Multitask electrical stimulation for cortical language mapping: Hints for necessity and economic mode of application

Abstract

SUMMARYPurpose: Electrical stimulation mapping (ESM) is the gold standard for identifying language-relevant cortex prior to neurosurgical resections near the eloquent cortex. However, its application mode is not standardized, as some procedures rely on a single task, whereas others depend on task batteries. In this study, we examine whether multitask ESM is necessary, quantify the information loss that occurs from restricting the number of applied tasks, and search for a procedure that allows for time-efficient, multitask ESM. Methods: Thirty-eight epilepsy and 11 brain tumor patients with subdural grid electrodes receive extraoperative ESM for language cortex at 1,890 stimulation sites. The applied test battery includes counting, naming, repeating, reading, Token Test, and body commands. Correlation analysis and principal component analysis are used to identify the functional overlap between tasks. Sensitivity analysis is the basis for determining the optimal task order, which requires a minimum number of stimulations for identifying language loci. Results: Correlation coefficients between tasks are )0.17 to 0.63; frontal and temporoparietal language cortex are organized differently. Naming is the most sensitive task, but 31% % (temporoparietal) to 43% % (frontal) of language sites remained undetected after naming alone. The optimal procedure starts with naming and the Token Test and differs thereafter between frontal and temporoparietal cortex. Omitting the Token Test and body commands from the battery results in up to 26% % information loss. Discussion: Despite considerable overlap between different tasks, multitask ESM appears necessary to avoid missing language relevant cortex. Applying the tasks in an optimal order allows economizing the procedure.

Extraoperative neurostimulation mapping: Results from an international survey of epilepsy surgery programs

“…Whereas identification of motor and sensory cortex often involves stimulation‐evoked positive responses, identification of language cortex requires that the patient engage in a language task, and that stimulation disrupt the performance of that task . It is well established that at a given cortical site, stimulation‐induced language deficits can be function specific . For example, stimulation might disrupt reading but not naming, or vice versa.…”

“…Despite its importance, task selection has received minimal attention . Wellmer et al . conducted a comprehensive analysis to determine the most economical set of tasks needed to identify eloquent cortex.…”

“…9 It is well established that at a given cortical site, stimulation-induced language deficits can be function specific. 7,[10][11][12][13] For example, stimulation might disrupt reading but not naming, or vice versa. Testing limited to the nondisrupted function would yield a false-negative result.…”

“…Comprehensive literature review reveals only a limited number of papers addressing isolated aspects of the procedure, mainly from a nonclinical perspective . Only a few investigations have addressed the clinical procedure . Given the lack of empirical data to support clinical guidelines, procedures are typically based on institutional tradition, anecdotal experience, or simply, personal preferences.…”

“…2,3 Only a few investigations have addressed the clinical procedure. [4][5][6][7] Given the lack of empirical data to support clinical guidelines, procedures are typically based on institutional tradition, anecdotal experience, or simply, personal preferences.…”