Zusammenfassung
Die funktionelle Magnetresonanztomographie (fMRT) wird im Rahmen der Epilepsiediagnostik vor epilepsiechirurgischen Eingriffen insbesondere zur Lateralisation von Sprache und Gedächtnis und zur Lokalisation der Zentralregion eingesetzt, um den eloquenten Kortex von der epilepsieverursachenden, chirurgisch zugänglichen Läsion abzugrenzen. Dabei ist die fMRT Teil einer Sequenz nichtinvasiver klinischer Tests (Anamnese, Anfall-Semiologie, neurologischer Status, interiktales und iktales EEG, strukturelles MRT, Video-EEG-Monitoring, Neuropsychologie). Das Ergebnis dieser Sequenz ist die Entscheidung für oder gegen einen elektiven epilepsiechirurgischen Eingriff bzw. für oder gegen weitere invasive Diagnostik (Wada-Test, intra- oder extraoperative kortikale Stimulation). Komplikationen epilepsiechirurgischer Eingriffe, z. B. Minderungen des Gedächtnisses oder der Benennleistung nach Temporallappenresektion bzw. aphasische Störungen und Paresen nach Frontallappenresektion, sind selten und selten von katastrophalem Ausmaß, was eine Standortbestimmung für das klinische fMRT erschwert. In diesem Artikel werden daher Studien vorgestellt, die die Übereinstimmung zwischen fMRT und anderen „Goldstandards“ oder postoperativer Morbidität untersucht haben.
Abstract
Functional magnetic resonance imaging (fMRI) is frequently used in the presurgical diagnostic procedure of epilepsy patients, in particular for lateralization of speech and memory and for localization of the primary motor cortex to delineate the epileptogenic lesion from eloquent brain areas. fMRI is one of the non-invasive procedures in the presurgical diagnostic process, together with medical history, seizure semiology, neurological examination, interictal and ictal EEG, structural MRI, video EEG monitoring and neuropsychology. This diagnostic sequence leads either to the decision for or against elective epilepsy surgery or to the decision to proceed with invasive diagnostic techniques (Wada test, intra-operative or extra-operative cortical stimulation). It is difficult to evaluate the contribution of the fMRI test in isolation to the validity of the entire diagnostic sequence. Complications such as memory loss and aphasia in temporal lobe resections or paresis after frontal lobe resections are rare and rarely of disastrous extent. This further complicates the evaluation of the clinical relevance of fMRI as a predictive tool. In this article studies which investigated the concordance between fMRI and other diagnostic gold standards will be presented as well as the association between presurgical fMRI and postsurgical morbidity.
Literatur
Adcock JE, Wise RG, Oxbury JM et al (2003) Quantitative fMRI assessment of the differences in lateralization of language-related brain activation in patients with temporal lobe epilepsy. Neuroimage 18:423–438
Baciu M, Kahane P, Minotti L et al (2001) Functional MRI assessment of the hemispheric predominance for language in epileptic patients using a simple rhyme detection task. Epileptic Disord 3:117–124
Bahn M, Lin W, Silbergeld DL et al (1997) Localization of language cortices by functional MR imaging compared with intracarotid amobarbital hemispheric sedation. Am J Roentgenol 169:575–579
Benke T, Köylü B, Visani P et al (2006) Language lateralization in temporal lobe epilepsy: a comparison between fMRI and the Wada test. Epilepsia 47:1308–1319
Benson RR, FitzGerald DB, LeSueur LL et al (1999) Language dominance determined by whole brain functional MRI in patients with brain lesions. Neurology 52:798–809
Binder JR, Swanson SJ, Hammeke TA et al (1996) Determination of language dominance using functional MRI: a comparison with the Wada test. Neurology 46:978–984
Brannen JH, Badie B, Moritz CH et al (2001) Reliability of functional MR imaging with word-generation tasks for mapping Broca’s area. Am J Neuroradiol 22:1711–1718
Carpentier A, Pugh KR, Westerveld M et al (2001) Functional MRI of language processing: dependence on input modality and temporal lobe epilepsy. Epilepsia 42:1242–1254
Cousin E, Baciu M, Pichat C et al (2009) Functional MRI evidence for language plasticity in adult epileptic patients: preliminary results. Neuropsychiatr Dis Treat 4:235–256
Deblaere K, Boon PA, Vandemaele P et al (2004) MRI language dominance assessment in epilepsy patients at 1.0 T: region of interest analysis and comparison with intracarotid amytal testing. Neuroradiology 46:413–420
De Tiege X, Connelly A, Liegeois F et al (2009) Influence of motor functional magnetic resonance imaging on the surgical management of children and adolescents with symptomatic focal epilepsy. Neurosurgery 64:856–864
Desmond JE, Sum JM, Wagner AD et al (1995) Functional MRI measurement of language lateralization in Wada-tested patients. Brain 118:1411–1419
Detre J, Maccotta L, King D et al (1998) Functional MRI lateralization of memory in temporal lobe epilepsy. Neurology 50:926–932
Fernández G, de Greiff A, von Oertzen J et al (2001) Language mapping in less than 15 minutes: real-time functional MRI during routine clinical investigation. Neuroimage 14:585–594
Fernández G, Specht K, Weis S et al (2003) Intrasubject reproducibility of presurgical language lateralization and mapping using fMRI. Neurology 60:969–975
Frings L, Wagner K, Halsband U et al (2008) Lateralization of hippocampal activation differs between left and right temporal lobe epilepsy patients and correlates with postsurgical verbal learning decrement. Epilepsy Res 78:161–170
Gaillard W, Balsamo L, Xu B et al (2002) Language dominance in partial epilepsy patients identified with an fMRI reading task. Neurology 59:256–265
Gaillard W, Balsamo L, Xu B et al (2004) fMRI language task panel improves determination of language dominance. Neurology 63:1403–1408
Golby AJ, Poldrack RA, Brewer JB et al (2001) Material-specific lateralization in the medial temporal lobe and prefrontal cortex during memory encoding. Brain 124:1841–1854
Griffin S, Tranel D (2007) Age of seizure onset, functional reorganization, and neuropsychological outcome in temporal lobectomy. J Clin Exp Neuropsychol 29:13–24
Guzzetta A, Staudt M, Petacchi E et al (2007) Brain representation of active and passive hand movements in children. Pediatr Res 61:485–490
Haag A, Knake S, Hamer HM et al (2008) The Wada test in Austrian, Dutch, German, and Swiss epilepsy centers from 2000 to 2005: a review of 1421 procedures. Epilepsy Behav 13:83–89
Haller S, Bartsch AJ (2009) Pitfalls in fMRI. Eur Radiol [Epub]
Hamer HM, Morris HH, Mascha EJ et al (2002) Complications of invasive video-EEG monitoring with subdural grid electrodes. Neurology 58:97–103
Hertz-Pannier L, Gaillard WD, Mott SH et al (1997) Noninvasive assessment of language dominance in children and adolescents with functional MRI: a preliminary study. Neurology 48:1003–1012
Hirsch J, Ruge MI, Kim KH et al (2000) An integrated functional magnetic resonance imaging procedure for preoperative mapping of cortical areas associated with tactile, motor, language, and visual functions. Neurosurgery 47:711–21
Jansen JF, Aldenkamp AP, Marian, Ajoie HJ et al (2006) Functional MRI reveals declined prefrontal cortex activation in patients with epilepsy on topiramate therapy. Epilepsy Behav 9:181–185
Janszky J, Ebner A, Kruse B et al (2003) Functional organization of the brain with malformations of cortical development. Ann Neurol 53:759–767
Janszky J, Jokeit H, Kontopoulou K et al (2005) Functional MRI predicts memory performance after right mesiotemporal epilepsy surgery. Epilepsia 46:244–250
Janszky J, Ollech I, Jokeit H et al (2004) Epileptic activity influences the lateralization of mesiotemporal fMRI activity. Neurology 63:1813–1817
Jayakar P, Bernal B, Santiago Medina L, Altman N (2002) False lateralization of language cortex on functional MRI after a cluster of focal seizures. Neurology 58:490–492
Jokeit H, Okujava M, Woermann FG (2001) Memory fMRI lateralizes temporal lobe epilepsy. Neurology 57:1786–1793
Krings T, Schreckenberger M, Rohde V et al (2001) Metabolic and electrophysiological validation of functional MRI. J Neurol Neurosurg Psychiatry 71:762–771
Krings T, Töpper R, Willmes K et al (2002) Activation in primary and secondary motor areas in patients with CNS neoplasms and weakness. Neurology 58:381–390
Lehéricy S, Cohen L, Bazin B et al (2000) Functional MR evaluation of temporal and frontal language dominance compared with the Wada test. Neurology 54:1625–1633
Liégeois F, Connelly A, Salmond CH et al (2002) A direct test for lateralization of language activation using fMRI: comparison with invasive assessments in children with epilepsy. Neuroimage 17:1861–1867
Medina LS, Bernal B, Ruiz J (2007) Role of functional MR in determining language dominance in epilepsy and nonepilepsy populations: a Bayesian analysis. Radiology 242:94–100
Möddel G, Lineweaver T, Schuele SU et al (2009) Atypical language lateralization in epilepsy patients. Epilepsia 50:1506–1516
Powell HW, Richardson MP, Symms MR et al (2007) Preoperative fMRI predicts memory decline following anterior temporal lobe resection. J Neurol Neurosurg Psychiatry 79:686–693
Rabin ML, Narayan VM, Kimberg DY et al (2004) Functional MRI predicts post-surgical memory following temporal lobectomy. Brain 127:2286–2298
Richardson MP, Strange BA, Thompson PJ et al (2004) Pre-operative verbal memory fMRI predicts post-operative memory decline after left temporal lobe resection. Brain 127:2419–2426
Rutten GJ, Ramsey NF, van Rijen PC et al (2002) Intrahemispheric reorganization of motor hand function to the primary motor cortex predicted with functional magnetic resonance imaging and transcranial magnetic stimulation. J Child Neurol 17:292–297
Rutten GJ, Ramsey NF, van Rijen PC et al (2002a) FMRI-determined language lateralization in patients with unilateral or mixed language dominance according to the Wada test. Neuroimage 17:447–460
Rutten GJ, Ramsey NF, van Rijen PC et al (2002b) Development of a functional magnetic resonance imaging protocol for intraoperative localization of critical temporoparietal language areas. Ann Neurol 52:350–360
Sabbah P, Chassoux F, Leveque C et al (2003) Functional MR imaging in assessment of language dominance in epileptic patients. Neuroimage 18:460–467
Sabsevitz DS, Swanson JM, Hammeke TA et al (2003) Use of preoperative functional neuroimaging to predict language deficits from epilepsy. Neurology 60:1788–1792
Schlösser MJ, Luby M, Spencer DD et al (1999) Comparative localization of auditory comprehension by using functional magnetic resonance imaging and cortical stimulation. J Neurosurg 9:626–635
Spreer J, Arnold S, Quiske A et al (2002) Determination of hemisphere dominance for language: comparison of frontal and temporal fMRI activation with intracarotid amytal testing. Neuroradiology 44:467–474
Spreer J, Schwarzwald R, Garcia Mertixell A et al (2004) Stellenwert der fMRT zur Bestimmung der zerebralen Sprachdominanz: Eine aktuelle Standortbestimmung. Klin Neuroradiol 14:202–210
Springer JA, Binder JR, Hammeke TA et al (1999) Language dominance in neurologically normal and epilepsy subjects: a functional MRI study. Brain 122:2033–2046
Staudt M, Gerloff C, Grodd W et al (2004) Reorganization in congenital hemiparesis acquired at different gestational ages. Ann Neurol 56:854–863
Wagner K, Frings L, Halsband U et al (2007) Hippocampal functional connectivity reflects verbal episodic memory network integrity. Neuroreport 18:1719–1723
Wellmer J, Weber B, Weis S et al (2008) Strongly lateralized activation in language fMRI of atypical dominant patients – implications for presurgical work-up. Epilepsy Res 80:67–76
Woermann FG, Jokeit H, Luerding R et al (2003) Language lateralization by Wada test and fMRI in 100 patients with epilepsy. Neurology 61:699–701
Woermann FG, Vollmar C (2009) Clinical MRI in adults with focal epilepsy: a critical review. Epilepsy Behav 15:40–49
Worthington C, Vincent DJ, Bryant AE et al (1997) Comparison of functional magnetic resonance imaging for language localization and intracarotid speech amytal testing in presurgical evaluation for intractable epilepsy. Preliminary results. Stereotact Funct Neurosurg 69:197–201
Wüstenberg T, Jordan K, Giesel FL, Villinger A (2003) Physiologische und technische Grenzen der funktionellen Magnetresonanztomographie und die damit verbundenen Konsequenzen für die klinische Anwendung. Radiologe 43:552–557
Yetkin W, Swanson S, Fischer M et al (1998) Functional MR of frontal lobe activation: comparison with Wada language results. Am J Neuroradiol 19:1095–1098
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Woermann, F., Labudda, K. Klinischer Einsatz der funktionellen MRT bei chronischer Epilepsie. Radiologe 50, 123–130 (2010). https://doi.org/10.1007/s00117-009-1894-z
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DOI: https://doi.org/10.1007/s00117-009-1894-z