Pediatric Language Mapping Using Transcranial Magnetic Stimulation
Abstract number :
3.178
Submission category :
3. Neurophysiology / 3E. Brain Stimulation
Year :
2022
Submission ID :
2204610
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:25 AM
Authors :
Kishore Vedala, MD – Cincinnati Children's Hospital; Hansel Greiner, MD – Epileptologist, Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital; Darren Kadis, PhD – Scientist, Neurosciences and Mental Health, The Hospital for Sick Children; Jennifer Vannest, PhD – Associate Professor, Speech Language Pathology, University of Cincinnati
Rationale: Repetitive transcranial magnetic stimulation (rTMS) has been utilized as a potentially effective noninvasive tool for language mapping. This has been more extensively studied in adults, but there is less data available on the effectiveness of rTMS as a tool for language mapping in pediatric patients. Moreover, the available data has been limited only to object naming tasks and not to other tasks such as verb generation. In this study, we aimed to map language lateralization in healthy pediatric patients using navigated rTMS using both object naming and verb generation tasks.
Methods: Children aged 5-18 years underwent bilateral language mapping using repetitive TMS (rTMS). Stimulation was delivered at 5 Hz, in 1-2 second bursts, during visual naming and auditory verb generation tasks. We targeted 33 sites per hemisphere, each stimulated 3 times for each task, to induce language interruption. Participants were allowed to withdraw at any point. Thirty-four participants completed the object naming task and 27 participants completed the verb generation task. For each participant completing the object naming task and for 15 of the participants completing the verb generation task, there were two raters scoring errors. For each task with two raters, an interrater reliability score was determined using Gwet AC2 agreement score. Lateralization of language was determined for each task by comparing error prevalence in each hemisphere using Wilcoxon signed rank test. Two participants were included in the interrater reliability scores but excluded from the lateralization analysis as the error prevalence for these patients was greater than 3 SDs from the mean.
Results: Interrater percent agreement for both object naming stimulation and verb generation stimulation was > 80% for each of the participants with two raters with an average percent agreement of 95% for object naming and 93% for verb generation. Left sided object naming errors (mean = 7.73, SD = 5.79) were greater than right-sided object naming errors (mean = 6.27; SD = 5.47), though this difference was not statistically significant (p = 0.269). Likewise, left-sided verb generation errors (mean 12.80, SD 10.56) were greater than right-sided verb generation errors (mean = 11.64, SD = 9.61), though this difference was also not statistically significant (p = 0.603). Total verb generation errors (mean = 24.44, SD = 19.49) were observed more commonly than object naming errors (mean = 14.00, SD = 10.56) with statistical significance (p = 0.019), and this effect was seen with both left sided (p = 0.023), and right sided (p = 0.016) stimulation.
Conclusions: Pediatric patients are likely to utilize bilateral hemispheres for language tasks including object naming and verb generation. Verb generation tasks are more likely to produce errors with TMS stimulation than object naming tasks, independent of the hemisphere stimulated. This potentially suggests greater utilization of language centers with verb generation tasks in pediatric patients, though further studies are needed.
Funding: None
Neurophysiology