Cortical Language Areas and Plasticity in Pediatric Patients With Epilepsy: A Review  Naomi Chou, BS, Sandra Serafini, PhD, Carrie R. Muh, MD, MS  Pediatric Neurology  Volume 78, Pages 3-12 (January 2018) DOI: 10.1016/j.pediatrneurol.2017.10.001 Copyright © 2017 The Authors Terms and Conditions

Figure 1 This intraoperative photo depicts ECS grids and strips placed on cortical areas for extraoperative ECS language mapping (anterior is to the left; superior is up). A 6 × 8 electrode grid overlies the left parietal lobe (top), while a 4 × 8 electrode grid overlies the left temporal lobe (bottom). Circumferential subdural 1 × 8 electrode strips further extend the mapping area. ECS, electrical cortical stimulation. Pediatric Neurology 2018 78, 3-12DOI: (10.1016/j.pediatrneurol.2017.10.001) Copyright © 2017 The Authors Terms and Conditions

Figure 2 Probabilistic mapping of auditory naming cortical function based on our unpublished ECS data from 21 pediatric patients with temporal lobe epilepsy. Auditory language functional areas are spread over a wide region with no single area demonstrating auditory function in 100% of patients tested. The MSTG shows the highest likelihood of containing auditory naming language function in our cohort of patients. MSTG and MITG showed auditory language errors with stimulation that were significantly higher than baseline unstimulated error rates in more than 40% of the patients tested. The shading within each color demonstrates the number of patients tested at each area (1, 2 to 5, or ≥6). AnG, angular gyrus; AITG, anterior inferior temporal gyrus; AMFG, anterior middle frontal gyrus; AMTG, anterior middle temporal gyrus; ASFG, anterior superior frontal gyrus; ASMG, anterior supramarginal gyrus; ASTG, anterior superior temporal gyrus; DLOG, dorsal lateral occipital gyrus; DPoG, dorsal postcentral gyrus; DPrG, dorsal precentral gyrus; ECS, electrical cortical stimulation; MITG, middle inferior temporal gyrus; MMFG, middle middle frontal gyrus; MMTG, middle middle temporal gyrus; MPoG, middle postcentral gyrus; MPrG, middle precentral gyrus; MSFG, middle superior frontal gyrus; MSTG, medial superior temporal gyrus; OpIFG, opercular inferior frontal gyrus; OrIFG, orbital inferior frontal gyrus; PITG, posterior inferior temporal gyrus; PMFG, posterior middle frontal gyrus; PMTG, posterior middle temporal gyrus; PSFG, posterior superior frontal gyrus; PSMG, posterior supramarginal gyrus; PSTG, posterior superior temporal gyrus; PolIFG, polar inferior frontal gyrus; PolITG: polar inferior temporal gyrus; PolMFG, polar middle frontal gyrus; PolMTG, polar middle temporal gyrus; PolOG, polar occipital gyrus; PolSFG, polar superior frontal gyrus; PolSTG, polar superior temporal gyrus; SPL, superior parietal lobule; TrIFG, triangular inferior frontal gyrus; VLOG, ventral lateral occipital gyrus; VPoG, ventral postcentral gyrus; VPrG, ventral precentral gyrus. Pediatric Neurology 2018 78, 3-12DOI: (10.1016/j.pediatrneurol.2017.10.001) Copyright © 2017 The Authors Terms and Conditions

Figure 3 Representative images of the patient's brain with recurrent tumor after the first resection. Left: A T2-weighted spin echo axial magnetic resonance image of the resection cavity and recurrent tumor shows the resection of portions of the left superior temporal gyrus and middle temporal gyrus (yellow outline) and recurrent tumor posterior to the cavity (red outline). Right: A schematic depiction of the approximate borders of the resected area (yellow, anterior temporal), recurrent tumor (red, posterior temporal), and English visual naming sites from the first ECS mapping session (black dots). Reproduced with permission from Serafini et al.34 Pediatric Neurology 2018 78, 3-12DOI: (10.1016/j.pediatrneurol.2017.10.001) Copyright © 2017 The Authors Terms and Conditions