Navigated transcranial magnetic stimulation (nTMS) is a noninvasive technique often used for localization of the functional motor cortex via induction of motor evoked potentials (MEPs) in neurosurgical patients. There has, however, been no published record of its application in pediatric epilepsy surgery. In this study, the authors aimed to investigate the feasibility of nTMS-based motor mapping in the preoperative diagnostic workup within a population of children with medically refractory epilepsy.

A single-institution database was screened for preoperative nTMS motor mappings obtained in pediatric patients (aged 0 to 18 years, 2012 to present) with medically refractory epilepsy. Patient clinical data, demographic information, and mapping results were extracted and used in statistical analyses.

Sixteen patients met the inclusion criteria, 15 of whom underwent resection. The median age was 9 years (range 0–17 years). No adverse effects were recorded during mapping. Specifically, no epileptic seizures were provoked via nTMS. Recordings of valid MEPs induced by nTMS were obtained in 10 patients. In the remaining patients, no MEPs could be elicited. Failure to generate MEPs was associated significantly with younger patient age (r = 0.8020, p = 0.0001863). The most frequent seizure control outcome was Engel Epilepsy Surgery Outcome Scale class I (9 patients).

Navigated TMS is a feasible, effective, and well-tolerated method for mapping the motor cortex of the upper and lower extremities in pediatric patients with epilepsy. Patient age modulates elicitability of MEPs, potentially reflecting various stages of myelination. Successful motor mapping has the potential to add to the existing presurgical diagnostic workup in this population, and further research is warranted.

导航经颅磁刺激 (nTMS) 是一种无创技术，通常用于通过神经外科患者运动诱发电位 (MEP) 的感应来定位功能性运动皮层。然而，目前还没有关于其在小儿癫痫手术中的应用的公开记录。在这项研究中，作者旨在调查基于 nTMS 的运动映射在医学难治性癫痫儿童人群的术前诊断检查中的可行性。

单一机构数据库筛选了在患有医学难治性癫痫的儿科患者（0 至 18 岁，2012 年至今）中获得的术前 nTMS 运动映射。提取患者临床数据、人口统计信息和绘图结果并用于统计分析。

16 名患者符合纳入标准，其中 15 名接受了切除术。中位年龄为 9 岁（范围 0-17 岁）。测绘过程中没有记录到任何不利影响。具体来说，没有通过 nTMS 引起癫痫发作。在 10 名患者中获得了由 nTMS 诱导的有效 MEP 的记录。在其余患者中，无法引出 MEP。未能生成 MEP 与较年轻的患者年龄显着相关（r = 0.8020，p = 0.0001863）。最常见的癫痫控制结果是恩格尔癫痫手术结果量表 I 级（9 名患者）。

导航 TMS 是一种可行、有效且耐受性良好的方法，用于绘制儿科癫痫患者的上肢和下肢运动皮层。患者年龄调节 MEP 的诱发性，可能反映髓鞘形成的各个阶段。成功的运动映射有可能增加该人群现有的术前诊断检查，因此有必要进行进一步的研究。