Clinical Utility of Transcranial Magnetic Stimulation (TMS) in the Presurgical Evaluation of Motor, Speech, and Language Functions in Young Children With Refractory Epilepsy or Brain Tumor: Preliminary Evidence
Accurate presurgical mapping of motor, speech, and language cortices, while crucial for neurosurgical planning and minimizing post-operative functional deficits, is challenging in young children with neurological disease. In such children, both invasive (cortical stimulation mapping) and non-invasiv...
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Frontiers Media S.A.
2021-05-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2021.650830/full |
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| author | Shalini Narayana Shalini Narayana Shalini Narayana Savannah K. Gibbs Stephen P. Fulton Stephen P. Fulton Amy Lee McGregor Amy Lee McGregor Basanagoud Mudigoudar Basanagoud Mudigoudar Sarah E. Weatherspoon Sarah E. Weatherspoon Frederick A. Boop Frederick A. Boop Frederick A. Boop James W. Wheless James W. Wheless |
| author_facet | Shalini Narayana Shalini Narayana Shalini Narayana Savannah K. Gibbs Stephen P. Fulton Stephen P. Fulton Amy Lee McGregor Amy Lee McGregor Basanagoud Mudigoudar Basanagoud Mudigoudar Sarah E. Weatherspoon Sarah E. Weatherspoon Frederick A. Boop Frederick A. Boop Frederick A. Boop James W. Wheless James W. Wheless |
| author_sort | Shalini Narayana |
| collection | DOAJ |
| description | Accurate presurgical mapping of motor, speech, and language cortices, while crucial for neurosurgical planning and minimizing post-operative functional deficits, is challenging in young children with neurological disease. In such children, both invasive (cortical stimulation mapping) and non-invasive functional mapping imaging methods (MEG, fMRI) have limited success, often leading to delayed surgery or adverse post-surgical outcomes. We therefore examined the clinical utility of transcranial magnetic stimulation (TMS) in young children who require functional mapping. In a retrospective chart review of TMS studies performed on children with refractory epilepsy or a brain tumor, at our institution, we identified 47 mapping sessions in 36 children 3 years of age or younger, in whom upper and lower extremity motor mapping was attempted; and 13 children 5–6 years old in whom language mapping, using a naming paradigm, was attempted. The primary hand motor cortex was identified in at least one hemisphere in 33 of 36 patients, and in both hemispheres in 27 children. In 17 children, primary leg motor cortex was also successfully identified. The language cortices in temporal regions were successfully mapped in 11 of 13 patients, and in six of them language cortices in frontal regions were also mapped, with most children (n = 5) showing right hemisphere dominance for expressive language. Ten children had a seizure that was consistent with their clinical semiology during or immediately following TMS, none of which required intervention or impeded completion of mapping. Using TMS, both normal motor, speech, and language developmental patterns and apparent disease induced reorganization were demonstrated in this young cohort. The successful localization of motor, speech, and language cortices in young children improved the understanding of the risk-benefit ratio prior to surgery and facilitated surgical planning aimed at preserving motor, speech, and language functions. Post-operatively, motor function was preserved or improved in nine out of 11 children who underwent surgery, as was language function in all seven children who had surgery for lesions near eloquent cortices. We provide feasibility data that TMS is a safe, reliable, and effective tool to map eloquent cortices in young children. |
| first_indexed | 2024-12-20T04:57:46Z |
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| language | English |
| last_indexed | 2024-12-20T04:57:46Z |
| publishDate | 2021-05-01 |
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| spelling | doaj.art-d75917d050e54a3cb3d6f165405480542022-12-21T19:52:41ZengFrontiers Media S.A.Frontiers in Neurology1664-22952021-05-011210.3389/fneur.2021.650830650830Clinical Utility of Transcranial Magnetic Stimulation (TMS) in the Presurgical Evaluation of Motor, Speech, and Language Functions in Young Children With Refractory Epilepsy or Brain Tumor: Preliminary EvidenceShalini Narayana0Shalini Narayana1Shalini Narayana2Savannah K. Gibbs3Stephen P. Fulton4Stephen P. Fulton5Amy Lee McGregor6Amy Lee McGregor7Basanagoud Mudigoudar8Basanagoud Mudigoudar9Sarah E. Weatherspoon10Sarah E. Weatherspoon11Frederick A. Boop12Frederick A. Boop13Frederick A. Boop14James W. Wheless15James W. Wheless16Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United StatesLe Bonheur Children's Hospital, The Neuroscience Institute, Memphis, TN, United StatesDepartment of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN, United StatesLe Bonheur Children's Hospital, The Neuroscience Institute, Memphis, TN, United StatesDivision of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United StatesLe Bonheur Children's Hospital, The Neuroscience Institute, Memphis, TN, United StatesDivision of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United StatesLe Bonheur Children's Hospital, The Neuroscience Institute, Memphis, TN, United StatesDivision of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United StatesLe Bonheur Children's Hospital, The Neuroscience Institute, Memphis, TN, United StatesDivision of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United StatesLe Bonheur Children's Hospital, The Neuroscience Institute, Memphis, TN, United StatesLe Bonheur Children's Hospital, The Neuroscience Institute, Memphis, TN, United StatesSemmes Murphey Neurologic and Spine Institute, Memphis, TN, United StatesDepartment of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, United StatesDivision of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United StatesLe Bonheur Children's Hospital, The Neuroscience Institute, Memphis, TN, United StatesAccurate presurgical mapping of motor, speech, and language cortices, while crucial for neurosurgical planning and minimizing post-operative functional deficits, is challenging in young children with neurological disease. In such children, both invasive (cortical stimulation mapping) and non-invasive functional mapping imaging methods (MEG, fMRI) have limited success, often leading to delayed surgery or adverse post-surgical outcomes. We therefore examined the clinical utility of transcranial magnetic stimulation (TMS) in young children who require functional mapping. In a retrospective chart review of TMS studies performed on children with refractory epilepsy or a brain tumor, at our institution, we identified 47 mapping sessions in 36 children 3 years of age or younger, in whom upper and lower extremity motor mapping was attempted; and 13 children 5–6 years old in whom language mapping, using a naming paradigm, was attempted. The primary hand motor cortex was identified in at least one hemisphere in 33 of 36 patients, and in both hemispheres in 27 children. In 17 children, primary leg motor cortex was also successfully identified. The language cortices in temporal regions were successfully mapped in 11 of 13 patients, and in six of them language cortices in frontal regions were also mapped, with most children (n = 5) showing right hemisphere dominance for expressive language. Ten children had a seizure that was consistent with their clinical semiology during or immediately following TMS, none of which required intervention or impeded completion of mapping. Using TMS, both normal motor, speech, and language developmental patterns and apparent disease induced reorganization were demonstrated in this young cohort. The successful localization of motor, speech, and language cortices in young children improved the understanding of the risk-benefit ratio prior to surgery and facilitated surgical planning aimed at preserving motor, speech, and language functions. Post-operatively, motor function was preserved or improved in nine out of 11 children who underwent surgery, as was language function in all seven children who had surgery for lesions near eloquent cortices. We provide feasibility data that TMS is a safe, reliable, and effective tool to map eloquent cortices in young children.https://www.frontiersin.org/articles/10.3389/fneur.2021.650830/fulltranscranial magnetic stimulationmotor mappinglanguage mappingepilepsybrain tumorpresurgical |
| spellingShingle | Shalini Narayana Shalini Narayana Shalini Narayana Savannah K. Gibbs Stephen P. Fulton Stephen P. Fulton Amy Lee McGregor Amy Lee McGregor Basanagoud Mudigoudar Basanagoud Mudigoudar Sarah E. Weatherspoon Sarah E. Weatherspoon Frederick A. Boop Frederick A. Boop Frederick A. Boop James W. Wheless James W. Wheless Clinical Utility of Transcranial Magnetic Stimulation (TMS) in the Presurgical Evaluation of Motor, Speech, and Language Functions in Young Children With Refractory Epilepsy or Brain Tumor: Preliminary Evidence Frontiers in Neurology transcranial magnetic stimulation motor mapping language mapping epilepsy brain tumor presurgical |
| title | Clinical Utility of Transcranial Magnetic Stimulation (TMS) in the Presurgical Evaluation of Motor, Speech, and Language Functions in Young Children With Refractory Epilepsy or Brain Tumor: Preliminary Evidence |
| title_full | Clinical Utility of Transcranial Magnetic Stimulation (TMS) in the Presurgical Evaluation of Motor, Speech, and Language Functions in Young Children With Refractory Epilepsy or Brain Tumor: Preliminary Evidence |
| title_fullStr | Clinical Utility of Transcranial Magnetic Stimulation (TMS) in the Presurgical Evaluation of Motor, Speech, and Language Functions in Young Children With Refractory Epilepsy or Brain Tumor: Preliminary Evidence |
| title_full_unstemmed | Clinical Utility of Transcranial Magnetic Stimulation (TMS) in the Presurgical Evaluation of Motor, Speech, and Language Functions in Young Children With Refractory Epilepsy or Brain Tumor: Preliminary Evidence |
| title_short | Clinical Utility of Transcranial Magnetic Stimulation (TMS) in the Presurgical Evaluation of Motor, Speech, and Language Functions in Young Children With Refractory Epilepsy or Brain Tumor: Preliminary Evidence |
| title_sort | clinical utility of transcranial magnetic stimulation tms in the presurgical evaluation of motor speech and language functions in young children with refractory epilepsy or brain tumor preliminary evidence |
| topic | transcranial magnetic stimulation motor mapping language mapping epilepsy brain tumor presurgical |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2021.650830/full |
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