Language and motor function thresholds during pediatric extra-operative electrical cortical stimulation brain mapping

Alonso Zea Vera, Gewalin Aungaroon, Paul S. Horn, Anna W. Byars, Hansel M. Greiner, Jeffrey R. Tenney, Todd M. Arthur, Nathan E. Crone, Katherine D. Holland, Francesco T. Mangano, Ravindra Arya

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2087-2093
Number of pages7
JournalClinical Neurophysiology
Volume128
Issue number10
DOIs
StatePublished - Oct 2017

Keywords

  • After-discharges
  • Direct cortical stimulation
  • Epilepsy surgery
  • Functional brain mapping

ASJC Scopus subject areas

  • Sensory Systems
  • Neurology
  • Clinical Neurology
  • Physiology (medical)

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    Zea Vera, A., Aungaroon, G., Horn, P. S., Byars, A. W., Greiner, H. M., Tenney, J. R., Arthur, T. M., Crone, N. E., Holland, K. D., Mangano, F. T., & Arya, R. (2017). Language and motor function thresholds during pediatric extra-operative electrical cortical stimulation brain mapping. Clinical Neurophysiology, 128(10), 2087-2093. https://doi.org/10.1016/j.clinph.2017.07.006