Cortical stimulation mapping for localization of visual and auditory language in pediatric epilepsy patients.
Abstract
OBJECTIVE:To determine resection margins near eloquent tissue, electrical cortical
stimulation (ECS) mapping is often used with visual naming tasks. In recent years,
auditory naming tasks have been found to provide a more comprehensive map. Differences
in modality-specific language sites have been found in adult patients, but there is
a paucity of research on ECS language studies in pediatric patients. The goals of
this study were to evaluate word-finding distinctions between visual and auditory
modalities and identify which cortical subregions most often contain critical language
function in a pediatric population. METHODS:Twenty-one pediatric patients with epilepsy
or temporal lobe pathology underwent ECS mapping using visual (n = 21) and auditory
(n = 14) tasks. Fisher's exact test was used to determine whether the frequency of
errors in the stimulated trials was greater than the patient's baseline error rate
for each tested modality and subregion. RESULTS:While the medial superior temporal
gyrus was a common language site for both visual and auditory language (43.8% and
46.2% of patients, respectively), other subregions showed significant differences
between modalities, and there was significant variability between patients. Visual
language was more likely to be located in the anterior temporal lobe than was auditory
language. The pediatric patients exhibited fewer parietal language sites and a larger
range of sites overall than did adult patients in previously published studies. CONCLUSIONS:There
was no single area critical for language in more than 50% of patients tested in either
modality for which more than 1 patient was tested (n > 1), affirming that language
function is plastic in the setting of dominant-hemisphere pathology. The high rates
of language function throughout the left frontal, temporal, and anterior parietal
regions with few areas of overlap between modalities suggest that ECS mapping with
both visual and auditory testing is necessary to obtain a comprehensive language map
prior to epileptic focus or tumor resection.
Type
Journal articleSubject
AMTG = anterior middle temporal gyrusASMG = anterior supramarginal gyrus
ASTG = anterior superior temporal gyrus
ECS = electrical cortical stimulation
MITG = medial inferior temporal gyrus
MMTG = medial middle temporal gyrus
MPrG = medial precentral gyrus
MSTG = medial superior temporal gyrus
OpIFG = opercular inferior frontal gyrus
PMFG = posterior middle frontal gyrus
PMTG = posterior middle temporal gyrus
PSMG = posterior supramarginal gyrus
PSTG = posterior superior temporal gyrus
PolMTG = polar middle temporal gyrus
auditory
brain mapping
cortical stimulation
epilepsy
fMRI = functional MRI
language
pediatric
temporal
visual
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https://hdl.handle.net/10161/25391Published Version (Please cite this version)
10.3171/2019.8.peds1922Publication Info
Muh, Carrie R; Chou, Naomi D; Rahimpour, Shervin; Komisarow, Jordan M; Spears, Tracy
G; Fuchs, Herbert E; ... Grant, Gerald A (2019). Cortical stimulation mapping for localization of visual and auditory language in pediatric
epilepsy patients. Journal of neurosurgery. Pediatrics, 25(2). pp. 1-10. 10.3171/2019.8.peds1922. Retrieved from https://hdl.handle.net/10161/25391.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Herbert Edgar Fuchs
Professor of Neurosurgery
Clinical neuro-oncology research including collaborations studying molecular genetics
of childhood brain tumors. Potential role of the free electron laser in surgery
of pediatric brain tumors. Current work includes animal models with human brain tumor
xenografts in preclinical studies. Collaboration with the neurooncology laboratory
of Dr. Darell Bigner in preclinical studies of new therapeutic agents.
Gerald Arthur Grant
Allan H. Friedman Distinguished Professor of Neurosurgery
Jordan Komisarow
Assistant Professor of Neurosurgery
Carrie Rebecca Muh
Adjunct Assistant Professor in the Department of Neurosurgery
Carrie R. Muh is a Pediatric Neurosurgeon specializing in the surgical treatment of
epilepsy. She worked full time at Duke University from 2011 to 2019 and became Adjunct
faculty when she moved to New York Medical College in 2019. Dr. Muh grew up in California
and began scientific research in high school as part of the NASA Student Space Biology
initiative. She went on to study at the Massachusetts Institute of Technology (MIT)
where she earned two Bachelor's degrees, in Biology
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