Functional magnetic resonance for the localization of eloquent areas in epilepsy surgery candidates: comparison to cortical electrostimulation mapping

Abstract Introduction Surgical treatment for epilepsy comprises resective techniques in most patients. In those with epilepsy of sites close to highly specialized or eloquent areas, very precise anatomic delimitation is required. So far the most reliable method for anatomic localization of function is direct cortical electrostimulation mapping (CEM). Functional magnetic resonance (fMRI) is a non-invasive method that could also be used for this purpose. Objective To determine the sensitivity and specificity of fMRI for the identification of eloquent areas compared to CEM in epilepsy surgery candidates. Methods Four patients who underwent presurgical fMRI and grid implantation in eloquent areas for epileptic focus localization with video-EEG were included in this study. Once the seizure onset site was identified, CEM was performed and a postsurgical structural magnetic resonance was reconstructed with Eclipse software to determine grid position. After correlating pre and postsurgical images, the site of the grid contacts where eloquent areas were identified was compared to localization by fMRI. Results One hundred and twenty electrodes in six eloquent areas were evaluated and compared to location by fMRI: five hand motor areas and one language area in the temporal lobe. We found a global sensitivity of 0.86, specificity of 0.96, positive predictive value of 0.89, negative predictive value of 0.95 and accuracy of 0.94 for fMRI. Conclusion In this study fMRI showed high specificity and proved to be useful for language lateralization. It is necessary to study this technique further, especially for language areas.