02881nas a2200397 4500008004100000022001400041245011100055210006900166260001200235300001100247490000700258520172500265653001501990653002002005653001802025653002002043653002502063653002702088653002402115653001102139653001102150653001302161653002902174653003202203653001102235100002602246700001902272700002602291700002402317700001902341700001902360700001802379700002302397700001502420856004802435 2014 eng d a1933-071500aReal-time functional mapping: potential tool for improving language outcome in pediatric epilepsy surgery.0 aRealtime functional mapping potential tool for improving languag c09/2014 a287-950 v143 a
Accurate language localization expands surgical treatment options for epilepsy patients and reduces the risk of postsurgery language deficits. Electrical cortical stimulation mapping (ESM) is considered to be the clinical gold standard for language localization. While ESM affords clinically valuable results, it can be poorly tolerated by children, requires active participation and compliance, carries a risk of inducing seizures, is highly time consuming, and is labor intensive. Given these limitations, alternative and/or complementary functional localization methods such as analysis of electrocorticographic (ECoG) activity in high gamma frequency band in real time are needed to precisely identify eloquent cortex in children. In this case report, the authors examined 1) the use of real-time functional mapping (RTFM) for language localization in a high gamma frequency band derived from ECoG to guide surgery in an epileptic pediatric patient and 2) the relationship of RTFM mapping results to postsurgical language outcomes. The authors found that RTFM demonstrated relatively high sensitivity (75%) and high specificity (90%) when compared with ESM in a "next-neighbor" analysis. While overlapping with ESM in the superior temporal region, RTFM showed a few other areas of activation related to expressive language function, areas that were eventually resected during the surgery. The authors speculate that this resection may be associated with observed postsurgical expressive language deficits. With additional validation in more subjects, this finding would suggest that surgical planning and associated assessment of the risk/benefit ratio would benefit from information provided by RTFM mapping.
10aAdolescent10aAnticonvulsants10aBrain Mapping10aCerebral Cortex10aElectric Stimulation10aElectroencephalography10aEpilepsies, Partial10aFemale10aHumans10aLanguage10aNeuropsychological Tests10aSensitivity and Specificity10aSpeech1 aKorostenskaja, Milena1 aChen, Po-Ching1 aSalinas, Christine, M1 aWesterveld, Michael1 aBrunner, Peter1 aSchalk, Gerwin1 aCook, Jane, C1 aBaumgartner, James1 aLee, Ki, H uhttp://www.ncbi.nlm.nih.gov/pubmed/24995815