Cortical cartography reveals political and physical maps

• Type of Material: Article
• Authors: David Loring, Emory University; William Davis Gaillard, Children’s National Medical Center; Susan Y. Bookheimer, University of California Los Angeles; Kimford Meador, Emory University; Jeffrey G. Ojemann, Seattle Children’s Hospital
• Language: English
• Date: 2014-05-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2014 International League Against Epilepsy.
• Final Published Version (URL): http://dx.doi.org/10.1111/epi.12553
• Title of Journal or Parent Work: Epilepsia
• ISSN: 0013-9580
• Volume: 55
• Issue: 5
• Start Page: 633
• End Page: 637
• Grant/Funding Information: See publication for full funding statement.
• Keywords: RESECTION; Science & Technology; AWAKE CRANIOTOMY; LANGUAGE LATERALIZATION; fMRI; Life Sciences & Biomedicine; Wada testing; EPILEPSY PATIENTS; Neurosciences & Neurology; FMRI; SURGERY; Magnetoencephalography; MEMORY DECLINE; Clinical Neurology; OUTCOMES; Cortical stimulation mapping; FUNCTIONAL MRI; TEMPORAL LOBECTOMY
• Research Categories: Biology, Neuroscience

Abstract

Advances in functional imaging have provided noninvasive techniques to probe brain organization of multiple constructs including language and memory. Because of high overall rates of agreements with older techniques, including Wada testing and cortical stimulation mapping (CSM), some have proposed that those approaches should be largely abandoned because of their invasiveness, and replaced with noninvasive functional imaging methods. High overall agreement, however, is based largely on concordant language lateralization in series dominated by cases of typical cerebral dominance. Advocating a universal switch from Wada testing and cortical stimulation mapping to functional magnetic resonance imaging (fMRI) or magnetoencephalography (MEG) ignores the differences in specific expertise across epilepsy centers, many of which often have greater skill with one approach rather than the other, and that Wada, CSM, fMRI, and MEG protocols vary across institutions resulting in different outcomes and reliability. Specific patient characteristics also affect whether Wada or CSM might influence surgical management, making it difficult to accept broad recommendations against currently useful clinical tools. Although the development of noninvasive techniques has diminished the frequency of more invasive approaches, advocating their use to replace Wada testing and CSM across all epilepsy surgery programs without consideration of the different skills, protocols, and expertise at any given center site is ill-advised.