Cortical localization in epilepsy

项目摘要/摘要 在说话时说出正确的单词的能力对正常的社交、学术和职业至关重要 功能正常。不幸的是，对于许多患有失控癫痫的儿童来说，手术治疗可以控制癫痫发作 会将这些重要的语言技能置于危险境地。对成人难治性癫痫的广泛研究表明 根据临床可以在手术前预测的对单词产生或命名能力的重大风险 这些因素，在某些情况下，妨碍了术前语言映射的使用。与之形成鲜明对比的是，我们 目前无法预测儿童表达语言的风险，以及目前的映射技术 已被利用的研究未能可靠地识别和保护儿童的语言皮质。这代表着一个严重的差距 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，传统的命名方法仅依赖于 不考虑反应速度和命名的其他认知特征的视觉对象命名可能会错失真 评估中的命名缺陷，以及未能在皮质语言映射中识别必要的命名区域。在……里面 成人，在术前评估中添加听觉描述命名有助于偏侧化 与致痫皮质相关的功能障碍，并通过识别关键语言提高了映射效率 否则就不会被发现的大脑皮层。我们最近开发了儿科听觉命名和 对与癫痫相关的偏侧化表现出显著敏感性的互补视觉命名方法 难治性癫痫患儿的术前功能障碍。这些措施现在能够实现准确和 儿童命名的详细评估。该项目将使用这些最新开发的测试、预测试和 术后，在皮质语言映射中：1)确定预测短期和长期- 术后长期下降，2)确定下降是全局性的还是局限于一种方式，以及3)确定 基于通道的命名是否能更有效地识别和保护儿童的语言皮质。结果 承诺基于经验的儿童难治性癫痫术后言语技能风险知识， 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 和康复。随着越来越多的儿童接受癫痫手术，我们预计会有越来越多的 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.