Electrocorticography-Based Real-Time Functional Mapping for Pediatric Epilepsy Surgery

Precise localization of eloquent cortex in children may provide much needed surgical guidance and expand surgical epilepsy treatment options. It reduces the risk of postsurgical functional deficits and benefits children's quality of life, educational capacity, and long-term employment potential. The ultimate goal of functional mapping for pediatric epilepsy surgery is to decrease postsurgical functional morbidity. In this review article, we will discuss the electrocorticography (ECoG)-based real-time functional mapping (RTFM) technique for localizing motor-, somatosensory-, and language-specific regions. The examples demonstrating ECoG-based RTFM mapping techniques will be given from the data produced by the authors. We will demonstrate that the RTFM technique is a functional mapping tool based on direct measurement of neural activity that is time- and effort-effective, safe, well tolerated by children, and is expected to lead to reduced postsurgical functional morbidity in pediatric epilepsy patients. In conjunction with other utilized functional imaging modalities, RTFM may reduce cognitive morbidity and, as a consequence, benefit children's quality of life and educational capacity.