Wellmer Jörg, Weber Christian, Mende Meinhard, von der Groeben Ferdinand, Urbach Horst, Clusmann Hans, Elger Christian E, Helmstaedter Christoph
Department of Epileptology, University Hospital Bonn, Bonn, Germany.
Epilepsia. 2009 Oct;50(10):2267-75. doi: 10.1111/j.1528-1167.2009.02192.x. Epub 2009 Jul 14.
Electrical stimulation mapping (ESM) is the gold standard for identifying language-relevant cortex prior to neurosurgical resections near the eloquent cortex. However, its application mode is not standardized, as some procedures rely on a single task, whereas others depend on task batteries. In this study, we examine whether multitask ESM is necessary, quantify the information loss that occurs from restricting the number of applied tasks, and search for a procedure that allows for time-efficient, multitask ESM.
Thirty-eight epilepsy and 11 brain tumor patients with subdural grid electrodes receive extraoperative ESM for language cortex at 1,890 stimulation sites. The applied test battery includes counting, naming, repeating, reading, Token Test, and body commands. Correlation analysis and principal component analysis are used to identify the functional overlap between tasks. Sensitivity analysis is the basis for determining the optimal task order, which requires a minimum number of stimulations for identifying language loci.
Correlation coefficients between tasks are -0.17 to 0.63; frontal and temporoparietal language cortex are organized differently. Naming is the most sensitive task, but 31% (temporoparietal) to 43% (frontal) of language sites remained undetected after naming alone. The optimal procedure starts with naming and the Token Test and differs thereafter between frontal and temporoparietal cortex. Omitting the Token Test and body commands from the battery results in up to 26% information loss.
Despite considerable overlap between different tasks, multitask ESM appears necessary to avoid missing language relevant cortex. Applying the tasks in an optimal order allows economizing the procedure.
在靠近明确皮层的神经外科手术切除前，电刺激图谱（ESM）是识别与语言相关皮层的金标准。然而，其应用模式并不标准化，因为一些程序依赖于单一任务，而其他程序则依赖于任务组。在本研究中，我们研究了多任务ESM是否必要，量化了因限制应用任务数量而产生的信息损失，并寻找一种能实现高效、多任务ESM的程序。
38例癫痫患者和11例脑肿瘤患者接受了硬膜下网格电极置入术，并在1890个刺激位点进行了语言皮层的术中ESM。应用的测试任务组包括计数、命名、复述、阅读、代币测验和身体指令。采用相关性分析和主成分分析来识别任务之间的功能重叠。敏感性分析是确定最佳任务顺序的基础，该顺序需要最少的刺激次数来识别语言位点。
任务之间的相关系数为-0.17至0.63；额叶和颞顶叶语言皮层的组织方式不同。命名是最敏感的任务，但仅进行命名后，仍有31%（颞顶叶）至43%（额叶）的语言位点未被检测到。最佳程序从命名和代币测验开始，此后额叶和颞顶叶皮层有所不同。从任务组中省略代币测验和身体指令会导致高达26%的信息损失。
尽管不同任务之间存在相当大的重叠，但多任务ESM似乎对于避免遗漏与语言相关的皮层是必要的。以最佳顺序应用任务可以节省程序时间。
