title: Real-time functional mapping with electrocorticography in pediatric epilepsy: comparison with fMRI and ESM findings.
abstract: SIGFRIED (SIGnal modeling For Real-time Identification and Event Detection) software provides real-time functional mapping (RTFM) of eloquent cortex for epilepsy patients preparing to undergo resective surgery. This study presents the first application of paradigms used in functional magnetic resonance (fMRI) and electrical cortical stimulation mapping (ESM) studies for shared functional cortical mapping in the context of RTFM. Results from the 3 modalities are compared. A left-handed 13-year-old male with intractable epilepsy participated in functional mapping for localization of eloquent language cortex with fMRI, ESM, and RTFM. For RTFM, data were acquired over the frontal and temporal cortex. Several paradigms were sequentially presented: passive (listening to stories) and active (picture naming and verb generation). For verb generation and story processing, fMRI showed atypical right lateralizing language activation within temporal lobe regions of interest and bilateral frontal activation with slight right lateralization. Left hemisphere ESM demonstrated no eloquent language areas. RTFM procedures using story processing and picture naming elicited activity in the right lateral and basal temporal regions. Verb generation elicited strong right lateral temporal lobe activation, as well as left frontal lobe activation. RTFM results confirmed atypical language lateralization evident from fMRI and ESM. We demonstrated the feasibility and usefulness of a new RTFM stimulation paradigm during presurgical evaluation. Block design paradigms used in fMRI may be optimal for this purpose. Further development is needed to create age-appropriate RTFM test batteries.
authors.forename: Milena
authors.initials: M
authors.lastname: Korostenskaja
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Wilson
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Rose
authors.forename: Peter
authors.initials: P
authors.lastname: Brunner
authors.forename: Gerwin
authors.initials: G
authors.lastname: Schalk
authors.forename: James
authors.initials: J
authors.lastname: Leach
authors.forename: Francesco T
authors.initials: FT
authors.lastname: Mangano
authors.forename: Hisako
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Leonid
authors.initials: L
authors.lastname: Rozhkov
authors.forename: Elana
authors.initials: E
authors.lastname: Harris
authors.forename: Po-Ching
authors.initials: PC
authors.lastname: Chen
authors.forename: Joo-Hee
authors.initials: JH
authors.lastname: Seo
authors.forename: Ki H
authors.initials: KH
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D001931:Brain Mapping / Q000379:methods*; D062207:Brain-Computer Interfaces; D002540:Cerebral Cortex / Q000503:physiopathology* / Q000601:surgery; D003198:Computer Simulation; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004292:Dominance, Cerebral / Q000502:physiology; D004558:Electric Stimulation / Q000379:methods; D004569:Electroencephalography / Q000379:methods*; D004827:Epilepsy / Q000175:diagnosis* / Q000503:physiopathology* / Q000601:surgery; D005240:Feasibility Studies; D005625:Frontal Lobe / Q000503:physiopathology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D064847:Multimodal Imaging / Q000379:methods; D012815:Signal Processing, Computer-Assisted; D012984:Software; D013067:Speech Perception / Q000502:physiology; D013702:Temporal Lobe / Q000503:physiopathology; D014705:Verbal Behavior / Q000502:physiology; D014825:Vocabulary