Brain Advance Access originally published online on September 30, 2004
Brain 2004 127(11):2419-2426; doi:10.1093/brain/awh293
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Brain Vol. 127 No. 11 © Guarantors of Brain 2004; all rights reserved
Pre-operative verbal memory fMRI predicts post-operative memory decline after left temporal lobe resection
1 Department of Clinical and Experimental Epilepsy and 2 Wellcome Department of Imaging Neuroscience, Institute of Neurology, University College London, and 3 National Society for Epilepsy Chalfont Centre, Chalfont St Peter, UK
Correspondence to: Dr Mark Richardson, Box 29, Institute of Neurology, Queen Square, London WC1N 3BG UK E-mail: m.richardson{at}ion.ucl.ac.uk
Functional MRI (fMRI) of cognitive tasks depends on technology widely available in the clinical sphere, but has yet to show a role in the investigation of patients. We report here the first demonstration of a clinically valuable role for cognitive fMRI. Temporal lobe epilepsy (TLE) is commonly caused by hippocampal sclerosis and is frequently resistant to drug treatment. Surgical resection of the left hippocampus in this setting can cure seizures, but may produce significant verbal memory decline, which is hard to predict. We report 10 right-handed TLE patients with left hippocampal sclerosis who underwent left hippocampal resection. We compared currently used data for the prediction of post-operative verbal memory decline in such patients with a novel fMRI assessment of verbal memory encoding. Multiple regression analyses showed that fMRI provided the strongest independent predictor of memory outcome after surgery. At the individual subject level, the fMRI data had high positive predictive value for memory decline.
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