nTMS in pediatrics: Special issues and solutions

Abstract

Neurosurgical treatment of pediatric patients harbors specific considerations. Neocortical resective surgery is unique in the challenges of operating in the proximity of eloquent cortex, and in some diseases, such as focal intractable epilepsy, an appreciable fraction of neocortical resections are destined to be in the pediatric population. Using nTMS for motor and language mapping is becoming increasingly valued in pediatric presurgical planning. The nTMS technique has demonstrable utility for obtaining the information needed for localization of motor and language function in children, with minimal associated health risks and very little difficulty on behalf of the operator. This chapter outlines the special considerations for nTMS in pediatric patients, including modifications to equipment setups, stimulation intensities, and potential influence of antiepileptic medications. It moreover outlines the differences of nTMS compared to other functional mapping techniques in the pediatric population and provides practical information on how to work with children of any age in order to obtain optimal mapping results.