Pediatric Language Mapping: Sensitivity of Neurostimulation and Wada Testing in Epilepsy Surgery

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Abstract
Summary:  Purpose: Functional mapping of eloquent cortex with electrical neurostimulation is used both intra‐ and extraoperatively to tailor resections. In pediatric patients, however, functional mapping studies frequently fail to localize language. Wada testing has also been reported to be less sensitive in children. Methods: Thirty children (4.7 – 14.9 years) and 18 adult controls (18–59 years) who underwent extraoperative language mapping via implanted subdural electrodes at the NYU Comprehensive Epilepsy Center were included in the study. Ten children and 14 adults underwent preoperative Wada testing. Success of the procedures was defined as the identification of at least one language site by neurostimulation mapping and determination of hemispheric language dominance on the Wada test. Results: In children younger than 10.2 years, cortical stimulation identified language cortex at a lower rate than was seen in children older than 10.2 years and in adults (p < 0.05). This threshold, demonstrated by survival and χ2 analysis, was sharply defined in our data set. Additionally, Wada testing was more likely to be successful than was extraoperative mapping in this younger age group (p < 0.05). Conclusions: Analysis of our series demonstrates that language cortex is less likely to be identified in children younger than 10 years, suggesting that alternatives to the current methods of cortical electrical stimulation, particularly the use of preoperative language lateralization, may be required in this age group.