Tolerability of transcranial magnetic stimulation language mapping in children

Hansel M Greiner; Ellen Maue; Paul S Horn; Jennifer Vannest; Kishore Vedala; James L Leach; Jeffrey R Tenney; Brady Williamson; Hisako Fujiwara; Robert C Coghill; Francesco T Mangano; Darren S Kadis

doi:10.1016/j.eplepsyres.2023.107183

Tolerability of transcranial magnetic stimulation language mapping in children

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

Authors

Affiliations

¹ Division of Neurology, Cincinnati Children's Hospital Medical Center; Univeristy of Cincinnati, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA. Electronic address: hansel.greiner@cchmc.org.
² Division of Neurology, Cincinnati Children's Hospital Medical Center; Univeristy of Cincinnati, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
³ Univeristy of Cincinnati, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
⁴ Univeristy of Cincinnati, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Physiology, Faculty of Medicine, University of Toronto, Canada.
⁵ Univeristy of Cincinnati, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Childrens Hospital Medical Center, USA; Center for Understanding Pediatric Pain, Cincinnati Childrens Hospital Medical Center, USA.
⁶ Univeristy of Cincinnati, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Neurosurgery, Cincinnati Children's Hospital Medical Center, USA.
⁷ Neurosciences and Mental Health, Research Institute, Hospital for Sick Children, Toronto, Canada; Department of Physiology, Faculty of Medicine, University of Toronto, Canada.

PMID: 37352728
PMCID: PMC10527515 (available on 2024-08-01)
DOI: 10.1016/j.eplepsyres.2023.107183

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.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Brain Mapping / methods
Cerebral Cortex
Child
Humans
Language*
Pain / etiology
Transcranial Magnetic Stimulation* / adverse effects
Transcranial Magnetic Stimulation* / methods

Grants and funding

R21 NS106631/NS/NINDS NIH HHS/United States