Presurgical Language fMRI in Epilepsy: An Introduction

  • Christopher F. A. BenjaminEmail author
  • Kostakis Gkiatis
  • George K. Matsopoulos
  • Kyriakos Garganis
Part of the Contemporary Clinical Neuroscience book series (CCNE)


Neurosurgery has the potential to cure epilepsy, but only if language-critical cortex can be identified and avoided. Functional magnetic resonance imaging (fMRI) was developed to map the brain correlates of cognition in the early 1990s and was rapidly translated from a research to a clinical tool: within 15 years, it had been validated and could be billed clinically for predicting language decline after neurosurgery. While fMRI is now well established as a clinical tool, it remains an unusually complex investigation. Its use requires knowledge of topics including epilepsy, cognitive assessment, fMRI physics, statistical analysis, and brain-behavior relationships. The goal of this chapter is to provide an accessible survey of a set of these areas for readers looking to gain an overview of fMRI. We examine the clinical context in epilepsy, aspects of cognitive design and available protocols, as well as data analysis and clinical reporting with reference to well-known (e.g., Broca’s, Wernicke’s areas) and less-appreciated language areas (e.g., Exner’s and basal temporal language areas). We lend particular emphasis to practical guidance and introduce the user to relevant tools and references throughout.


Electrical cortical stimulation Epilepsy Functional magnetic resonance imaging Language Wada test 



(Functional) magnetic resonance imaging


Analysis of Functional Neuroimages (software)


Blood oxygenation level dependent


Electrical cortical stimulation




FMRIB software library (software)


General linear model


Hemodynamic response function


Intracarotid Sodium Amytal procedure (colloquially ‘Wada test’)


Statistical Parametric Mapping (software)


Echo time


Temporal lobe epilepsy


Repetition time



This work was supported in part by an American Academy of Neurology Clinical Research Training Scheme award (2018; Benjamin).


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Further Reading

  1. Benjamin, CFA., Dhingra, I., Li AX, Blumenfeld H, Alkawadri R, Bickel S., … Spencer DD (2018) Presurgical language fMRI: Technical practices in epilepsy surgical planning. Human Brain Mapping, 39(10), 4032–4042.PubMedPubMedCentralCrossRefGoogle Scholar
  2. Benjamin, CFA, Li, A., Blumenfeld H, Constable RT, Alkawadri R, Bickel S., … Hirsch LJ (2018). Presurgical language fMRI: Clinical practices and patient outcomes in epilepsy surgical planning. Human Brain Mapping: 39(7): 2777–2785 A pair of surveys detailing how clinical fMRI is currently used by clinicians and acquired by analysts in epilepsy programs worldwide.PubMedPubMedCentralCrossRefGoogle Scholar
  3. Poldrack, R., Mumford, J., & Nichols, T. (2011). Handbook of functional MRI data analysis. New York, NY: Cambridge University Press. Overview of fMRI: This short, accessible and clearly written volume covers virtually all practical aspects of fMRI, from selecting software to understanding analysis.Google Scholar
  4. Szaflarski, J., Gloss, D., Binder, J., Gaillard, W., Golby, A., Holland, S., … Theodore, W. (2017). Practice guideline summary: Use of fMRI in the presurgical evaluation of patients with epilepsy. Neurology, 88(4), 395–402. Reviews the data supporting clinical language fMRI in epilepsy surgical planning from a peak neurological body.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Christopher F. A. Benjamin
    • 1
    Email author
  • Kostakis Gkiatis
    • 2
  • George K. Matsopoulos
    • 2
  • Kyriakos Garganis
    • 3
  1. 1.Yale University School of MedicineNew HavenUSA
  2. 2.Department of Electrical and Computer EngineeringNational Technical University of AthensAthensGreece
  3. 3.Epilepsy Monitoring UnitSt Luke’s HospitalThessalonikiGreece

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