So Elson L, Alwaki Abdulrahman
Mayo Clinic College of Medicine and Science, Rochester, Minnesota, U.S.A.
J Clin Neurophysiol. 2018 Mar;35(2):98-105. doi: 10.1097/WNP.0000000000000435.
Electrical stimulation mapping (ESM) of the brain remains a major procedure for guiding epilepsy and tumor surgeries. This article collates available experiences and data in ESM to develop a guide for conducting the procedure. There are many factors that influence the yield of ESM. The stimulation parameters offered in this article need to be adjusted within safe limits to address the factors. Each ESM procedure should be tailored to the patient's age and baseline mental or psychological capacity. Stimulation-induced seizures and EEG afterdischarges disrupt ESM procedure and render the interpretation of the results difficult. There are specific measures that can lessen the risk of seizures and afterdischarges during ESM. Electrical stimulation mapping procedure requires several tasks on the part of those conducting the procedure, such as operating the stimulator and the EEG recording equipment, administering behavioral or language tests and observing both patient and EEG responses to the stimulation. A team of experienced staff is necessary for individual assumption of each task. Knowledge of the spatial relationship between electrode contacts and underlying normal or abnormal brain structures is essential for interpreting ESM results. When testing for motor or sensory response, be aware of the distinction between responses at the primary motor area and responses at the supplementary sensorimotor area. The anatomy of supplementary sensorimotor area is more variable and functional than it is fixed and structural, although its general confines and somatotopic organization are known. In addition, negative motor responses to stimulation must be recognized to avoid misinterpretation of ESM results, especially in language mapping.
大脑电刺激图谱（ESM）仍然是指导癫痫和肿瘤手术的主要手段。本文整理了ESM方面的现有经验和数据，以制定该操作的指南。有许多因素会影响ESM的成功率。本文提供的刺激参数需要在安全范围内进行调整，以应对这些因素。每次ESM操作都应根据患者的年龄以及基线精神或心理能力进行调整。刺激诱发的癫痫发作和脑电图后放电会干扰ESM操作，并使结果解读变得困难。有一些特定措施可以降低ESM期间癫痫发作和后放电的风险。大脑电刺激图谱操作要求实施该操作的人员完成多项任务，例如操作刺激器和脑电图记录设备、进行行为或语言测试以及观察患者和脑电图对刺激的反应。需要一组经验丰富的工作人员分别承担各项任务。了解电极触点与潜在正常或异常脑结构之间的空间关系对于解读ESM结果至关重要。在测试运动或感觉反应时，要注意区分初级运动区的反应和辅助感觉运动区的反应。辅助感觉运动区的解剖结构比其固定结构更具变异性和功能性，尽管其大致范围和躯体定位组织是已知的。此外，必须识别对刺激的负性运动反应，以避免误解ESM结果，尤其是在语言图谱绘制中。
