Aphasia and cognitive impairment decrease the reliability of rnTMS language mapping

• Published in: Acta neurochirurgica 2018-02, Vol.160 (2), p.343-356
• Main Authors: Schwarzer, Vera, Bährend, Ina, Rosenstock, Tizian, Dreyer, Felix R., Vajkoczy, Peter, Picht, Thomas
• Format: Article
• Language: English
• Subjects: Aphasia; Bias; Biometrics; Brain; Brain cancer; Brain mapping; Cognitive ability; Histology; Impairment; Incidence; Interventional Radiology; Language; Lesions; Magnetic fields; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Neurology; Neuroradiology; Neurosurgery; Original Article - Brain Tumors; Pain; Statistical analysis; Surgical Orthopedics; Transcranial magnetic stimulation
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-017-3397-4

Background Navigated transcranial magnetic stimulation (nTMS) is a non-invasive mapping tool to locate functional areas of the brain. While gaining importance in the preoperative planning process in motor eloquent regions, its usefulness for reliably identifying language areas is still being discussed. The aim of this study was to identify biometric factors which might influence and therefore bias the results of repetitive nTMS (rnTMS) over cortex areas relevant for language. Method We included data of 101 patients with language eloquent brain lesions who underwent preoperative rnTMS examination bihemispherically. Prior to rnTMS mapping, all patients performed two to three baseline runs of a picture-naming paradigm without stimulation, and only promptly and correctly named objects were retained for TMS mapping. Nine biometric factors (age, gender, baseline dataset, cognitive performance score, aphasia score, histology of lesion, affected hemisphere, location of lesion on the hemisphere, pain caused by examination) were included in the statistical analysis measuring their correlation with the incidence of errors during baseline naming as well as during rnTMS mapping. Results The incidence of baseline errors correlated with aphasia ( p