Language dominance in children with epilepsy: concordance of fMRI with intracarotid amytal testing and cortical stimulation.

Accurate localization of language function is critical in children undergoing epilepsy surgery. Functional magnetic resonance imaging (fMRI) is a noninvasive mapping method that has begun to replace electrocortical stimulation mapping (ESM) and the intracarotid amytal test (IAT). We used both quantitative and qualitative methods to evaluate the concordance of fMRI with ESM and IAT in 20 children using a panel of language tasks. In no cases did fMRI assessment of language hemisphere dominance identify the opposite hemisphere from assessment by IAT or ESM. Concordance with IAT and ESM was higher using fMRI visual inspection than an fMRI laterality index, which failed to lateralize language in a number of the subjects. We have demonstrated that fMRI has good concordance with more traditional methods of language mapping. When fMRI demonstrates bilateral language activations, however, we continue to recommend confirmatory testing by either IAT or ESM prior to resection in classic language regions.