Authors :
Presenting Author: Ioannis Ntoumanis, PhD – Cook Children's Health Care System
Mally Townsend, BS – Cook Children's Health Care System
Cynthia Keator, MD – Cook Children's
M. Scott Perry, MD – Cook Children’s Physician Network
Crystal Cooper, PhD – UT Arlington
Christos Papadelis, PhD – Cook Children's Health Care System
Rationale:
Successful epilepsy surgery requires not only the complete resection of the epileptogenic zone but also the preservation of eloquent areas that control essential functions, such as movement and language. Conventional methods for mapping the eloquent cortex rely on monotonous tasks, which can limit engagement, particularly in pediatric populations. To address this limitation, we developed a novel video game specifically designed to elicit activity in key eloquent areas (motor, language, auditory, and visual cortices) within a single, child-friendly paradigm.Methods:
Five typically developing (TD) children (2 females, aged 9-12 years) and two children with drug-resistant epilepsy (DRE; 1 female, aged 10-16 years) completed the video game while their brain activity was recorded with magnetoencephalography (MEG). The video game featured a galaxy-themed background with a spaceship at the bottom of the screen (Figure 1). Each of the 200 trials began with the image of an object appearing at the center of the screen. Participants were instructed to name the object first covertly and then overtly. Afterward, the image of an alien started to slowly descend from the top of the screen toward the spaceship, signaling the decision-making phase. Participants had up to 4 seconds to categorize the object as food or non-food by pressing a button with either their right or left index finger. Upon pressing the button, the object was launched from the spaceship toward the alien. Correct responses were accompanied by a pure tone of 1000 Hz, which was played binaurally when the object reached the alien. The entire game lasted approximately 25 minutes. The sources of neural activities underlying motor, auditory, language, and visual evoked fields were localized with the minimum norm estimate.
Results:
Our preliminary results showed consistent activation of expected brain regions, including the contralateral primary motor cortex, bilateral auditory cortex, visual cortex, and Broca’s area in both patients and healthy controls. Results from a representative TD participant and a patient with DRE are illustrated in Figure 2. After the experiment, all participants reported they would be willing to play the video game again, and, on a scale from 1 (not at all) to 4 (a lot), their average likeability rating was 3.15.
Conclusions:
Our video game was able to localize the eloquent cortex in both TD children and children with DRE, while keeping children entertained. Established fMRI tasks are planned to be used as a gold standard to evaluate the localization of the eloquent areas provided by the video game. Overall, our novel method for mapping the eloquent cortex may enhance pre-surgical evaluation in patients with drug-resistant epilepsy and could be expanded to improve our understanding of brain reorganization in other pediatric neurological disorders, such as cerebral palsy.Funding:
This work was supported by the National Institute of Neurological Disorders and Stroke (R01NS134944).