TY - JOUR
T1 - Language and motor function thresholds during pediatric extra-operative electrical cortical stimulation brain mapping
AU - Zea Vera, Alonso
AU - Aungaroon, Gewalin
AU - Horn, Paul S.
AU - Byars, Anna W.
AU - Greiner, Hansel M.
AU - Tenney, Jeffrey R.
AU - Arthur, Todd M.
AU - Crone, Nathan E.
AU - Holland, Katherine D.
AU - Mangano, Francesco T.
AU - Arya, Ravindra
N1 - Funding Information:
RA receives research support from Pediatric Epilepsy Research Foundation (Co-I). KDH receives funding from the following NIH Grants: R01 NS062756 (PI), R01 NS062806 (Co-I), and R01 NS065020 (Co-I). Other co-authors do not have any pertinent disclosures.
Publisher Copyright:
© 2017 International Federation of Clinical Neurophysiology
PY - 2017/10
Y1 - 2017/10
N2 - Objective To examine current thresholds and their determinants for language and motor mapping with extra-operative electrical cortical stimulation (ECS). Methods ECS electrocorticograph recordings were reviewed to determine functional thresholds. Predictors of functional thresholds were found with multivariable analyses. Results In 122 patients (age 11.9 ± 5.4 years), average minimum, frontal, and temporal language thresholds were 7.4 (± 3.0), 7.8 (± 3.0), and 7.4 (± 3.1) mA respectively. Average minimum, face, upper and lower extremity motor thresholds were 5.4 (± 2.8), 6.1 (± 2.8), 4.9 (± 2.3), and 5.3 (± 3.3) mA respectively. Functional and after-discharge (AD)/seizure thresholds were significantly related. Minimum, frontal, and temporal language thresholds were higher than AD thresholds at all ages. Minimum motor threshold was higher than minimum AD threshold up to 8.0 years of age, face motor threshold was higher than frontal AD threshold up to 11.8 years age, and lower subsequently. UE motor thresholds remained below frontal AD thresholds throughout the age range. Conclusions Functional thresholds are frequently above AD thresholds in younger children. Significance These findings raise concerns about safety and neurophysiologic validity of ECS mapping. Functional and AD/seizure thresholds relationships suggest individual differences in cortical excitability which cannot be explained by clinical variables.
AB - Objective To examine current thresholds and their determinants for language and motor mapping with extra-operative electrical cortical stimulation (ECS). Methods ECS electrocorticograph recordings were reviewed to determine functional thresholds. Predictors of functional thresholds were found with multivariable analyses. Results In 122 patients (age 11.9 ± 5.4 years), average minimum, frontal, and temporal language thresholds were 7.4 (± 3.0), 7.8 (± 3.0), and 7.4 (± 3.1) mA respectively. Average minimum, face, upper and lower extremity motor thresholds were 5.4 (± 2.8), 6.1 (± 2.8), 4.9 (± 2.3), and 5.3 (± 3.3) mA respectively. Functional and after-discharge (AD)/seizure thresholds were significantly related. Minimum, frontal, and temporal language thresholds were higher than AD thresholds at all ages. Minimum motor threshold was higher than minimum AD threshold up to 8.0 years of age, face motor threshold was higher than frontal AD threshold up to 11.8 years age, and lower subsequently. UE motor thresholds remained below frontal AD thresholds throughout the age range. Conclusions Functional thresholds are frequently above AD thresholds in younger children. Significance These findings raise concerns about safety and neurophysiologic validity of ECS mapping. Functional and AD/seizure thresholds relationships suggest individual differences in cortical excitability which cannot be explained by clinical variables.
KW - After-discharges
KW - Direct cortical stimulation
KW - Epilepsy surgery
KW - Functional brain mapping
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U2 - 10.1016/j.clinph.2017.07.006
DO - 10.1016/j.clinph.2017.07.006
M3 - Article
C2 - 28774583
AN - SCOPUS:85026402035
VL - 128
SP - 2087
EP - 2093
JO - Electroencephalography and Clinical Neurophysiology - Electromyography and Motor Control
JF - Electroencephalography and Clinical Neurophysiology - Electromyography and Motor Control
SN - 1388-2457
IS - 10
ER -