Functional Imaging with MRI using BOLD techniques plays an increasing role in clinical practice. fMRI may be used for interictal source localization but is more commonly used to identify eloquent areas to be spared during epilepsy surgery. fMRI is used to identify primary sensory cortex –visual, sensory, and auditory and to identify motor cortex. There are several language paradigms that may be used to identify frontal (“expressive”) and temporal (“receptive”) speech. These methods have excellent agreement with Wada and predict post operative naming outcomes. There are circumstances in which fMRI is not helpful as the BOLD response may be disrupted by several pathological processes. fMRI memory tasks have good agreement with Wada, demonstrate material specificity, show functional capacity to be more important than functional reserve, and may predict outcomes of specific memory tasks.
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