TY - JOUR
T1 - Presurgical language localization with visual naming associated ECoG high- gamma modulation in pediatric drug-resistant epilepsy
AU - Arya, Ravindra
AU - Wilson, J. Adam
AU - Fujiwara, Hisako
AU - Rozhkov, Leonid
AU - Leach, James L.
AU - Byars, Anna W.
AU - Greiner, Hansel M.
AU - Vannest, Jennifer
AU - Buroker, Jason
AU - Milsap, Griffin
AU - Ervin, Brian
AU - Minai, Ali
AU - Horn, Paul S.
AU - Holland, Katherine D.
AU - Mangano, Francesco T.
AU - Crone, Nathan E.
AU - Rose, Douglas F.
N1 - Publisher Copyright:
Wiley Periodicals, Inc. © 2017 International League Against Epilepsy
PY - 2017/4/1
Y1 - 2017/4/1
N2 - Objective: This prospective study compared presurgical language localization with visual naming–associated high-γ modulation (HGM) and conventional electrical cortical stimulation (ECS) in children with intracranial electrodes. Methods: Patients with drug-resistant epilepsy who were undergoing intracranial monitoring were included if able to name pictures. Electrocorticography (ECoG) signals were recorded during picture naming (overt and covert) and quiet baseline. For each electrode the likelihood of high-γ (70–116 Hz) power modulation during naming task relative to the baseline was estimated. Electrodes with significant HGM were plotted on a three-dimensional (3D) cortical surface model. Sensitivity, specificity, and accuracy were calculated compared to clinical ECS. Results: Seventeen patients with mean age of 11.3 years (range 4–19) were included. In patients with left hemisphere electrodes (n = 10), HGM during overt naming showed high specificity (0.81, 95% confidence interval [CI] 0.78–0.85), and accuracy (0.71, 95% CI 0.66–0.75, p < 0.001), but modest sensitivity (0.47) when ECS interference with naming (aphasia or paraphasic errors) and/or oral motor function was regarded as the gold standard. Similar results were reproduced by comparing covert naming-associated HGM with ECS naming sites. With right hemisphere electrodes (n = 7), no ECS-naming deficits were seen without interference with oral-motor function. HGM mapping showed a high specificity (0.81, 95% CI 0.78–0.84), and accuracy (0.76, 95% CI 0.71–0.81, p = 0.006), but modest sensitivity (0.44) compared to ECS interference with oral-motor function. Naming-associated ECoG HGM was consistently observed over Broca's area (left posterior inferior-frontal gyrus), bilateral oral/facial motor cortex, and sometimes over the temporal pole. Significance: This study supports the use of ECoG HGM mapping in children in whom adverse events preclude ECS, or as a screening method to prioritize electrodes for ECS testing.
AB - Objective: This prospective study compared presurgical language localization with visual naming–associated high-γ modulation (HGM) and conventional electrical cortical stimulation (ECS) in children with intracranial electrodes. Methods: Patients with drug-resistant epilepsy who were undergoing intracranial monitoring were included if able to name pictures. Electrocorticography (ECoG) signals were recorded during picture naming (overt and covert) and quiet baseline. For each electrode the likelihood of high-γ (70–116 Hz) power modulation during naming task relative to the baseline was estimated. Electrodes with significant HGM were plotted on a three-dimensional (3D) cortical surface model. Sensitivity, specificity, and accuracy were calculated compared to clinical ECS. Results: Seventeen patients with mean age of 11.3 years (range 4–19) were included. In patients with left hemisphere electrodes (n = 10), HGM during overt naming showed high specificity (0.81, 95% confidence interval [CI] 0.78–0.85), and accuracy (0.71, 95% CI 0.66–0.75, p < 0.001), but modest sensitivity (0.47) when ECS interference with naming (aphasia or paraphasic errors) and/or oral motor function was regarded as the gold standard. Similar results were reproduced by comparing covert naming-associated HGM with ECS naming sites. With right hemisphere electrodes (n = 7), no ECS-naming deficits were seen without interference with oral-motor function. HGM mapping showed a high specificity (0.81, 95% CI 0.78–0.84), and accuracy (0.76, 95% CI 0.71–0.81, p = 0.006), but modest sensitivity (0.44) compared to ECS interference with oral-motor function. Naming-associated ECoG HGM was consistently observed over Broca's area (left posterior inferior-frontal gyrus), bilateral oral/facial motor cortex, and sometimes over the temporal pole. Significance: This study supports the use of ECoG HGM mapping in children in whom adverse events preclude ECS, or as a screening method to prioritize electrodes for ECS testing.
KW - Epilepsy surgery
KW - Functional brain mapping
KW - High-frequency oscillations
KW - Language mapping
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U2 - 10.1111/epi.13708
DO - 10.1111/epi.13708
M3 - Article
C2 - 28225156
AN - SCOPUS:85013482364
SN - 0013-9580
VL - 58
SP - 663
EP - 673
JO - Epilepsia
JF - Epilepsia
IS - 4
ER -