Abstract
Direct Cortical Stimulation (DCS) for motor mapping and monitoring has special characteristics in children. Several physiological, pathological, and pharmacological factors determine higher cortical motor thresholds (CMT) in this population. It is known that physiological CMT to electrical or magnetic stimulation progressively decrease from the first months of life reaching adult values at about the age of 18 years. Certain pathological conditions such as errors in neuronal migration, dysembryoplastic neuroepithelial tumor, cortical dysplasia, and retro-rolandic low grade glioma may further increase CMT. In addition, some antiepileptic drugs, especially those blocking voltage-dependent Na+ channels also decrease cortical excitability. Despite these difficulties, in our experience DCS was successful in mapping the motor cortex in 34 out of 34 surgeries in 32 children aged 3–17 years old. Under total intravenous anesthesia (propofol plus remifentanil) and employing five-stimulus anodic trains with inter-stimulus intervals of 2–3 ms, DCS intensities needed to evoke limb- or face-muscle responses ranged from 20 to 85 mA. Although these intensities are higher than those reported in adult patients, they remained within safety limits (5.95 uC/ph) and did not exert seizures in any case. Atypical somatotopic representation due to anatomical distortion or cortical reorganization was also found in some patients.
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