A novel effective paradigm of intraoperative electrical stimulation mapping in children

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  • 1 Departments of Paediatric Neurology and
  • 3 Neurosurgery, Second Faculty of Medicine and Motol University Hospital; and
  • 2 Departments of Measurement and
  • 4 Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Czech Republic
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OBJECTIVE

Resective epilepsy surgery is an established treatment method for children with focal intractable epilepsy, but the use of this method introduces the risk of postsurgical motor deficits. Electrical stimulation mapping (ESM), used to define motor areas and pathways, frequently fails in children. The authors developed and tested a novel ESM protocol in children of all age categories.

METHODS

The ESM protocol utilizes high-frequency electric cortical stimulation combined with continuous intraoperative motor-evoked potential (MEP) monitoring. The relationships between stimulation current intensity and selected presurgical and surgery-associated variables were analyzed in 66 children (aged 7 months to 18 years) undergoing 70 resective epilepsy surgeries in proximity to the motor cortex or corticospinal tracts.

RESULTS

ESM elicited MEP responses in all children. Stimulation current intensity was associated with patient age at surgery and date of surgery (F value = 6.81, p < 0.001). Increase in stimulation current intensity predicted postsurgical motor deficits (F value = 44.5, p < 0.001) without effects on patient postsurgical seizure freedom (p > 0.05).

CONCLUSIONS

The proposed ESM paradigm developed in our center represents a reliable method for preventing and predicting postsurgical motor deficits in all age groups of children. This novel ESM protocol may increase the safety and possibly also the completeness of epilepsy surgery. It could be adopted in pediatric epilepsy surgery centers.

ABBREVIATIONS ESM = electrical stimulation mapping; fMRI = functional MRI; MEP = motor-evoked potential.

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Contributor Notes

Correspondence Pavel Kršek: Motol Epilepsy Center, Charles University, Motol University Hospital, Prague, Czech Republic. pavel.krsek@post.cz.

INCLUDE WHEN CITING Published online April 17, 2020; DOI: 10.3171/2020.2.PEDS19451.

A.J. and B.B. contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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