Language lateralization with resting-state and task-based functional MRI in pediatric epilepsy

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Determining language laterality in patients with intractable epilepsy is important in operative planning. Wada testing is the gold standard, but it has a risk of stroke. Both Wada and task-based functional MRI (tb-fMRI) require patient cooperation. Recently, resting-state fMRI (rs-fMRI) has been explored for language lateralization. In the present study, the correlation between rs-fMRI and tb-fMRI in language lateralization is estimated in a pediatric population with intractable epilepsy.


rs-fMRI and tb-fMRI language lateralization testing performed as part of epilepsy surgery evaluation was retrospectively reviewed.


Twenty-nine patients underwent rs-fMRI and tb-fMRI; a total of 38 rs-fMRI studies and 30 tb-fMRI studies were obtained. tb-fMRI suggested left dominance in 25 of 30 cases (83%), right in 3 (10%), and in 2 (7%) the studies were nondiagnostic. In rs-fMRI, 26 of 38 studies (68%) suggested left dominance, 3 (8%) right dominance, 6 (16%) bilateral, and 3 (8%) were nondiagnostic. When tb-fMRI lateralized to the left hemisphere (25 cases), rs-fMRI was lateralized to the left in 23 patients (92%) and it was bilateral/equal in 2 (8%). When tb-fMRI lateralized to the right (3 cases), rs-fMRI lateralized to the right in all cases (100%). The overall concordance rate was 0.93 (95% CI 0.76–0.99) when considering cases with tb-fMRI and rs-fMRI performed within 6 months of each other, and tb-fMRI results were not nondiagnostic.


rs-fMRI significantly correlated with tb-fMRI in lateralizing language and suggests the potential role for identifying hemispheric dominance via rs-fMRI. Further investigation and validation studies are warranted.

ABBREVIATIONS BOLD = blood oxygen level–dependent; fMRI = functional MRI; rs-fMRI = resting-state fMRI; RSN = resting-state network; tb-fMRI = task-based fMRI.

Article Information

Correspondence Varina L. Boerwinkle: Phoenix Children’s Hospital, Barrow Neurological Institute, Phoenix, AZ.

INCLUDE WHEN CITING Published online October 19, 2018; DOI: 10.3171/2018.7.PEDS18162.

Disclosures Dr. Curry reports being a consultant for Medtronic, Inc., and Monteris, Inc. Dr. Wilfong reports being a consultant for LivaNova. He receives support for non–study-related clinical or research efforts that he oversees from the following: LivaNova, UCB, Zogenix, and Greenwich Biosciences.

© AANS, except where prohibited by US copyright law.



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    An example of task-based language lateralization. Upper: Axial and sagittal images depicting expressive language function during tasks such as verb and word generation and sentence completion. Lower: Axial and sagittal images demonstrating receptive language function during tasks such as word and story listening. Studies demonstrated right-hemispheric dominance in this patient. Figure is available in color online only.

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    An example of resting-state language lateralization. Left and right: Axial, coronal, and sagittal images showing the patient’s language-area RSNs overlapping, each in a different color. The images on the right in the two panels are windowed to show the same patient’s left sagittal language view of the RSNs. The language network areas are spatially clearly far more extensive in the left rather than the right hemisphere, and this patient was determined to have left-hemispheric language dominance. Figure is available in color online only.





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