Real-Time Functional Mapping: Potential Tool for Improving Language Outcome in Pediatric Epilepsy Surgery
Journal Article - Open Access
Health Research, Inc. at Wadsworth Menands United States
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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 andor 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 90when 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 riskbenefit ratio would benefit from information provided by RTFM mapping.
- Medicine and Medical Research