Cortical localization in epilepsy

项目概要/摘要 在说话时产生正确单词的能力对于正常的社交，学术和职业至关重要 功能不幸的是，对于许多患有无法控制的癫痫的儿童来说， 会危及这些重要的语言技能。对患有难治性癫痫的成年人的广泛研究表明， 根据临床表现，术前可预测的单词产生或“命名”能力的重大风险 在某些情况下，使用术前语言映射进行预防。与此形成鲜明对比的是， 目前无法预测儿童表达性语言的风险，目前的映射技术 然而，目前的研究未能可靠地识别和保护儿童的语言皮层。这表明， 临床护理，因为语言的预测和保护在发育过程中至关重要。一个关键问题是， 儿童命名的方法，包括行为评估和术前语言映射。 命名神经科学的重大进展表明，传统的方法，仅仅依靠 视觉物体命名不考虑反应速度和命名的其他认知特征， 命名缺陷的评估，并未能确定必要的命名区皮层语言映射。在 在成年人中，将听觉描述命名添加到术前评估中有助于偏侧 功能障碍相关的癫痫皮质，并已提高映射效率，通过识别关键的语言 否则无法检测到的皮质。我们最近开发了小儿听觉命名， 互补的视觉命名措施，显示出显着的敏感性偏侧癫痫相关的 难治性癫痫患儿术前功能障碍。这些措施现在可以实现准确和 对儿童命名的详细评估。该项目将使用这些最近开发的测试， 术后，并在皮层语言映射：1）确定预测短期和长期的因素， 术语术后衰退，2）确定何时衰退是全局的或仅限于一种模态，以及3）确定 基于模态的命名是否能更有效地识别和保护儿童的语言皮层。结果 承诺基于经验的知识，对难治性癫痫儿童术后语言技能的风险， 改善儿童的语言映射，以及语言发展的认知神经科学的进展 和恢复。随着越来越多的儿童接受癫痫手术，我们可以预期， 需要准确预测、保护和测量儿科语言结果。

Project Summary/Abstract The ability to produce the correct words while speaking is critical for normal social, academic and occupational functioning. Unfortunately, for many children with uncontrolled epilepsy, surgical treatment for seizure control can place these vital language skills at risk. Extensive research in adults with refractory epilepsy has shown significant risk to word production or “naming” ability that can be predicted before surgery based on clinical factors and, in some cases, prevented using preoperative language mapping. In marked contrast, we are currently unable to predict risk to expressive language in children, and the mapping techniques currently utilized have failed to reliably identify and protect language cortex in children. This represents a serious gap in clinical care, as prediction and protection of language are critical during development. A key problem has been the approach to naming in children, both in behavioral assessment and in preoperative language mapping. Significant advances in the neuroscience of naming have shown that traditional methods, which rely solely on visual object naming without regard to speed of response and other cognitive features of naming, can miss true naming deficits in assessment, and fail to identify essential naming areas in cortical language mapping. In adults, the addition of auditory description naming to preoperative assessment has assisted in lateralization of dysfunction related to epileptogenic cortex, and has improved mapping efficacy by identifying critical language cortex that otherwise remained undetected. We recently developed pediatric auditory naming and complementary visual naming measures that showed significant sensitivity to lateralized epilepsy-related dysfunction in preoperative children with refractory epilepsy. These measures now enable accurate and detailed assessment of naming in children. This project will use these recently developed tests, pre and postoperatively, and in cortical language mapping to: 1) identify the factors that predict both short- and long- term postoperative decline, 2) determine when decline is global or limited to one modality, and 3) determine whether modality-based naming can more effectively identify and protect language cortex in children. Results promise empirically based knowledge of risk to postoperative verbal skills in children with refractory epilepsy, improved language mapping in children, and advances in the cognitive neuroscience of language development and recovery. With increasing numbers of children undergoing epilepsy surgery, we can expect a growing need for accurate prediction, protection and measurement of pediatric language outcome.