, Richard S.

AU - Shmookler, Aaron

AU - Hoffman-Snyder, Charlene R.

AU - Wellik, Kay E.

AU - Demaerschalk, Bart M

AU - Wingerchuk, Dean Marko

PY - 2012/9

Y1 - 2012/9

N2 - Background: Presurgical evaluation for refractory epilepsy typically includes assessment of cognitive and language functions. The reference standard for determination of hemispheric language dominance has been the intracarotid amobarbital test (IAT) but functional magnetic resonance imaging (fMRI) is increasingly used. Objective: To critically assess current evidence regarding the diagnostic properties of fMRI in comparison with the IAT for determination of hemispheric language dominance. Methods: The objective was addressed through the development of a structured critically appraised topic. This included a clinical scenario, structured question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and content experts in the fields of epilepsy and neurosurgery. Results: A systematic review and meta-analysis that compared the sensitivity and specificity of fMRI to IAT-determined language lateralization was selected for critical appraisal. The review included data from 23 articles (n = 442); study methodology varied widely. fMRI was 83.5% sensitive and 88.1% specific for detection of hemispheric language dominance. Conclusions: There are insufficient data to support routine use of fMRI for the purpose of determining hemispheric language dominance in patients with intractable epilepsy. Larger, well-designed studies of fMRI for language and other cognitive outcomes as part of the presurgical and postsurgical evaluation of epilepsy patients are necessary.

AB - Background: Presurgical evaluation for refractory epilepsy typically includes assessment of cognitive and language functions. The reference standard for determination of hemispheric language dominance has been the intracarotid amobarbital test (IAT) but functional magnetic resonance imaging (fMRI) is increasingly used. Objective: To critically assess current evidence regarding the diagnostic properties of fMRI in comparison with the IAT for determination of hemispheric language dominance. Methods: The objective was addressed through the development of a structured critically appraised topic. This included a clinical scenario, structured question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and content experts in the fields of epilepsy and neurosurgery. Results: A systematic review and meta-analysis that compared the sensitivity and specificity of fMRI to IAT-determined language lateralization was selected for critical appraisal. The review included data from 23 articles (n = 442); study methodology varied widely. fMRI was 83.5% sensitive and 88.1% specific for detection of hemispheric language dominance. Conclusions: There are insufficient data to support routine use of fMRI for the purpose of determining hemispheric language dominance in patients with intractable epilepsy. Larger, well-designed studies of fMRI for language and other cognitive outcomes as part of the presurgical and postsurgical evaluation of epilepsy patients are necessary.

KW - Cerebral dominance

KW - Diagnosis

KW - Epilepsy

KW - Evidence-based medicine

KW - Functional laterality

KW - Language

KW - Magnetic resonance imaging

KW - Neurosurgical procedures

KW - Wada

UR - http://www.scopus.com/inward/record.url?scp=84865965665&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84865965665&partnerID=8YFLogxK

U2 - 10.1097/NRL.0b013e31826ac675

DO - 10.1097/NRL.0b013e31826ac675

M3 - Article

C2 - 22931746

AN - SCOPUS:84865965665

VL - 18

SP - 329

EP - 331

JO - Neurologist

JF - Neurologist

SN - 1074-7931

IS - 5

ER -