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

Alonso Zea Vera1, Gewalin Aungaroon1, Paul S Horn1

  • 1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.

Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology
|August 5, 2017
PubMed
Summary

Functional thresholds for electrical cortical stimulation (ECS) mapping are often higher than after-discharge (AD) thresholds in children, raising safety concerns for language and motor mapping.

Keywords:
After-dischargesDirect cortical stimulationEpilepsy surgeryFunctional brain mapping

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Area of Science:

  • Neuroscience
  • Epilepsy Surgery
  • Neurophysiology

Background:

  • Electrical cortical stimulation (ECS) is used for intraoperative brain mapping.
  • Determining safe and effective stimulation thresholds is crucial for patient outcomes.
  • Understanding age-related differences in cortical excitability is important for pediatric neurosurgery.

Purpose of the Study:

  • To investigate current thresholds for language and motor mapping using ECS.
  • To identify factors influencing these functional thresholds.
  • To compare functional thresholds with after-discharge (AD) thresholds in pediatric patients.

Main Methods:

  • Review of ECS electrocorticograph recordings from 122 pediatric patients.
  • Determination of functional thresholds for language and motor mapping.
  • Multivariable analyses to identify predictors of functional thresholds.

Main Results:

  • Language thresholds ranged from 7.4 to 7.8 mA, and motor thresholds from 4.9 to 6.1 mA.
  • Functional and AD/seizure thresholds were significantly related.
  • Language thresholds consistently exceeded AD thresholds; motor thresholds varied with age relative to AD thresholds.

Conclusions:

  • Functional thresholds for ECS mapping are frequently higher than AD thresholds in younger children.
  • These findings suggest potential safety and neurophysiologic validity concerns for ECS mapping in pediatric populations.
  • Individual differences in cortical excitability may explain observed threshold variations.