February 2017
Volume 25, Number 2
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Serving the Neurology Community Since 1993
AAN Guideline Assesses
fMRI for Presurgical Evaluation
of Patients With Epilepsy
When preparing for epilepsy surgery, neurologists may consider using functional MRI (fMRI) instead
of the intracarotid amobarbital procedure (IAP) to map
language and memory functions in the brain, according
to a practice guideline developed by the American
Academy of Neurology (AAN). The current evidence
is weak, however, and clinicians should advise patients carefully about the benefits and risks of IAP (also
known as the Wada test) and fMRI, according to the
guideline, which was published online ahead of print
January 11 in Neurology.
IAP, an invasive technique, is the current standard for
presurgical evaluation in epilepsy. fMRI is noninvasive
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and also considered safe. Neither of the two methods
has been standardized. “Because fMRI is becoming more
widely available, we wanted to see how it compares to
the Wada test,” said lead author Jerzy Szaflarski, MD,
PhD, Professor of Neurology at the University of Alabama at Birmingham. “While the risks associated with
the Wada test are rare, they can be serious, including
stroke and injury to the carotid artery.”
The AAN formed an 11-member panel to draft the
guidelines. Two panelists independently selected 37
possibly relevant articles. Studies with fewer than 15
cases, case reports, meta-analyses, and editorials were
excluded. Two panelists rated each article according
continued on page 7
© Mark Harmel / Science Source
