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Electromagnetic Source Imaging in Presurgical Evaluation of Children with Drug-Resistant Epilepsy
Published on: September 20, 2024
Multimodality localization of the sensorimotor cortex in pediatric patients undergoing epilepsy surgery
Carter D Wray1, Tim M Blakely, Sandra L Poliachik
1Department of Neurology, University of Washington, Seattle, Washington, USA. carterwraymd@gmail.com
Journal of Neurosurgery. Pediatrics
|June 12, 2012
Summary
High gamma electrocorticography (hgECoG) offers a more reliable, faster, and safer method for mapping sensorimotor cortex in children compared to traditional electrical cortical stimulation (ECS). This technique, along with fMRI and SSEPs, shows concordant results for localizing critical brain areas in pediatric epilepsy surgery.
Area of Science:
- Neuroscience
- Neurosurgery
- Pediatric Epilepsy
Background:
- Electrical cortical stimulation (ECS) is the gold standard for mapping cortical functional organization but has limitations including imprecision, potential for seizures, and low success rates, especially in children.
- Alternative methods like somatosensory evoked potentials (SSEPs), functional MRI (fMRI), and high gamma electrocorticography (hgECoG) reflect normal cortical function and offer potential improvements.
- Accurate localization of the sensorimotor cortex is crucial for neurosurgical interventions in pediatric epilepsy.
Purpose of the Study:
- To evaluate the concordance of sensorimotor cortex mapping using four different modalities: ECS, SSEPs, fMRI, and hgECoG in pediatric patients.
- To determine the efficacy, safety, and reliability of each mapping technique in children undergoing epilepsy surgery.
Main Methods:
- Retrospective chart review of pediatric patients who underwent epilepsy surgery between July 20, 1999, and July 1, 2011.
- Inclusion criteria required localization of the primary motor or somatosensory cortex using at least two of the following: ECS, SSEP, fMRI, or hgECoG.
- Analysis focused on the concordance and success rates of each mapping modality.
Main Results:
- Fifty pediatric patients met the inclusion criteria, with a mean age of 10.6 years at operation.
- High gamma electrocorticography (hgECoG) was the most successful modality for localizing the sensorimotor cortex, followed by SSEP and fMRI. ECS was least successful.
- The youngest patient undergoing hgECoG mapping was 2 years and 10 months old, representing the youngest reported case in the literature.
Conclusions:
- ECS, SSEP, fMRI, and hgECoG generally showed concordant results in localizing sensorimotor function in children.
- hgECoG demonstrated higher success rates, was faster, safer, and did not require patient cooperation, making it a preferred method for sensorimotor cortex mapping in pediatric epilepsy surgery.
- hgECoG and fMRI can effectively map the sensorimotor cortex in children younger than 3 years old, providing crucial information for surgical planning.
