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. 2023 Aug:194:107183.
doi: 10.1016/j.eplepsyres.2023.107183. Epub 2023 Jun 17.

Tolerability of transcranial magnetic stimulation language mapping in children

Hansel M Greiner  1 , Ellen Maue  2 , Paul S Horn  2 , Jennifer Vannest  3 , Kishore Vedala  3 , James L Leach  3 , Jeffrey R Tenney  2 , Brady Williamson  4 , Hisako Fujiwara  2 , Robert C Coghill  5 , Francesco T Mangano  6 , Darren S Kadis  7
Affiliations

Tolerability of transcranial magnetic stimulation language mapping in children

Hansel M Greiner et al. Epilepsy Res. 2023 Aug.

Abstract

Objective: Transcranial Magnetic Stimulation (TMS) has emerged as a viable non-invasive method for mapping language networks. Little is known about the tolerability of transcranial magnetic stimulation language mapping in children.

Methods: Children aged 5-18 years underwent bilateral language mapping using repetitive transcranial magnetic stimulation (rTMS) to target 33 sites/hemisphere. Stimulation was delivered at 5 Hz, in 1-2 second bursts, during visual naming and auditory verb generation. Pain unpleasantness and pain intensity were assessed using an unpleasantness visual analog scale (VAS).

Results: 49 participants tolerated motor mapping and had repetitive transcranial magnetic stimulation. 35/49 (71%) completed visual naming and 26/49 (53%) completed both visual naming and verb generation. Mean electrical field per participant was 115 V/m. Young age and lower language ability were associated with lower completion. Visual analogue scale scores were significantly higher (6.1 vs. 2.8) in participants who withdrew early compared to those who completed at least visual naming.

Conclusions: Pain measured by VAS was a major contributor to early withdrawal. However, a complete bilateral map was obtained with one paradigm in 71% of participants. Future studies designed to reduce pain during repetitive transcranial magnetic stimulation over language cortex will boost viability.

Significance: This study represents the first attempt to characterize tolerability of bilateral repetitive transcranial magnetic stimulation language mapping in healthy children.

Keywords: Repetitive TMS; Stimulation mapping; Transcranial magnetic stimulation.

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Conflict of interest statement

Declaration of Competing Interest None of the authors have any conflicts of interest to disclose.

Figures

Figure 1:
Figure 1:
Study flow.
Figure 2:
Figure 2:
a) schematic showing stimulation targets over the left frontal and right temporal language areas b) peeled view of left hemisphere reconstructed brain at a peeling depth of 20 mm, showing the standard 33 stimulation targets locations used. Each site was stimulated three times.
Figure 3:
Figure 3:
Survival curve as a function of the number of rTMS burst evaluated at the mean age of 11.7 years.
Figure 4.
Figure 4.
Average number of errors with visual naming (y-axis) per age bin in years (x-axis). The two bars represent errors rated by each individual rater.
See this image and copyright information in PMC

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