Working memory deficits after resection of the dorsolateral prefrontal cortex predicted by functional magnetic resonance imaging and electrocortical stimulation mapping

Electrocortical stimulation mapping (ESM) is the clinical standard for localizing critical sensorimotor and language functions, but other functions can be assessed with this technique as well. The authors describe an 8-year-old girl with a left frontal desmoplastic gangliocytoma and medically intractable epilepsy who underwent a chronic invasive recording using electrode grids. Prior to electrode implantation, functional magnetic resonance (fMR) imaging was performed using a research protocol that included a working memory task. The ESM procedure interfered with working memory at a dorsolateral prefrontal site as predicted by fMR imaging, but because this site was part of the epileptogenic region, it was included in the resection. Since the operation the patient has been seizure free and her overall cognitive performance has improved. Yet she shows a selective impairment in working memory tasks that has persisted for over two years, indicating that the area identified using fMR imaging and ESM was critically involved in working memory. Her performance did improve, however, suggesting that compensatory mechanisms took place. This case reveals an important and perhaps critical function of the dorsolateral prefrontal cortex. Work continues to assess the specific cognitive functions subserved by the region identified with fMR imaging and ESM.