Language mapping with navigated transcranial magnetic stimulation in pediatric and adult patients undergoing epilepsy surgery: Comparison with extraoperative direct cortical stimulation

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Summary Objective Navigated transcranial magnetic stimulation (nTMS) is becoming increasingly popular in noninvasive preoperative language mapping, as its results correlate well enough with those obtained by direct cortical stimulation (DCS) during awake surgery in adult patients with tumor. Reports in the context of epilepsy surgery or extraoperative DCS in adults are, however, sparse, and validation of nTMS with DCS in children is lacking. Furthermore, little is known about the risk of inducing epileptic seizures with nTMS in pediatric epilepsy patients. We provide the largest validation study to date in an epilepsy surgery population. Methods We compared language mapping with nTMS and extraoperative DCS in 20 epilepsy surgery patients (age range 9‐32 years; 14 children and adolescents). Results In comparison with DCS, sensitivity of nTMS was 68 specificity 76 positive predictive value 27 and negative predictive value 95 Age, location of ictal‐onset zone near or within DCS‐mapped language areas or severity of cognitive deficits had no significant effect on these values. None of our patients had seizures during nTMS. Significance Our study suggests that nTMS language mapping is clinically useful and safe in epilepsy surgery patients, including school‐aged children and patients with extensive cognitive dysfunction. Similar to in tumor surgery, mapping results in the frontal region are most reliable. False negative findings may be slightly more likely in epilepsy than in tumor surgery patients. Mapping results should always be verified by other methods in individual patients.
Original languageEnglish
JournalEpilepsia Open
Volume3
Issue number2
Pages (from-to)224-235
Number of pages12
ISSN2470-9239
DOIs
Publication statusPublished - 6 Apr 2018
MoE publication typeA1 Journal article-refereed

Fields of Science

  • Navigated transcranial magnetic stimulation, Epilepsy surgery, Pediatric, Direct cortical stimulation, Language mapping
  • 3112 Neurosciences
  • 3126 Surgery, anesthesiology, intensive care, radiology
  • 3124 Neurology and psychiatry
  • 515 Psychology
  • 6163 Logopedics

Cite this

@article{fe59dd65a93f4726b4c78af7d77734d1,
title = "Language mapping with navigated transcranial magnetic stimulation in pediatric and adult patients undergoing epilepsy surgery: Comparison with extraoperative direct cortical stimulation",
abstract = "Summary Objective Navigated transcranial magnetic stimulation (nTMS) is becoming increasingly popular in noninvasive preoperative language mapping, as its results correlate well enough with those obtained by direct cortical stimulation (DCS) during awake surgery in adult patients with tumor. Reports in the context of epilepsy surgery or extraoperative DCS in adults are, however, sparse, and validation of nTMS with DCS in children is lacking. Furthermore, little is known about the risk of inducing epileptic seizures with nTMS in pediatric epilepsy patients. We provide the largest validation study to date in an epilepsy surgery population. Methods We compared language mapping with nTMS and extraoperative DCS in 20 epilepsy surgery patients (age range 9‐32 years; 14 children and adolescents). Results In comparison with DCS, sensitivity of nTMS was 68 specificity 76 positive predictive value 27 and negative predictive value 95 Age, location of ictal‐onset zone near or within DCS‐mapped language areas or severity of cognitive deficits had no significant effect on these values. None of our patients had seizures during nTMS. Significance Our study suggests that nTMS language mapping is clinically useful and safe in epilepsy surgery patients, including school‐aged children and patients with extensive cognitive dysfunction. Similar to in tumor surgery, mapping results in the frontal region are most reliable. False negative findings may be slightly more likely in epilepsy than in tumor surgery patients. Mapping results should always be verified by other methods in individual patients.",
keywords = "Navigated transcranial magnetic stimulation, Epilepsy surgery, Pediatric, Direct cortical stimulation, Language mapping, 3112 Neurosciences, 3126 Surgery, anesthesiology, intensive care, radiology, 3124 Neurology and psychiatry, 515 Psychology, 6163 Logopedics",
author = "Henri Lehtinen and M{\"a}kel{\"a}, {Jyrki P.} and Teemu M{\"a}kel{\"a} and Pantelis Lioumis and Liisa Mets{\"a}honkala and Laura Hokkanen and Juha Wilenius and Eija Gaily",
year = "2018",
month = "4",
day = "6",
doi = "10.1002/epi4.12110",
language = "English",
volume = "3",
pages = "224--235",
journal = "Epilepsia Open",
issn = "2470-9239",
publisher = "John Wiley & Sons, Ltd",
number = "2",

}

TY - JOUR

T1 - Language mapping with navigated transcranial magnetic stimulation in pediatric and adult patients undergoing epilepsy surgery: Comparison with extraoperative direct cortical stimulation

AU - Lehtinen, Henri

AU - Mäkelä, Jyrki P.

AU - Mäkelä, Teemu

AU - Lioumis, Pantelis

AU - Metsähonkala, Liisa

AU - Hokkanen, Laura

AU - Wilenius, Juha

AU - Gaily, Eija

PY - 2018/4/6

Y1 - 2018/4/6

N2 - Summary Objective Navigated transcranial magnetic stimulation (nTMS) is becoming increasingly popular in noninvasive preoperative language mapping, as its results correlate well enough with those obtained by direct cortical stimulation (DCS) during awake surgery in adult patients with tumor. Reports in the context of epilepsy surgery or extraoperative DCS in adults are, however, sparse, and validation of nTMS with DCS in children is lacking. Furthermore, little is known about the risk of inducing epileptic seizures with nTMS in pediatric epilepsy patients. We provide the largest validation study to date in an epilepsy surgery population. Methods We compared language mapping with nTMS and extraoperative DCS in 20 epilepsy surgery patients (age range 9‐32 years; 14 children and adolescents). Results In comparison with DCS, sensitivity of nTMS was 68 specificity 76 positive predictive value 27 and negative predictive value 95 Age, location of ictal‐onset zone near or within DCS‐mapped language areas or severity of cognitive deficits had no significant effect on these values. None of our patients had seizures during nTMS. Significance Our study suggests that nTMS language mapping is clinically useful and safe in epilepsy surgery patients, including school‐aged children and patients with extensive cognitive dysfunction. Similar to in tumor surgery, mapping results in the frontal region are most reliable. False negative findings may be slightly more likely in epilepsy than in tumor surgery patients. Mapping results should always be verified by other methods in individual patients.

AB - Summary Objective Navigated transcranial magnetic stimulation (nTMS) is becoming increasingly popular in noninvasive preoperative language mapping, as its results correlate well enough with those obtained by direct cortical stimulation (DCS) during awake surgery in adult patients with tumor. Reports in the context of epilepsy surgery or extraoperative DCS in adults are, however, sparse, and validation of nTMS with DCS in children is lacking. Furthermore, little is known about the risk of inducing epileptic seizures with nTMS in pediatric epilepsy patients. We provide the largest validation study to date in an epilepsy surgery population. Methods We compared language mapping with nTMS and extraoperative DCS in 20 epilepsy surgery patients (age range 9‐32 years; 14 children and adolescents). Results In comparison with DCS, sensitivity of nTMS was 68 specificity 76 positive predictive value 27 and negative predictive value 95 Age, location of ictal‐onset zone near or within DCS‐mapped language areas or severity of cognitive deficits had no significant effect on these values. None of our patients had seizures during nTMS. Significance Our study suggests that nTMS language mapping is clinically useful and safe in epilepsy surgery patients, including school‐aged children and patients with extensive cognitive dysfunction. Similar to in tumor surgery, mapping results in the frontal region are most reliable. False negative findings may be slightly more likely in epilepsy than in tumor surgery patients. Mapping results should always be verified by other methods in individual patients.

KW - Navigated transcranial magnetic stimulation, Epilepsy surgery, Pediatric, Direct cortical stimulation, Language mapping

KW - 3112 Neurosciences

KW - 3126 Surgery, anesthesiology, intensive care, radiology

KW - 3124 Neurology and psychiatry

KW - 515 Psychology

KW - 6163 Logopedics

U2 - 10.1002/epi4.12110

DO - 10.1002/epi4.12110

M3 - Article

VL - 3

SP - 224

EP - 235

JO - Epilepsia Open

JF - Epilepsia Open

SN - 2470-9239

IS - 2

ER -