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Abstract

Objective:

To investigate the feasibility and clinical utility of using passive electrocorticography (ECoG) for online spatial-temporal functional mapping (STFM) of language cortex in patients being monitored for epilepsy surgery.

Methods:

We developed and tested an online system that exploits ECoG's temporal resolution to display the evolution of statistically significant high gamma (70–110 Hz) responses across all recording sites activated by a discrete cognitive task. We illustrate how this spatial-temporal evolution can be used to study the function of individual recording sites engaged during different language tasks, and how this approach can be particularly useful for mapping eloquent cortex.

Results:

Using electrocortical stimulation mapping (ESM) as the clinical gold standard for localizing language cortex, the average sensitivity and specificity of online STFM across 7 patients were 69.9% and 83.5%, respectively. Moreover, relative to regions of interest where discrete cortical lesions have most reliably caused language impairments in the literature, the sensitivity of STFM was significantly greater than that of ESM, while its specificity was also greater than that of ESM, though not significantly so.

Conclusions:

This study supports the feasibility and clinical utility of online STFM for mapping human language function, particularly under clinical circumstances in which time is limited and comprehensive ESM is impractical.

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Supplementary Material

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File (supplemental_data.pdf)
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File (video_e-2.mp4)
File (video_legends.pdf)

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Letters to the Editor
23 September 2016
Re: Multimodal presurgical language mapping
Yujing Wang, Research Trainee
M.S. Fifer; A. Flinker; A. Korzeniewska; M.C. Cervenka; W.S. Anderson; D.F. Boatman-Reich; N.E. Crone

We appreciate the comments by Babajani-Feremi et al. about our recent study of the clinical utility of electrocorticographic (ECoG) high gamma activation for online functional mapping. [1] We also read the recent study by Babajani-Feremi et al. with great interest. Their study compared the results of language mapping with high gamma ECoG, fMRI, TMS, and electrocortical stimulation mapping (ESM). [2] There is a great deal of agreement between the two studies. Using somewhat different methods, both studies showed that high gamma ECoG has good sensitivity and specificity with respect to ESM, and that ECoG provides a good estimate of the patient's functional anatomy. Because ECoG and ESM methods are fundamentally different (i.e. ECoG measures brain activation and ESM measures the effect of deactivation), we believe they are complementary and should both be done whenever feasible. Moreover, further studies are needed to evaluate the ability of these mapping techniques to predict surgical outcomes.

1. Wang Y, Fifer MS, Flinker A, et al. Spatial-temporal functional mapping of language at the bedside with electrocorticography. Neurology 2016;86:1181-1189.

2. Babajani-Feremi A, Narayana S, Rezaie R, et al. Language mapping using high gamma electrocorticography, fMRI, and TMS versus electrocortical stimulation. Clin Neurophysiol 2016; 127:1822-1836.

For disclosures, please contact the editorial office at [email protected].

16 May 2016
Multimodal presurgical language mapping
Abbas Babajani-Feremi
James W. Wheless, Andrew C. Papanicolaou, Memphis
We read with interest the article by Wang et al. on the feasibility of online language mapping using high-gamma electrocorticogarphic (hgECoG) activity. [1] If electrocortical stimulation mapping (ESM) is considered the gold standard, the results revealed that hgECoG had 69.9% sensitivity and 83.5% specificity. ESM does serve as the gold standard for presurgical language mapping, although it has several limitations. [2] While the results supported the clinical utility of hgECoG, it was not suggested that language mapping using ESM should be replaced by that using hgECoG.

We have compared localization of the language cortex using ESM, hgECoG, fMRI, and TMS3. [3] Our results revealed that areas involved in language processing can be identified by hgECoG, fMRI, and TMS. Furthermore, the sensitivity/specificity of language mapping using hgECoG, fMRI, and TMS compared to that using ESM were 100%/85%, 50%/80%, and 67%/66%, respectively. We concluded that hgECoG, fMRI, and TMS are valuable tools for presurgical language mapping. In addition, language mapping based on hgECoG, fMRI, and TMS can be used in conjunction with ESM, or as an alternative when the latter is deemed impractical. The article by Wang et al. validated prior use of hgECoG as a valuable component of presurgical language mapping.

1.Wang Y, Fifer MS, Flinker A, et al. Spatial-temporal functional mapping of language at the bedside with electrocorticography. Neurology 2016;86:1181-1189.

2. Papanicolaou AC, Rezaie R, Narayana S, et al. Is it time to replace the Wada test and put awake craniotomy to sleep? Epilepsia 2014;55:629-632.

3. Babajani-Feremi A, Narayana S, Rezaie R, et al. Language mapping using high gamma electrocorticography, fMRI, and TMS versus electrocortical stimulation. Clin Neurophysiol 2016;127:1822-1836.

For disclosures, please contact the editorial office at [email protected].

Information & Authors

Information

Published In

Neurology®
Volume 86Number 13March 29, 2016
Pages: 1181-1189
PubMed: 26935890

Publication History

Received: July 23, 2015
Accepted: October 27, 2015
Published online: March 2, 2016
Published in print: March 29, 2016

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Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

Study Funding

Supported by the National Institute of Neurological Disorders and Stroke (NINDS) grant NS40596 (to N.E.C.) and NS91139 (to N.E.C.).

Authors

Affiliations & Disclosures

Yujing Wang, MS*
From the Departments of Neurology (Y.W., A.K., M.C.C., D.F.B.-R., N.E.C.), Biomedical Engineering (M.S.F.), and Neurosurgery (W.S.A.), Johns Hopkins University, Baltimore, MD; Fischell Department of Bioengineering (Y.W.), University of Maryland College Park; and Department of Psychology (A.F.), New York University, New York.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Matthew S. Fifer, PhD*
From the Departments of Neurology (Y.W., A.K., M.C.C., D.F.B.-R., N.E.C.), Biomedical Engineering (M.S.F.), and Neurosurgery (W.S.A.), Johns Hopkins University, Baltimore, MD; Fischell Department of Bioengineering (Y.W.), University of Maryland College Park; and Department of Psychology (A.F.), New York University, New York.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
(1) National Institutes of Health, National Institute of Neurological Disorders and Stroke (NINDS), grants NS40596, funded graduate student for 4 years.
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Adeen Flinker, PhD
From the Departments of Neurology (Y.W., A.K., M.C.C., D.F.B.-R., N.E.C.), Biomedical Engineering (M.S.F.), and Neurosurgery (W.S.A.), Johns Hopkins University, Baltimore, MD; Fischell Department of Bioengineering (Y.W.), University of Maryland College Park; and Department of Psychology (A.F.), New York University, New York.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Anna Korzeniewska, PhD
From the Departments of Neurology (Y.W., A.K., M.C.C., D.F.B.-R., N.E.C.), Biomedical Engineering (M.S.F.), and Neurosurgery (W.S.A.), Johns Hopkins University, Baltimore, MD; Fischell Department of Bioengineering (Y.W.), University of Maryland College Park; and Department of Psychology (A.F.), New York University, New York.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Mackenzie C. Cervenka, MD
From the Departments of Neurology (Y.W., A.K., M.C.C., D.F.B.-R., N.E.C.), Biomedical Engineering (M.S.F.), and Neurosurgery (W.S.A.), Johns Hopkins University, Baltimore, MD; Fischell Department of Bioengineering (Y.W.), University of Maryland College Park; and Department of Psychology (A.F.), New York University, New York.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
(1) Philanthropic support from an individual to conduct research unrelated to the current study.
Funding for Travel or Speaker Honoraria:
1.
(1) American Epilepsy Society Annual Course, honorarium
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
(1) Nutricia, KetoCal study for adults, Principal Investigator, 2013 (2) Vitaflo, Betaquik study for adults with catamenial epilepsy, Principal investigator, 2015
Research Support, Government Entities:
1.
(1) NIH/NINDS, R01 NS 075020, Co-investigator, 2011-2015 (2) Army Research Laboratory, Integrated EEG/ECoG Data Collection, Co-investigator, 2014-2015
Research Support, Academic Entities:
1.
(1) Johns Hopkins University School of Medicine Clinician Scientist Career Development Award, Principal Investigator, 1/1/2013-12/31/2013
Research Support, Foundations and Societies:
1.
(1) William and Ella Owens Medical Research Foundation
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
William S. Anderson, MA, MD, PhD
From the Departments of Neurology (Y.W., A.K., M.C.C., D.F.B.-R., N.E.C.), Biomedical Engineering (M.S.F.), and Neurosurgery (W.S.A.), Johns Hopkins University, Baltimore, MD; Fischell Department of Bioengineering (Y.W.), University of Maryland College Park; and Department of Psychology (A.F.), New York University, New York.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Neurosurgery 2009-present, Editor Science Times
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NIH K08 1K08NS066099-01A1, 2010-2015, PI Dept. of the Army W911NF-12-R-0012, 2012-2015, PI NIH R01 1R01AG042165-01A1, 2012-2017, Co-I Dept. of the Army W911NF-12-R-0012-02 Proposal No. 65459-LS, Co-PI
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
Coulter Foundation The Neurosurgery Pain Research Institute at Johns Hopkins
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Dana F. Boatman-Reich, PhD
From the Departments of Neurology (Y.W., A.K., M.C.C., D.F.B.-R., N.E.C.), Biomedical Engineering (M.S.F.), and Neurosurgery (W.S.A.), Johns Hopkins University, Baltimore, MD; Fischell Department of Bioengineering (Y.W.), University of Maryland College Park; and Department of Psychology (A.F.), New York University, New York.
Disclosure
Scientific Advisory Boards:
1.
1) Non-profit entity: the Dana Foundation, scientific advisory board
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Frontiers in Auditory Neuroscience, editorial board member
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NIH-NIDCD, K24DC010028, PI, 2009-2015 Army Research Organization W911NF-12R001202, Co-PI, 2014-2017 Army Research Laboratory W911NF-1020022, Co-PI, 2014-2016
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Nathan E. Crone, MD
From the Departments of Neurology (Y.W., A.K., M.C.C., D.F.B.-R., N.E.C.), Biomedical Engineering (M.S.F.), and Neurosurgery (W.S.A.), Johns Hopkins University, Baltimore, MD; Fischell Department of Bioengineering (Y.W.), University of Maryland College Park; and Department of Psychology (A.F.), New York University, New York.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
(1) NINDS, NS40596, PI, 2010-2015, (2) NINDS, NS091139, PI, 2015, (3) NINDS, NS088606, PI, 2014-2015, (4) NS038493, co-I, 2011-2015.
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence to Wang: [email protected]
*
These authors contributed equally to this work.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

Author Contributions

Y. Wang: study concept and design, acquisition of data, analysis and interpretation, manuscript write-up. Dr. Fifer: study concept and design, acquisition of data, analysis and interpretation, manuscript write-up. Dr. Flinker: study concept, manuscript revision. Dr. Korzeniewska: study concept, manuscript revision. Dr. Cervenka: acquisition of data. Dr. Anderson: acquisition of data. Dr. Boatman-Reich: acquisition of data, manuscript revision. Dr. Crone: study concept, acquisition of data, analysis and interpretation, manuscript write-up, study supervision.

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  6. Neurophysiological mechanisms of DBS from a connectomic perspective, Connectomic Deep Brain Stimulation, (59-87), (2022).https://doi.org/10.1016/B978-0-12-821861-7.00027-0
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