title: Presurgical language localization with visual naming associated ECoG high- gamma modulation in pediatric drug-resistant epilepsy.
abstract: This prospective study compared presurgical language localization with visual naming-associated high-γ modulation (HGM) and conventional electrical cortical stimulation (ECS) in children with intracranial electrodes.
  
  
  
  Patients with drug-resistant epilepsy who were undergoing intracranial monitoring were included if able to name pictures. Electrocorticography (ECoG) signals were recorded during picture naming (overt and covert) and quiet baseline. For each electrode the likelihood of high-γ (70-116 Hz) power modulation during naming task relative to the baseline was estimated. Electrodes with significant HGM were plotted on a three-dimensional (3D) cortical surface model. Sensitivity, specificity, and accuracy were calculated compared to clinical ECS.
  
  
  
  Seventeen patients with mean age of 11.3 years (range 4-19) were included. In patients with left hemisphere electrodes (n = 10), HGM during overt naming showed high specificity (0.81, 95% confidence interval [CI] 0.78-0.85), and accuracy (0.71, 95% CI 0.66-0.75, p < 0.001), but modest sensitivity (0.47) when ECS interference with naming (aphasia or paraphasic errors) and/or oral motor function was regarded as the gold standard. Similar results were reproduced by comparing covert naming-associated HGM with ECS naming sites. With right hemisphere electrodes (n = 7), no ECS-naming deficits were seen without interference with oral-motor function. HGM mapping showed a high specificity (0.81, 95% CI 0.78-0.84), and accuracy (0.76, 95% CI 0.71-0.81, p = 0.006), but modest sensitivity (0.44) compared to ECS interference with oral-motor function. Naming-associated ECoG HGM was consistently observed over Broca's area (left posterior inferior-frontal gyrus), bilateral oral/facial motor cortex, and sometimes over the temporal pole.
  
  
  
  This study supports the use of ECoG HGM mapping in children in whom adverse events preclude ECS, or as a screening method to prioritize electrodes for ECS testing.
authors.affiliation: Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
authors.forename: Ravindra
authors.initials: R
authors.lastname: Arya
authors.affiliation: Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.|Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
authors.forename: J Adam
authors.initials: JA
authors.lastname: Wilson
authors.affiliation: Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
authors.forename: Hisako
authors.initials: H
authors.lastname: Fujiwara
authors.affiliation: Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
authors.forename: Leonid
authors.initials: L
authors.lastname: Rozhkov
authors.affiliation: Division of Pediatric Neuroradiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
authors.forename: James L
authors.initials: JL
authors.lastname: Leach
authors.affiliation: Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
authors.forename: Anna W
authors.initials: AW
authors.lastname: Byars
authors.affiliation: Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
authors.forename: Hansel M
authors.initials: HM
authors.lastname: Greiner
authors.affiliation: Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Vannest
authors.affiliation: Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.|Division of Clinical Engineering, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
authors.forename: Jason
authors.initials: J
authors.lastname: Buroker
authors.affiliation: Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, U.S.A.|Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
authors.forename: Griffin
authors.initials: G
authors.lastname: Milsap
authors.affiliation: Complex Adaptive Systems Lab, Department of Electrical Engineering and Computing Systems, University of Cincinnati, Cincinnati, Ohio, U.S.A.
authors.forename: Brian
authors.initials: B
authors.lastname: Ervin
authors.affiliation: Complex Adaptive Systems Lab, Department of Electrical Engineering and Computing Systems, University of Cincinnati, Cincinnati, Ohio, U.S.A.
authors.forename: Ali
authors.initials: A
authors.lastname: Minai
authors.affiliation: Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.|Division of Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Horn
authors.affiliation: Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
authors.forename: Katherine D
authors.initials: KD
authors.lastname: Holland
authors.affiliation: Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
authors.forename: Francesco T
authors.initials: FT
authors.lastname: Mangano
authors.affiliation: Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
authors.forename: Nathan E
authors.initials: NE
authors.lastname: Crone
authors.affiliation: Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Rose
mesh_terms: D000293:Adolescent; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology; D001931:Brain Mapping; D002648:Child; D002675:Child, Preschool; D000069279:Drug Resistant Epilepsy / Q000503:physiopathology* / Q000601:surgery; D004558:Electric Stimulation; D004567:Electrodes, Implanted; D004569:Electroencephalography; D005260:Female; D007839:Functional Laterality; D065818:Gamma Rhythm / Q000502:physiology*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007802:Language; D008279:Magnetic Resonance Imaging; D008297:Male; D009275:Names; D010775:Photic Stimulation; D015898:Tomography Scanners, X-Ray Computed; D055815:Young Adult
keywords: Epilepsy surgery; Functional brain mapping; High-frequency oscillations; Language mapping