Functional MRI?
September 19, 2012 6:23 PM   Subscribe

The fMRI (functional MRI) is primarily used in research; can I get one done for clinical reasons?

My neurologist is having me get an MRI later this week to investigate cognitive, learning, memory, and other brain problems that started a few months ago. My hunch is that the symptoms are related to severe sleep deprivation and medication interactions, so I'm guessing the MRI will come back ok. I'm concerned that there may be some damage or injury that's functional rather than structural in nature. (For example, severe sleep deprivation has been shown to impair frontal lobe functioning and hippocampus volume.)

If anything, an fMRI would, I think, be more likely to show what and where there are problems, and I'm wondering if there are any institutions using fMRI clinically-- or whether I might be able to be part of a research effort.

Can I get an fMRI done to help figure out what's going on?
posted by airguitar2 to Health & Fitness (11 answers total)
Hippocampus volume would show up on a structural scan, not functional. I'm also having trouble with "damage that's functional rather than structural in nature"-- it's all rooted in the biology of the brain. A chemical disruption wouldn't show up in fMRI any more than it would in structural. Have you read this paper?

With all those neurological issues, cognitive research studies are probably not going to enroll you, unless it's a study looking at sleep deprivation.

Doesn't hurt to ask about fMRI. You'll have the best luck if your doctor is at a hospital attached to a large research university, and does research himself/herself. EEG is much more common in a clinical setting. Ask about getting a sleep study (usually includes EEG), which is also clinically common. If the root of your trouble is sleep deprivation, that'll sort it out. fMRI probably wouldn't.
posted by supercres at 7:12 PM on September 19, 2012 [1 favorite]

What good would this information do your doctors? What good would it do you?
posted by phrontist at 7:22 PM on September 19, 2012 [2 favorites]

Response by poster: Here's the thing: my doctors are currently puzzled about what's going on-- their best guess is that I'm experiencing "depression," but I know that what I'm experiencing isn't depression. Been there, done that-- this ain't it. So what *is* it?

My hope (bear with me here) is that an fMRI might show exactly what areas of the brain (frontal lobe?) are experiencing lower activity than they should, and could perhaps give some insight as to what the best treatment would be. I am planning on getting a sleep study, and perhaps an EEG could show what areas are less active than they should be.
posted by airguitar2 at 7:32 PM on September 19, 2012

Phrontist has an excellent point. Doctors can diagnose problems related to severe sleep deprivation and medication interactions based on a simple history and physical exam - there is no need for an experimental fMRI.

fMRI simply is not used in standard clinical practice (at least not that I am aware of, although maybe it has some obscure use in the neurology world). It's expensive and it doesn't give us any valuable clinical information that would make it worth obtaining. It's interesting from an academic perspective, but if there's no researched evidence for treatments based on the findings... not very useful.

Also, you should be aware for discussion with doctors, in medical terminology a "functional disorder" can often be used as another term for a psychosomatic illness (the article I linked to defines it more diplomatically, but in common use that is how it is understood, i.e. "functional abdominal pain" is abdominal pain that no one will ever be able to find the etiology of through medical tests).
posted by treehorn+bunny at 7:49 PM on September 19, 2012 [2 favorites]

A problem with using a research technique as a diagnostic is that there are diagnostic guidelines inherent to tests used as 'diagnostic'. To put it very simply, when you get a blood test, the results include the number that came back for your blood along with the range of values that are normal and the range of values that are abnormal. For many diagnostic blood tests, there are a slew of arguments about what constitutes normal and what values indicate a need for treatment, and then there are the complications added by the fact that the method by which the blood is tested can skew things even more. That's why it's wrong for a doctor to use a diagnostic blood test as the sole indicator of any disease.

The research technique won't come with even these debatable guidelines, so it would be extremely difficult for anyone to say that you're normal or not, without a huge panel of other patients to compare you to. I'd say you're looking not just for an 'fMRI' but for a research group that performs the right fMRI for your suspected condition. Because they'd also have to have the right functional test for you to perform while you're in the MRI machine and the right metrics to figure out how you perform on this function. And even then, it might all just be very interesting, and possibly not useful to your diagnosis.

I can'tsuggest anyone doing clinical fMRIs, but the Neurology and Neuroscience department at Cornell/NYP in Manhattan does have a very active group during research fMRIs....maybe they could help steer you.
posted by Tandem Affinity at 8:00 PM on September 19, 2012 [5 favorites]

Sorry to hear you're having trouble.

You're definitely not part of a research study unless you have read and signed a consent form -- usually about 4-6 pages long and written in plain language. It would cover risks, explain that you will not be paid to participate in the study, and that while your participation might benefit others in future it will likely not benefit you in any way, explain that you may choose to drop out of the study at any time and that this decision would have no bearing on your further care or access to care. You would be walked through the form by a research nurse or assistant, asked if you understand each section, and likely also asked to initial every page.

In N America, medical research requires approval from an ethics board (usually based at the teaching university that is housing the research group in an academic situation). The ethics boards with which I am familiar are extremely strict, and reseach involving human subjects is taken very seriously.
posted by lulu68 at 8:02 PM on September 19, 2012

what areas of the brain (frontal lobe?) are experiencing lower activity than they should

Compared to what? That's how fMRI works: relative levels of activity, not absolute. It might show depressed response to stimulus, but even if you see that, it really doesn't inform treatment. You can't treat a low-functioning area directly unless you're doing DBS or TMS or something, and those really are more common as treatments for depression. Assuming your MRI is clean, get the sleep study, and work with your neurologist to find a drug that fixes your chemical balance, if one exists.
posted by supercres at 8:07 PM on September 19, 2012 [2 favorites]

A problem that no one is mentioning here is how much more expensive an fMRI is than an MRI. There is likely a list of symptoms and diseases that an insurance company will reimburse. I'm guessing that sleep depravation, depression and drug interactions aren't on that list.

Additionally, you can't just go get an fMRI and look for abnormalities in brain activity (for the most part, default network activity can be highly correlated with some problems such as autism). But most certainly for depression, fMRI is not needed to have a diagnosis. Depression is a list of symptoms. Depression can feel different than it felt last time and still be depression.
posted by Brent Parker at 11:47 PM on September 19, 2012 [1 favorite]

Concurring with others - there's a lot of debate about how useful fMRI is even as a research tool... it's very unlikely that your doctors (or any doctors) would be able to get any information from an fMRI that would be useful in directing your treatment.
posted by mskyle at 9:25 AM on September 20, 2012

unlike a regular anatomical MRI scan, an fMRI approach requires an actual study design, where you view/listen/touch/etc a stimulus, or perform a particular type of activity in a regulated fashion. Typically, this is done over a number of stimulus repetitions and over a number of subjects, to increase statistical power.

The design is then used to create a model against which the data is regressed. So if you viewed the experimental stimulus during certain time periods and the control stimulus during other time periods, you then look for voxels (3d pixels) which show activation patterns that match the pattern of stimulus onsets and offsets.

Designing an fMRI study isn't a trivial task, and, as far as I know, it's not as if you can just have a general fMRI scan. You generally have a very specific study design that asks a specific question.
posted by spacediver at 11:33 AM on September 20, 2012 [1 favorite]

If your doctors knew what to do with that information, they'd know to ask for it.

Depression is a bit of a catch-all term. It may be subjectively different from past depressions, but depression nonetheless.
posted by phrontist at 7:59 PM on September 20, 2012

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