Real-time functional mapping: potential tool for improving language outcome in pediatric epilepsy surgery.

TitleReal-time functional mapping: potential tool for improving language outcome in pediatric epilepsy surgery.
Publication TypeJournal Article
Year of Publication2014
AuthorsKorostenskaja, M, Chen, P-C, Salinas, CM, Westerveld, M, Brunner, P, Schalk, G, Cook, JC, Baumgartner, J, Lee, KH
JournalJ Neurosurg Pediatr
Date Published09/2014
KeywordsAdolescent, Anticonvulsants, Brain Mapping, Cerebral Cortex, Electric Stimulation, Electroencephalography, Epilepsies, Partial, Female, Humans, Language, Neuropsychological Tests, Sensitivity and Specificity, Speech

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.

Alternate JournalJ Neurosurg Pediatr
PubMed ID24995815
PubMed Central IDPMC4405165
Grant ListEB00856 / EB / NIBIB NIH HHS / United States
P41 EB018783 / EB / NIBIB NIH HHS / United States
R01 EB000856 / EB / NIBIB NIH HHS / United States
R01 EB006356 / EB / NIBIB NIH HHS / United States

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