Non-invasive assessment of hemispheric dominance for receptive language using magnetoencephalography (MEG) is now a well-established procedure used across several epilepsy centers in the context of pre-surgical evaluation of children and adults while awake, alert and attentive. However, the utility of MEG for the same purpose, in cases of sedated patients, is contested. Establishment of the efficiency of MEG is especially important in the case of children who, for a number of reasons, must be assessed under sedation. Here we explored the efficacy of MEG language mapping under sedation through retrospective review of 95 consecutive pediatric patients, who underwent our receptive language test as part of routine clinical evaluation. Localization of receptive language cortex and subsequent determination of laterality was successfully completed in 78% (n = 36) and 55% (n = 27) of non-sedated and sedated patients, respectively. Moreover, the proportion of patients deemed left hemisphere dominant for receptive language did not differ between non-sedated and sedated patients, exceeding 90% in both groups. Considering the challenges associated with assessing brain function in pediatric patients, the success of passive MEG in the context of the cases reviewed in this study support the utility of this method in pre-surgical receptive language mapping.
Magnetoencephalography (MEG) measures the field generated by the brain's electrical currents noninvasively. MEG is currently used for localization of epileptiform activity sources and for presurgical functional brain mapping. Such mapping with MEG requires the patients to be cooperative and lie still on their back for as long as ten minutes at a time. Hence, acquiring successful MEG in very young children, developmentally delayed individuals, and patients with skeletal abnormalities proves to be a challenge. Over the past several years, our group has undertaken research aimed at the effective use of sedation during MEG to identify epileptogenic areas and perform functional brain mapping in very young or developmentally delayed individuals. We summarize our experience of MEG data acquisition with sedation and demonstrate that epileptogenic areas can be identified and functional brain mapping can be successfully performed under sedation with propofol.
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