@article {3407, title = {Real-time functional mapping: potential tool for improving language outcome in pediatric epilepsy surgery.}, journal = {J Neurosurg Pediatr}, volume = {14}, year = {2014}, month = {09/2014}, pages = {287-95}, abstract = {

Accurate language localization expands surgical treatment options for epilepsy patients and reduces the risk of postsurgery language deficits. Electrical cortical stimulation mapping (ESM) is considered to be the clinical gold standard for language localization. While ESM affords clinically valuable results, it can be poorly tolerated by children, requires active participation and compliance, carries a risk of inducing seizures, is highly time consuming, and is labor intensive. Given these limitations, alternative and/or complementary functional localization methods such as analysis of electrocorticographic (ECoG) activity in high gamma frequency band in real time are needed to precisely identify eloquent cortex in children. In this case report, the authors examined 1) the use of real-time functional mapping (RTFM) for language localization in a high gamma frequency band derived from ECoG to guide surgery in an epileptic pediatric patient and 2) the relationship of RTFM mapping results to postsurgical language outcomes. The authors found that RTFM demonstrated relatively high sensitivity (75\%) and high specificity (90\%) when compared with ESM in a "next-neighbor" analysis. While overlapping with ESM in the superior temporal region, RTFM showed a few other areas of activation related to expressive language function, areas that were eventually resected during the surgery. The authors speculate that this resection may be associated with observed postsurgical expressive language deficits. With additional validation in more subjects, this finding would suggest that surgical planning and associated assessment of the risk/benefit ratio would benefit from information provided by RTFM mapping.

}, keywords = {Adolescent, Anticonvulsants, Brain Mapping, Cerebral Cortex, Electric Stimulation, Electroencephalography, Epilepsies, Partial, Female, Humans, Language, Neuropsychological Tests, Sensitivity and Specificity, Speech}, issn = {1933-0715}, doi = {10.3171/2014.6.PEDS13477}, url = {http://www.ncbi.nlm.nih.gov/pubmed/24995815}, author = {Korostenskaja, Milena and Chen, Po-Ching and Salinas, Christine M and Westerveld, Michael and Peter Brunner and Gerwin Schalk and Cook, Jane C and Baumgartner, James and Lee, Ki H} } @article {2197, title = {Passive real-time identification of speech and motor cortex during an awake craniotomy.}, journal = {Epilepsy Behav}, volume = {18}, year = {2010}, month = {05/2010}, pages = {123-8}, abstract = {

Precise localization of eloquent cortex is a clinical necessity prior to surgical resections adjacent to speech or\ motor\ cortex. In the intraoperative setting, this traditionally requires inducing temporary lesions by direct electrocortical stimulation (DECS). In an attempt to increase efficiency and potentially reduce the amount of necessary stimulation, we used a passive mapping procedure in the setting of an awake craniotomy for tumor in two patients resection. We recorded electrocorticographic (ECoG) signals from exposed cortex while patients performed simple cue-directed\ motor\ and speech tasks. SIGFRIED, a procedure for real-time event detection, was used to identify areas of\ cortical\ activation by detecting task-related modulations in the ECoG high gamma band. SIGFRIED{\textquoteright}s real-time output quickly localized\ motor\ and speech areas of cortex similar to those identified by DECS. In conclusion, real-time passive identification of\ cortical\ function using SIGFRIED may serve as a useful adjunct to\ cortical\ stimulation mapping in the intraoperative setting.

}, keywords = {Brain Mapping, Brain Neoplasms, Cerebral Cortex, Craniotomy, Electric Stimulation, Electroencephalography, Humans, Neurologic Examination}, issn = {1525-5069}, doi = {10.1016/j.yebeh.2010.02.017}, url = {http://www.ncbi.nlm.nih.gov/pubmed/20478745}, author = {Roland, Jarod and Peter Brunner and Johnston, James and Gerwin Schalk and Leuthardt, E C} } @article {2192, title = {A practical procedure for real-time functional mapping of eloquent cortex using electrocorticographic signals in humans.}, journal = {Epilepsy Behav}, volume = {15}, year = {2009}, month = {07/2009}, pages = {278-86}, abstract = {

Functional mapping of eloquent cortex is often necessary prior to invasive brain surgery, but current techniques that derive this mapping have important limitations. In this article, we demonstrate the first comprehensive evaluation of a rapid, robust, and practical mapping system that uses passive recordings of electrocorticographic signals. This mapping procedure is based on the BCI2000 and SIGFRIED technologies that we have been developing over the past several years. In our study, we evaluated 10 patients with epilepsy from four different institutions and compared the results of our procedure with the results derived using electrical cortical stimulation (ECS) mapping. The results show that our procedure derives a functional motor cortical map in only a few minutes. They also show a substantial concurrence with the results derived using ECS mapping. Specifically, compared with ECS maps, a next-neighbor evaluation showed no false negatives, and only 0.46 and 1.10\% false positives for hand and tongue maps, respectively. In summary, we demonstrate the first comprehensive evaluation of a practical and robust mapping procedure that could become a new tool for planning of invasive brain surgeries.

}, keywords = {Adult, Brain Mapping, Cerebral Cortex, Electric Stimulation, Electrodes, Implanted, Electroencephalography, Epilepsy, Female, Humans, Male, Middle Aged, Practice Guidelines as Topic, Signal Processing, Computer-Assisted, Young Adult}, issn = {1525-5069}, doi = {10.1016/j.yebeh.2009.04.001}, url = {http://www.ncbi.nlm.nih.gov/pubmed/19366638}, author = {Peter Brunner and A L Ritaccio and Lynch, Timothy M and Emrich, Joseph F and Adam J Wilson and Williams, Justin C and Aarnoutse, Erik J and Ramsey, Nick F and Leuthardt, E C and H Bischof and Gerwin Schalk} }