Brain Mapping in Children: Advancing Pediatric Epilepsy Surgery with cortiQ Cortical Mapping

Brain mapping plays a crucial role in pediatric epilepsy, offering life-changing advancements in diagnosing and treating neurological disorders in children. From pediatric epilepsy surgery to brain injury rehabilitation, functional mapping helps clinicians understand how different brain regions support movement, language, cognition, and other vital functions. Traditional techniques, such as electrical stimulation mapping (ESM) and functional MRI (fMRI), have long been used, but they come with limitations—especially for young patients who may struggle with compliance during testing.

Now, real-time functional mapping (RTFM) using cortiQ rapid cortical mapping and g.tec’s EEG solutions is revolutionizing pediatric brain mapping by providing fast, accurate, and non-invasive insights into brain function. Unlike traditional methods, RTFM can be performed with minimal disruption to a child’s ongoing epilepsy monitoring or treatment, making it a valuable tool in pediatric epilepsy surgery and brain injury assessment.

Several leading pediatric hospitals have already adopted these advanced technologies, integrating them into their neurology and neurosurgery programs. This article explores how top institutions, such as Boston Children’s Hospital, Florida Hospital for Children and C.S. Mott Children’s Hospital are using RTFM and sEEG-based functional mapping to improve surgical precision, minimize post-surgical deficits, and enhance the overall quality of life for children with epilepsy and brain injuries.

Real-World Applications: Pediatric Hospitals Leveraging Advanced Brain Mapping

Over the past decade, Dr. Milena Korostenskaja at Florida Hospital for Children has pioneered the use of cortiQ rapid cortical mapping for functional mapping with electrocorticography (ECoG) in pediatric patients with intractable epilepsy. Her work has helped establish child-friendly functional mapping protocols aimed at reducing post-surgical deficits. These protocols enhance motor and language area localization, offering a safer alternative to electrical stimulation mapping alone.

As the use of stereo EEG (sEEG) for invasive EEG monitoring has increased, Boston Children’s Hospital has adopted rapid real-time high-gamma frequency mapping (RTFM) to improve brain function localization during sEEG recordings. Dr. Takeoka integrates cortiQ mapping into their routine epilepsy monitoring, emphasizing its importance in tailoring epilepsy surgery, especially for focal resections in children with medically intractable epilepsy.

Clinical Impact of Real-Time Functional Mapping

Studies demonstrate that RTFM effectively identifies language and cognitive functions in children undergoing invasive EEG monitoring. In a cohort of 47 patients, RTFM detected high-gamma frequency activity (70-170 Hz) in response to task-related stimuli without interfering with seizure localization. Remarkably, some functional regions were found outside traditionally expected areas, highlighting the value of this technique for mapping structurally or functionally abnormal brains.

RTFM offers several advantages over traditional subdural electrode placement, including more precise stereotactic localization via depth electrodes. The results strongly correlate with cortical stimulation testing and functional MRI (fMRI) when available. Because RTFM detects functional networks beyond conventional cortical stimulation, it has the potential to enhance surgical planning and minimize post-surgical functional deficits. Future research will focus on optimizing this approach and assessing its long-term impact on clinical outcomes.

Expanding the Use of cortiQ in Pediatric Epilepsy Centers

The effectiveness of cortiQ rapid cortical mapping has been confirmed by institutions such as C.S. Mott Children’s Hospital, which employs cortiQ for functional mapping with sEEG in pediatric epilepsy patients. Importantly, cortiQ provides critical mapping data even for patients unable to participate in traditional electrical stimulation mapping.

Beyond its mapping capabilities, cortiQ offers practical benefits. It can be used alongside routine EEG monitoring for seizure localization, allowing clinicians to conduct mapping with or without antiepileptic drugs immediately after implantation. Several hospitals have successfully performed cortiQ brain mapping even before epilepsy monitoring officially begins.

Additionally, cortiQ is often used with brain stimulation to elicit functional responses or record cortical evoked responses from single-pulse brain stimulation. This enables clinicians to gather connectivity data between functional regions, further enriching brain mapping insights.

Advancing Pediatric Brain Injury Research

Recognizing the urgent need for research on pediatric brain injury outcomes, Dr. Shah at Weill Cornell Medicine, in collaboration with Dr. Stacy Suskauer, co-founded the Pediatric Brain Injury Consortium in 2019. This initiative unites eight leading pediatric rehabilitation centers across the U.S. to enhance understanding and treatment of pediatric brain injuries. The consortium aims to:

• Characterize the demographics and clinical progression of pediatric brain injuries.
• Identify key predictors of cognitive outcomes.
• Investigate the mechanisms underlying cognitive recovery.
• Develop standardized, age-appropriate outcome measures.
• Conduct clinical trials to evaluate interventions that improve long-term recovery.

To support this research, the team utilizes the g.Nautilus biosignal amplifier for high-quality EEG recordings from surface electrodes.

Innovations in European Pediatric Epilepsy Research

In Europe, researchers are also advancing pediatric epilepsy care through the High-Frequency Oscillations in Pediatric Epilepsy (HOPE) project. This initiative aims to improve localization of the epileptogenic zone and reduce post-surgical seizures. The project relies on high-density EEG recordings with high sampling rates, enabled by the g.HIamp and g.Pangolin ultra-high-density EEG systems.

Conclusion

The integration of cortiQ rapid cortical mapping and g.tec EEG solutions into pediatric epilepsy and brain injury research is revolutionizing the field. These technologies enhance functional mapping, improve surgical outcomes, and provide valuable data for optimizing treatment strategies. As research progresses, these innovations have the potential to further refine epilepsy care and pediatric brain injury rehabilitation worldwide.

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