Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
Epilepsia. 2024 Jul;65(7):1879-1898. doi: 10.1111/epi.18009. Epub 2024 May 24.
Electrical stimulation mapping (ESM) is used to locate the brain areas supporting language directly within the human cortex to minimize the risk of functional decline following epilepsy surgery. ESM is completed by utilizing subdural grid or depth electrodes (stereo-electroencephalography [sEEG]) in combination with behavioral evaluation of language. Despite technological advances, there is no standardized method of assessing language during pediatric ESM. To identify current clinical practices for pediatric ESM of language, we surveyed neuropsychologists in the Pediatric Epilepsy Research Consortium. Results indicated that sEEG is used for functional mapping at >80% of participating epilepsy surgery centers (n = 13/16) in the United States. However, >65% of sites did not report a standardized protocol to map language. Survey results indicated a clear need for practice recommendations regarding ESM of language. We then utilized PubMed/Medline and PsychInfo to identify 42 articles that reported on ESM of language, of which 18 met inclusion criteria, which included use of ESM/signal recording to localize language regions in children (<21 years) and a detailed account of the procedure and language measures used, and region-specific language localization outcomes. Articles were grouped based on the language domain assessed, language measures used, and the brain regions involved. Our review revealed the need for evidence-based clinical guidelines for pediatric language paradigms during ESM and a standardized language mapping protocol as well as standardized reporting of brain regions in research. Relevant limitations and future directions are discussed with a focus on considerations for pediatric language mapping.
电刺激映射(ESM)用于在人类大脑皮层内直接定位支持语言的脑区,以最大程度地降低癫痫手术后功能下降的风险。ESM 通过利用硬膜下网格或深度电极(立体脑电图 [sEEG])与语言行为评估相结合来完成。尽管技术有所进步,但在儿科 ESM 中评估语言尚无标准化方法。为了确定儿科语言 ESM 的当前临床实践,我们对儿科癫痫研究联合会的神经心理学家进行了调查。结果表明,超过 80%的美国参与癫痫手术中心(n=13/16)使用 sEEG 进行功能映射。然而,超过 65%的地点未报告用于语言映射的标准化方案。调查结果表明,明确需要制定有关语言 ESM 的实践建议。然后,我们利用 PubMed/Medline 和 PsychInfo 确定了 42 篇报告语言 ESM 的文章,其中 18 篇符合纳入标准,包括使用 ESM/信号记录在儿童(<21 岁)中定位语言区域,并详细说明使用的程序和语言措施以及特定区域的语言本地化结果。文章根据评估的语言域、使用的语言措施以及涉及的大脑区域进行分组。我们的综述表明,需要为儿科语言 ESM 制定基于证据的临床指南以及标准化的语言映射协议以及研究中大脑区域的标准化报告。讨论了相关的局限性和未来方向,重点是考虑儿科语言映射。
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