The role of functional MRI in the presurgical investigation of temporal lobe epilepsy patients: a clinical perspective and review.

Speculation regarding the role that fMRI might play in the presurgical assessment of temporal lobe epilepsy patients began almost as soon as the technology was introduced. Much of this speculation centred on hopes that fMRI might eventually supersede the invasive intracarotid amobarbital procedure (IAP). This review examines the progress that has been made to date towards this aim. A decade after its inception, fMRI paradigms that reliably lateralize language dominance have been established. However, fMRI has yet to achieve its full potential in the mapping of clinically relevant language skills in presurgical epilepsy patients. The role of fMRI in the assessment of postoperative amnesic risk is more complex. The results from recent fMRI memory studies in people with epilepsy have been encouraging. However, as yet, fMRI techniques cannot be used alone to confidently assess the risk of a postsurgical amnesic syndrome. It seems probable that these techniques will continue to be combined with traditional neuropsychological assessment and information from structural MRI studies and the other presurgical investigations to assess postoperative amnesic risk.