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

Case report

View More View Less
  • 1 Functional Brain Mapping and Brain-Computer Interface Lab, Center for Pediatric Research and Outcomes and Comprehensive Pediatric Epilepsy Center;
  • | 3 Division of Neuropsychology; and
  • | 4 Comprehensive Pediatric Epilepsy Center, Florida Hospital for Children;
  • | 2 MEG Lab and
  • | 6 Department of Radiology, Florida Hospital, Orlando, Florida; and
  • | 5 Wadsworth Center, New York State Department of Health, Albany, New York
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

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.

Abbreviations used in this paper:

ECoG = electrocorticography; EEG = electroencephalography; ESM = electrical cortical stimulation mapping; RTFM = real-time functional mapping; SIGFRIED = SIGnal modeling For Real-time Identification and Event Detection.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Anderson NR, , Blakely T, , Schalk G, , Leuthardt EC, & Moran DW: Electrocorticographic (ECoG) correlates of human arm movements. Exp Brain Res 223:110, 2012

    • Search Google Scholar
    • Export Citation
  • 2

    Bauer PR, , Vansteensel MJ, , Bleichner MG, , Hermes D, , Ferrier CH, & Aarnoutse EJ, et al.: Mismatch between electrocortical stimulation and electrocorticography frequency mapping of language. Brain Stimulat 6:524531, 2013

    • Search Google Scholar
    • Export Citation
  • 3

    Berg AT, , Shinnar S, , Levy SR, , Testa FM, , Smith-Rapaport S, & Beckerman B: Early development of intractable epilepsy in children: a prospective study. Neurology 56:14451452, 2001

    • Search Google Scholar
    • Export Citation
  • 4

    Brown EC, , Rothermel R, , Nishida M, , Juhász C, , Muzik O, & Hoechstetter K, et al.: In vivo animation of auditory-language-induced gamma-oscillations in children with intractable focal epilepsy. Neuroimage 41:11201131, 2008

    • Search Google Scholar
    • Export Citation
  • 5

    Brunner P, , Ritaccio AL, , Lynch TM, , Emrich JF, , Wilson JA, & Williams JC, et al.: A practical procedure for real-time functional mapping of eloquent cortex using electrocorticographic signals in humans. Epilepsy Behav 15:278286, 2009

    • Search Google Scholar
    • Export Citation
  • 6

    Cervenka MC, , Corines J, , Boatman-Reich DF, , Eloyan A, , Sheng X, & Franaszczuk PJ, et al.: Electrocorticographic functional mapping identifies human cortex critical for auditory and visual naming. Neuroimage 69:267276, 2013

    • Search Google Scholar
    • Export Citation
  • 7

    Crone NE, , Boatman D, , Gordon B, & Hao L: Brazier Award-winning article, 2001. Induced electrocorticographic gamma activity during auditory perception. Clin Neurophysiol 112:565582, 2001

    • Search Google Scholar
    • Export Citation
  • 8

    Crone NE, , Miglioretti DL, , Gordon B, & Lesser RP: Functional mapping of human sensorimotor cortex with electrocorticographic spectral analysis. II Event-related synchronization in the gamma band. Brain 121:23012315, 1998

    • Search Google Scholar
    • Export Citation
  • 9

    Crone NE, , Miglioretti DL, , Gordon B, , Sieracki JM, , Wilson MT, & Uematsu S, et al.: Functional mapping of human sensorimotor cortex with electrocorticographic spectral analysis. I Alpha and beta event-related desynchronization. Brain 121:22712299, 1998

    • Search Google Scholar
    • Export Citation
  • 10

    Crone NE, , Sinai A, & Korzeniewska A: High-frequency gamma oscillations and human brain mapping with electrocorticography. Prog Brain Res 159:275295, 2006

    • Search Google Scholar
    • Export Citation
  • 11

    Davies KG, , Risse GL, & Gates JR: Naming ability after tailored left temporal resection with extraoperative language mapping: increased risk of decline with later epilepsy onset age. Epilepsy Behav 7:273278, 2005

    • Search Google Scholar
    • Export Citation
  • 12

    Edwards E, , Nagarajan SS, , Dalal SS, , Canolty RT, , Kirsch HE, & Barbaro NM, et al.: Spatiotemporal imaging of cortical activation during verb generation and picture naming. Neuroimage 50:291301, 2010

    • Search Google Scholar
    • Export Citation
  • 13

    Hermann BP, , Perrine K, , Chelune GJ, , Barr W, , Loring DW, & Strauss E, et al.: Visual confrontation naming following left anterior temporal lobectomy: a comparison of surgical approaches. Neuropsychology 13:39, 1999

    • Search Google Scholar
    • Export Citation
  • 14

    Korostenskaja M, , Wilson AJ, , Rose DF, , Brunner P, , Schalk G, & Leach J, et al.: Real-time functional mapping with electrocorticography in pediatric epilepsy: comparison with fMRI and ESM findings. Clin EEG Neurosci 2013

    • Search Google Scholar
    • Export Citation
  • 15

    Kunii N, , Kamada K, , Ota T, , Kawai K, & Saito N: A detailed analysis of functional magnetic resonance imaging in the frontal language area: a comparative study with extraoperative electrocortical stimulation. Neurosurgery 69:590597, 2011

    • Search Google Scholar
    • Export Citation
  • 16

    Leuthardt EC, , Miller K, , Anderson NR, , Schalk G, , Dowling J, & Miller J, et al.: Electrocorticographic frequency alteration mapping: a clinical technique for mapping the motor cortex. Neurosurgery 60:4 Suppl 2 260271, 2007

    • Search Google Scholar
    • Export Citation
  • 17

    Miller KJ, , Abel TJ, , Hebb AO, & Ojemann JG: Rapid online language mapping with electrocorticography. Clinical article. J Neurosurg Pediatr 7:482490, 2011

    • Search Google Scholar
    • Export Citation
  • 18

    Ojemann G, , Ojemann J, , Lettich E, & Berger M: Cortical language localization in left, dominant hemisphere. An electrical stimulation mapping investigation in 117 patients. J Neurosurg 71:316326, 1989

    • Search Google Scholar
    • Export Citation
  • 19

    Qian T, , Zhou W, , Ling Z, , Gao S, , Liu H, & Hong B: Fast presurgical functional mapping using task-related intracranial high gamma activity. Laboratory investigation. J Neurosurg 119:2636, 2013

    • Search Google Scholar
    • Export Citation
  • 20

    Schalk G, , Brunner P, , Gerhardt LA, , Bischof H, & Wolpaw JR: Brain-computer interfaces (BCIs): detection instead of classification. J Neurosci Methods 167:5162, 2008

    • Search Google Scholar
    • Export Citation
  • 21

    Schalk G, , Leuthardt EC, , Brunner P, , Ojemann JG, , Gerhardt LA, & Wolpaw JR: Real-time detection of event-related brain activity. Neuroimage 43:245249, 2008

    • Search Google Scholar
    • Export Citation
  • 22

    Schalk G, , McFarland DJ, , Hinterberger T, , Birbaumer N, & Wolpaw JR: BCI2000: a general-purpose brain-computer interface (BCI) system. IEEE Trans Biomed Eng 51:10341043, 2004

    • Search Google Scholar
    • Export Citation
  • 23

    Sinai A, , Bowers CW, , Crainiceanu CM, , Boatman D, , Gordon B, & Lesser RP, et al.: Electrocorticographic high gamma activity versus electrical cortical stimulation mapping of naming. Brain 128:15561570, 2005

    • Search Google Scholar
    • Export Citation
  • 24

    Sinai A, , Crone NE, , Wied HM, , Franaszczuk PJ, , Miglioretti D, & Boatman-Reich D: Intracranial mapping of auditory perception: event-related responses and electrocortical stimulation. Clin Neurophysiol 120:140149, 2009

    • Search Google Scholar
    • Export Citation
  • 25

    Vannest JJ, , Karunanayaka PR, , Altaye M, , Schmithorst VJ, , Plante EM, & Eaton KJ, et al.: Comparison of fMRI data from passive listening and active-response story processing tasks in children. J Magn Reson Imaging 29:971976, 2009

    • Search Google Scholar
    • Export Citation
  • 26

    Vansteensel MJ, , Bleichner MG, , Dintzner LT, , Aarnoutse EJ, , Leijten FS, & Hermes D, et al.: Task-free electrocorticography frequency mapping of the motor cortex. Clin Neurophysiol 124:11691174, 2013

    • Search Google Scholar
    • Export Citation
  • 27

    Wray CD, , Blakely TM, , Poliachik SL, , Poliakov A, , McDaniel SS, & Novotny EJ, et al.: Multimodality localization of the sensorimotor cortex in pediatric patients undergoing epilepsy surgery. Clinical article. J Neurosurg Pediatr 10:16, 2012

    • Search Google Scholar
    • Export Citation
  • 28

    Wu HC, , Nagasawa T, , Brown EC, , Juhasz C, , Rothermel R, & Hoechstetter K, et al.: γ-oscillations modulated by picture naming and word reading: intracranial recording in epileptic patients. Clin Neurophysiol 122:19291942, 2011

    • Search Google Scholar
    • Export Citation
  • 29

    Wu M, , Wisneski K, , Schalk G, , Sharma M, , Roland J, & Breshears J, et al.: Electrocorticographic frequency alteration mapping for extraoperative localization of speech cortex. Neurosurgery 66:E407E409, 2010

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 353 139 12
Full Text Views 338 18 1
PDF Downloads 189 14 1
EPUB Downloads 0 0 0