A Non-Invasive Modality for Pediatrics

Nexstim nTMS Brain Mapping

Nexstim nTMS brain mapping is commonly used with brain tumor and epilepsy patients. It is uniquely suited for pediatrics because of the limited brain mapping options available for this population. For young patients not mature enough for task-based fMRI and MEG mapping, Nexstim may be the only non-invasive brain mapping option.1

With nTMS, motor mapping can be done entirely passively, and has been done in children as young as 8 weeks of age. Children may be mapped while playing with toys, watching cartoons and sitting in their caregivers lap. nTMS captures functional areas that may have migrated due to lesion-induced functional reorganization, which can be dramatic in this population.1, 2

 

Nexstim nTMS language mapping is conducted in a child-friendly environment and has been performed on children as young as 4 years of age. Unlike invasive mapping directly on the brain's surface, nTMS can be performed bilaterally, capturing function that may have relocated to the opposite hemisphere--which is not uncommon in pediatrics.1, 3

nTMS motor mapping in pediatrics

  • The youngest reported patient successfully mapped was 8 weeks of age1
  • Conducted in a child-friendly environment without the need for sedation
  • May reduce the need for two-staged cases for invasive functional brain mapping1

nTMS language mapping in pediatrics

  • The youngest reported patient successfully mapped was 4 years of age1
  • Bilateral mapping captures inter-hemispheric functional reorganization1
  • Multilingual mapping enables visualization of cortical regions associated with each language5

nTMS & MEG: A powerful combination in epilepsy surgery

Combining MEG and nTMS can yield powerful results. MEG can be used to investigate the onset zone for epileptic seizures, whereas nTMS can provide the margin to functional tissue, providing safe resection zones.4 This combination may reduce the number of patients required to undergo two-staged cases for invasive ECS monitoring, which carries significant health risks.4,6

“[MEG and nTMS] can be added to the standard preoperative work-up and may even hold a potential to replace the ECS in a subgroup of patients with epilepsy who have the suspected epileptogenic zone near the sensorimotor cortex and seizures frequent enough for ictal MEG.” - Vitikainen et al.

How nTMS is used in practice

See how one major epilepsy program in the US is using Nexstim nTMS motor and language mapping preoperatively to advance epilepsy care. This article also highlights how nTMS provides unique advantages to the pediatric population.

To the article

 

For children with epilepsy or brain tumors, nTMS can facilitate timely surgery which could otherwise be delayed, because other mapping methods were infeasible or unsuccessful.

Shalini Narayana, MD, Professor of Neurology,
Le Bonheur Children's Hospital, United States.

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References

1. Narayana, S. et al. Clinical utility of transcranial magnetic stimulation in the presurgical evaluation of motor, speech and language functions in young children with refractory epilepsy or brain tumor: preliminary evidence. Front. Neurol. 12, 664782 (2021).

2. Raffa, G. et al. The role of navigated transcranial magnetic stimulation for surgery of motor‑eloquent brain tumors: a systematic review and meta‑analysis. Clin. Neurol. Neurosurg. 180, 47–53 (2019).

3. Pasichnik, A. et al. Discrepant expressive language lateralization in children and adolescents with epilepsy. Ann. Clin. Transl. Neurol. 9, 597–607 (2022).

4. Vitikainen, A.-M. et al. Combined use of non-invasive techniques for improved functional localization for a selected group of epilepsy surgery candidates. NeuroImage 45, 342–348 (2009).

5. Gibbs, J. W. et al. Presurgical language mapping in bilingual children using transcranial magnetic stimulation: illustrative case. J. Neurosurg. Case Lessons 2, CASE21152 (2021).

6. Önal, M. Z.et al. Complications of invasive subdural grid monitoring in children with epilepsy. J. Neurosurg. 98, 1017–1026 (2003).