Real-time functional mapping: potential tool for improving language outcome in pediatric epilepsy surgery

Area of Science:

• Neuroscience
• Epileptology
• Pediatric Neurosurgery

Background:

• Accurate language localization is crucial for epilepsy surgery to expand treatment options and minimize post-surgical language deficits.
• Electrical cortical stimulation mapping (ESM) is the gold standard but is challenging for pediatric patients due to tolerability, compliance, and time constraints.
• Alternative methods for functional brain mapping in children are needed to precisely identify eloquent cortex.

Observation:

• This case report evaluated real-time functional mapping (RTFM) using high gamma band electrocorticography (ECoG) in a pediatric epilepsy patient.
• RTFM was used to guide language localization during surgery.
• The study assessed the relationship between RTFM findings and postsurgical language outcomes.

Findings:

• RTFM demonstrated high sensitivity (75%) and specificity (90%) compared to ESM.
• RTFM identified additional areas of expressive language activation not identified by ESM.
• Resection of these RTFM-identified areas correlated with postsurgical expressive language deficits.

Implications:

• RTFM may offer a valuable, less invasive alternative or complement to ESM for language mapping in pediatric epilepsy surgery.
• RTFM findings could enhance surgical planning and risk/benefit assessments.
• Further validation is needed to confirm RTFM's utility and impact on patient outcomes.