Concept Graph & Resume using Claude 3 Opus | Chat GPT4 | Llama 3:

Resume:

1.- Dr. Masanori Takeoka discussed functional brain mapping with stereo EEG in pediatric epilepsy surgery at Boston Children's Hospital.

2.- The goal is to maximize intervention while considering effects on normal brain function. Surgical resection risks permanent deficits.

3.- Localizing eloquent function is crucial in tailoring epilepsy surgery. Stereo EEG has become widely used for invasive monitoring.

4.- Functional mapping techniques previously optimized for subdural electrodes are being expanded for stereo EEG.

5.- Non-invasive mapping includes fMRI, TMS, MEG. Invasive mapping uses cortical stimulation, evoked potentials, high gamma mapping.

6.- Real-time high gamma mapping (RTFM) has been developed for subdural electrodes and expanded to stereo EEG in children.

7.- RTFM is passive, time-efficient, used in the OR and bedside, and FDA-approved. It preserves seizure capture.

8.- RTFM is less likely to induce seizures than cortical stimulation and can be used in low-threshold regions.

9.- RTFM allows longer, more complex paradigms, real-time results and troubleshooting. It's valuable beyond just epilepsy cases.

10.- Stereo EEG is replacing subdurals, especially in children. Placement is hypothesis-based and tailored to each case.

11.- Paradigms are adjusted for cooperation and cognitive level. Electrode maps and paradigms are optimized to reduce artifacts.

12.- Data was presented from 46 pediatric cases over 5.5 years at Boston Children's Hospital with medically intractable epilepsy.

13.- Motor and sensory mapping localizes function to avoid disabling deficits. Face/hand representation is greater than leg.

14.- RTFM results generally concordant with cortical stimulation for motor/sensory mapping. Some abnormal co-activation patterns seen.

15.- Preparing language paradigms is challenging due to variability in age, development, cognition. Paradigms are tailored to each child.

16.- 15 patients with left frontal/temporal electrodes underwent expressive/receptive language mapping. RTFM helped differentiate response types.

17.- RTFM is valuable for receptive language mapping, especially in children with limited cooperation for cortical stimulation testing.

18.- RTFM requires more cooperation for expressive vs receptive language. It can confirm bilateral language seen on fMRI.

19.- Visual mapping with RTFM identifies broad networks beyond primary visual cortex that could be affected by resection.

20.- Cortical stimulation is established but has limitations (time, seizure risk, pair-wise testing). RTFM offers complementary advantages.

21.- RTFM is limited by electrode placement but can sample deeper regions and allow longer, more flexible paradigms.

22.- RTFM is unlikely to trigger seizures and can avoid stimulus spread issues. It allows simultaneous multi-site testing.

23.- RTFM enables studying previously inaccessible regions relevant to language/cognition. It complements cortical stimulation, especially in children.

24.- Unexpected findings with RTFM suggest broader networks. Verifying the patient isn't accidentally activating other functions is important.

25.- RTFM suggests motor/language networks may be more extensive than expected from cortical stimulation. Insular involvement needs further study.

26.- An ideal receptive language paradigm could include multiple difficulty levels and non-linguistic sound for subtraction.

27.- Epilepsy is often not completely curable, but can be well-controlled, especially if the cause is not genetic.

28.- The youngest patients mapped were 3-4 years old with stereo EEG, around 1 year old with subdural grids.

29.- Stereo EEG wounds heal well compared to subdural grids. Holes are not noticeable once healed.

30.- In summary, RTFM and cortical stimulation offer complementary tools for functional mapping in pediatric epilepsy. A combined approach is valuable.

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