TY - JOUR T1 - Real-time functional mapping: potential tool for improving language outcome in pediatric epilepsy surgery. JF - J Neurosurg Pediatr Y1 - 2014 A1 - Korostenskaja, Milena A1 - Chen, Po-Ching A1 - Salinas, Christine M A1 - Westerveld, Michael A1 - Peter Brunner A1 - Gerwin Schalk A1 - Cook, Jane C A1 - Baumgartner, James A1 - Lee, Ki H KW - Adolescent KW - Anticonvulsants KW - Brain Mapping KW - Cerebral Cortex KW - Electric Stimulation KW - Electroencephalography KW - Epilepsies, Partial KW - Female KW - Humans KW - Language KW - Neuropsychological Tests KW - Sensitivity and Specificity KW - Speech AB -

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.

VL - 14 UR - http://www.ncbi.nlm.nih.gov/pubmed/24995815 IS - 3 ER - TY - JOUR T1 - Real-Time Functional Mapping with Electrocorticography in Pediatric Epilepsy: Comparison with fMRI and ESM Findings. JF - Clinical EEG and neuroscience Y1 - 2014 A1 - Korostenskaja, Milena A1 - Adam J Wilson A1 - Rose, Douglas F A1 - Peter Brunner A1 - Gerwin Schalk A1 - Leach, James A1 - Mangano, Francesco T A1 - Fujiwara, Hisako A1 - Rozhkov, Leonid A1 - Harris, Elana A1 - Chen, Po-Ching A1 - Seo, Joo-Hee A1 - Lee, Ki H KW - Brain-computer interface (BCI) KW - cortical stimulation KW - electrocorticography (ECoG) KW - epilepsy surgery KW - functional magnetic resonance imaging (fMRI) KW - functional mapping KW - pediatrics KW - SIGFRIED AB - SIGFRIED (SIGnal modeling For Real-time Identification and Event Detection) software provides real-time functional mapping (RTFM) of eloquent cortex for epilepsy patients preparing to undergo resective surgery. This study presents the first application of paradigms used in functional magnetic resonance (fMRI) and electrical cortical stimulation mapping (ESM) studies for shared functional cortical mapping in the context of RTFM. Results from the 3 modalities are compared. A left-handed 13-year-old male with intractable epilepsy participated in functional mapping for localization of eloquent language cortex with fMRI, ESM, and RTFM. For RTFM, data were acquired over the frontal and temporal cortex. Several paradigms were sequentially presented: passive (listening to stories) and active (picture naming and verb generation). For verb generation and story processing, fMRI showed atypical right lateralizing language activation within temporal lobe regions of interest and bilateral frontal activation with slight right lateralization. Left hemisphere ESM demonstrated no eloquent language areas. RTFM procedures using story processing and picture naming elicited activity in the right lateral and basal temporal regions. Verb generation elicited strong right lateral temporal lobe activation, as well as left frontal lobe activation. RTFM results confirmed atypical language lateralization evident from fMRI and ESM. We demonstrated the feasibility and usefulness of a new RTFM stimulation paradigm during presurgical evaluation. Block design paradigms used in fMRI may be optimal for this purpose. Further development is needed to create age-appropriate RTFM test batteries. UR - http://www.ncbi.nlm.nih.gov/pubmed/24293161 ER -