Presurgical brain mapping of the language network in pediatric patients with epilepsy using resting-state fMRI

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  • 1 Schulich School of Medicine & Dentistry and
  • | 2 Department of Electrical and Computer Engineering, Brain and Mind Institute, University of Western Ontario, London;
  • | 3 Lawson Health Research Institute, London;
  • | 4 Department of Medical Imaging, Children’s Hospital at London Health Sciences Centre, London; and
  • | 5 Departments of Pediatrics and
  • | 6 Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
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OBJECTIVE

Epilepsy affects neural processing and often causes intra- or interhemispheric language reorganization, rendering localization solely based on anatomical landmarks (e.g., Broca’s area) unreliable. Preoperative brain mapping is necessary to weigh the risk of resection with the risk of postoperative deficit. However, the use of conventional mapping methods (e.g., somatosensory stimulation, task-based functional MRI [fMRI]) in pediatric patients is technically difficult due to low compliance and their unique neurophysiology. Resting-state fMRI (rs-fMRI), a “task-free” technique based on the neural activity of the brain at rest, has the potential to overcome these limitations. The authors hypothesized that language networks can be identified from rs-fMRI by applying functional connectivity analyses.

METHODS

Cases in which both task-based fMRI and rs-fMRI were acquired as part of the preoperative clinical protocol for epilepsy surgery were reviewed. Task-based fMRI consisted of 2 language tasks and 1 motor task. Resting-state fMRI data were acquired while the patients watched an animated movie and were analyzed using independent component analysis (i.e., data-driven method). The authors extracted language networks from rs-fMRI data by performing a similarity analysis with functionally defined language network templates via a template-matching procedure. The Dice coefficient was used to quantify the overlap.

RESULTS

Thirteen children underwent conventional task-based fMRI (e.g., verb generation, object naming), rs-fMRI, and structural imaging at 1.5T. The language components with the highest overlap with the language templates were identified for each patient. Language lateralization results from task-based fMRI and rs-fMRI mapping were comparable, with good concordance in most cases. Resting-state fMRI–derived language maps indicated that language was on the left in 4 patients (31%), on the right in 5 patients (38%), and bilateral in 4 patients (31%). In some cases, rs-fMRI indicated a more extensive language representation.

CONCLUSIONS

Resting-state fMRI–derived language network data were identified at the patient level using a template-matching method. More than half of the patients in this study presented with atypical language lateralization, emphasizing the need for mapping. Overall, these data suggest that this technique may be used to preoperatively identify language networks in pediatric patients. It may also optimize presurgical planning of electrode placement and thereby guide the surgeon’s approach to the epileptogenic zone.

ABBREVIATIONS

fMRI = functional MRI; ICA = independent component analysis; LI = laterality index; MNI = Montreal Neurological Institute; rs-fMRI = resting-state fMRI; RSN = resting-state network.

Supplementary Materials

    • Supplemental Fig. 1 (PDF 926 KB)
Figure from Coblentz et al. (pp 346–356).

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Contributor Notes

Correspondence Daiana R. Pur: University of Western Ontario, London, ON, Canada. dpur@uwo.ca.

INCLUDE WHEN CITING Published online January 8, 2021; DOI: 10.3171/2020.8.PEDS20517.

Disclosures Dr. Andrade: consultant for UCB Canada, speakers bureau of Esai Canada, and clinical or research support for the study described from Linova Core VNS Study.

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