Talk:Cortical stimulation mapping

In

In the next few days, Melissa Chavez, Heather Funk, and Daniel Farrell will begin making dramatic changes to this page as a project for Professor Joe Burdo’s BI481 Introduction to Neuroscience class (Fall 2012) in which students are to edit an underdeveloped or incomplete neuroscience article. This project is related to the initiative founded by the Society for Neuroscience to improve information about neuroscience on Wikipedia. We will continue working on this page for the duration of the semester.

More about our project for BI481: user:NeuroJoe/BI481 Fall 2012

Chavezmb (talk) 01:56, 31 October 2012 (UTC)Chavezmb

The article is well written and informative. The information is divided well into separate sections throughout the article. It would be helpful to hyperlink a few terms such as cerebral cortex and motor cortex. It may also be useful to define or explain what a reversible lesion is.

The section about epilepsy states near the end that CSM can only be used to treat focal epilepsy. It might make sense to put this information at the beginning of the section instead of at the end so that the reader does not begin reading it thinking that CSM can be used as a treatment for any type of epilepsy. Also, if possible, you may want to include an explanation of why CSM cannot be used to treat other forms of epilepsy.

In the section about epilepsy, the second sentence contains the word with instead of to. Also there was one spelling error in the last section of the article in the hyperlink for multiple sclerosis.

The last section of the article about Transcranial Magnetic Stimulation is very informative, but it may not be necessary as there is already a Wikipedia page for TMS. You included the link to the Wikipedia page for TMS, so I’m not sure if you need the entire section about it in your article. It was a good idea to include links to relevant Wikipedia pages at the end of the article.

Overall the article is very detailed and well organized. It is not repetitive and provides a good overview of Cortical Stimulation Mapping with very relevant information. Ekeena (talk) 02:44, 19 November 2012 (UTC)

Thanks for the review we appreciate your input. We've added more hyperlinks and I re-worded the procedure section to spell out more clearly what a reversible lesion does so that it is easier to understand. We also emphasize now when and why CSM is used to treat epilepsy, because it is so invasive it is not always necessary. Thanks for pointing out the spelling and grammar errors and we've altered the TMS section to make it more of a comparison with CSM. Thanks again! Dfarrell007 (talk) 04:24, 4 December 2012 (UTC)

This article is informative, interesting, and well cited, but I have a few suggestions. In terms of structure, I don't think that there needs to be a large heading for "Comparison with other techniques". Instead, you should just begin with TSM by introducing it as an alternative means for brain mapping. Perhaps the introductory bit could be placed in the beginning of the article because it seems repetitive where it is now.

Also, I think you could elaborate a little bit more on the mechanism of the stimulation. What exactly is happening? What should the physician look for after stimulating the brain area? Are motor pathways and the subsequent muscle movements stimulated or inhibited? How are "crucial" brain areas determined when surgeons look at the brain before cutting? It is vague when you discuss certain areas of the brain as being vital ones that surgeons avoid during resections. What criteria do they use to deem these areas vital or not? Also, I think the bits about ontological use/epileptic use are repetitive. In the end, the procedure is used by surgeons to determine what areas of the brain to avoid/preserve when deciding where to resect.

One last thing--the paragraph under the "Procedure" section that discusses the interference of cerebral spinal fluid with the mapping could use a little bit more elaboration. Just hyperlinking to the word "shunting" doesn't seem very informative. Explaining what that means and why it happens could strengthen the paragraph and elucidate the concept.

Overall, though, I think this is a great article! The bit on using CSM as a treatment for blindness was my favorite; it was clear, well written, and interesting!

User:OliviaHall10 (talk) 06:15, 19 November 2012 (UTC)

Thanks for your suggestions, they were helpful and I think they have definitely improved our article. We've altered the TMS and CSM comparison. I tried to make the mechanism of stimulation more clear and easier to understand, let us know if it is still confusing. I didn't want to be too repetitive about testing for impaired function of a stimulated area, and I offered an example of the type of motor or language response that could be tested. Pretty much any brain area that has a functional response is vital and I tried to clarify that that is what determines if an area of the brain can be safely resected, without becoming too repetitive. I agree the shunting concept was difficult to understand as it was, I added to that sentence to clarify how this is a complication for delivering electrical current to the brain. Glad the vision section was engaging and thank you again for your review. Dfarrell007 (talk) 04:24, 4 December 2012 (UTC)

I think you have made great progress on this article! It is clearly written, well structured, and very informative. I saw a small edit that could be made to the introduction. I believe the first time that your article title appears you need to bold it; you have the title bolded now in the second time it appears. I also think that the final sentence of the introduction "It is also often used in the clinical treatment of epilepsy" is a little repetitive since you already stated that CSM is useful for a number of clinical and therapeutic applications.

I really enjoyed the history section, it was interesting to see how this technique has evolved over the years. However, I was thinking that you may want to consider adding the time frame that Cushing did his work as well as elaborate on how his research led to the treatment of epilepsy.

Also, a short technical modification for the procedure section. You have the word "resected" linked to a disambiguation page, you may want to edit this so that it links directly to the relevant page. I agree with the previous reviewer's suggestions about the procedure section. I think it could use more details about the actual effects of stimulation on the neurons and how this stimulation is measured. You may want to include more physiological details on how the neurons are actually stimulated. Additionally, you may want to add more specifics on how the appropriate current density is determined/what this value is quantitatively.

As for the somatotopy section, I also agree that you should mention the areas of the brain that have been removed successfully in the motor mapping section. Would you also want to put in an additional section for somatosensory mapping, as you mention it in the introduction and have subsections for both motor and language mapping? I found a small spelling mistake in the language mapping section: "Cortical stimulation mapping has also identied a language area in the basal temporal cortex that was previously unknown."

For the clinical applications sections, I thought the following sentence could be revised: "CSM is routinely utilized for epileptic patients in order to pin point the focal point of the seizures. Once the focal point of the seizures is determined, this information, along with information provided by CSM" Is this sentence saying that first the more general focal point region is determined by another mechanism and then the exact location is detected by CSM? If this is the point you're trying to get across, you should make the distinction between locating a more general region and then pin pointing the specific location with CSM. Also, you may want to mention what techniques are used to determine the general region (electroencephalography?) here instead of later in this section in order to make this distinction more clear. Under the epilepsy subsection, you may want to consider linking to term steriotaxically to its wikipedia article because it is a technical term that some readers may be unfamiliar with.

In the neuro-oncology section I was a little unclear about the sentence saying that there needed to be a balance between quality and quantity of life. Maybe you could make a little more clear about what procedure provides more quality of life and why and what provides more quantity and why.

I hope these suggestions are helpful. Keep up the great work done so far on this article! Ellen.white4 (talk) 21:20, 19 November 2012 (UTC)

Thanks for the review! More information was added about the active time period of Cushing, the current density values, the somatosensory cortex, and the researchers Penfield and Boldfrey. We also added a hyperlink for Penfield however no wikipedia page exists for Boldfrey. We didnt want to bog down the procedure section with too many technical details about current density and levels because they are difficult for a non-expert to understand. However we added more of an explanation of how much current is applied and roughly for how long. Another issue is that current levels and procedures really vary depending on the testing done by the patient and the facility where it is done so we didnt want to get too specific on numbers here since there aren't 'absolute' numerical standards for CSM. Additionally we added a subsection on somatosensory mapping at your suggestion but actually identifying which brain areas have been successfully removed we felt would be too technical for the article. The exact anatomy of brain areas that are removed in treatments are variable from patient to patient, which is what CSM is useful to show.

We tried to clarify the section of neuro-oncology relating to how quality and quantity of life is balanced in determining the size of tumor resection. This was done by adding more detail about how a greater resection leads to a possibly greater life expectancy but with the risk of costing the patient function, or quality of life. We hope this makes it clearer and we've revised our writing so it is easier to understand, let us know if you have further suggestions! Dfarrell007 (talk) 04:36, 4 December 2012 (UTC)

Overall I enjoyed reading your article because it was well written and very informative. I thought the article was broken down into a logical order of sections. The main focus was placed on the more significant sections including procedure, somatotopy and clinical applications, which helps to strengthen your article. A general trend I noticed throughout the article was a lack of hyperlinking. I think that by adding more hyperlinks, it will help the audience to have a better understanding of CSM.

The introduction section was well written and laid the groundwork for what the reader could expect in the upcoming article. I think that a picture in the introduction would help to make the page even better and closer to a “Good Wikipedia” article.

Both the history and somatotopy sections were well written and very interesting. It was good to break down somatotopy into motor and language, because both involve very distinct regions of the brain.

The procedure section was very informative and gave a very detailed explanation of CSM. However, I believe this section could use more hyperlinking to allow readers of all experience and knowledge levels to further their comprehension of the CSM procedure. Terms such as amplitude and duration may not be common knowledge to an average reader without a biological background. I think your article would also benefit from a clarification of what standard grid electrode placement entails. Additionally, can you elaborate on what a safe current level for patient testing is?

The clinical applications section was well organized into epilepsy, neuro-oncology and vision. The second line of the epilepsy section appears to have a grammatical error. The epilepsy section is very detailed and requires clarification. Academic terms such as steriotaxically, focal epilepsy, and epileptogenic require hyperlinking or explanation to clarify these terms for the audience. I am also curious if there are any other applications that were left out that could possibly be included in an introduction statement to this section? Also, in the oncology section, can you further elaborate on what baseline function refers to? Overall it was useful to learn about the applications of CSM.

I think the Links to Other Wikipedia Article section is unnecessary because the links listed in the section were utilized previously within the article. An exception would be the “electrocorticography” link. If this mapping method is relevant to CSM then I think it should be addressed previously within your article.

Thanks for your suggestions. We made your revisions and added more relevant links throughout the article instead of listing them at the bottom. We tried to clarify the epilepsy section and make it clearer. There are certainly more applications, we just chose to focus on a few specific ones that are common and interesting. We also clarified that electrodes can come in many formats, a grid pattern being one of them. Thanks again for your input! Dfarrell007 (talk) 04:43, 4 December 2012 (UTC) James.murphy.0530 (talk) 23:29, 19 November 2012 (UTC)

Review

The first thing I would like to point out is your hyperlinking, make sure you hyperlink such things as cerebral cortex and other specific subjects that you talk about. It's a hallmark of wikipedia and needs to be done. Also, stay away from language such as "is still useful." This term is showing bias to what the author thinks is or isn't still useful. The reading should be reading a non-biased written article. You can state if it is or isn't used, but stay away from whether it is useful; same thing with stating it is the "gold standard," sounds kind of biased. You can say it is the predominant method used for diagnosing something but don't say its the gold standard. I'm away that there is a page for it but it may cause some trouble.

Also you talk in your history about Ferrier and Horsley, make sure you cite that sentence because you are stating a fact. When you talk about comparison to other techniques, make sure you still focus on your own technique. Other pages are for the other techniques, yours should say why yours is used and the advantages/disadvantages to the other tests. AdamMJenks (talk) 14:39, 29 November 2012 (UTC)

Thanks for your review. We've added more hyperlinks throughout the article and hopefully this will help readers who are less familiar with the concepts. Additionally we've revised our language to be more neutral and not judge the usefulness of one technique versus another. We decided to keep the term “Gold standard” when describing the technique because it is considered a medical term for those procedures that have undergone an accepted diagnostic test in order to meet this standard. Both the hyper linking of “Gold Standard (test)” and the citation of the statement support our use of the term. In this sense CSM is the gold standard since the surgeon can pin point an exact physical location in the brain with a specific function. Additionally, citations were added for information about Ferrier and Horsely. We changed the last section significantly to bring it back to CSM and emphasize the comparison and not TMS on its own. Thank you again for your input. Dfarrell007 (talk) 04:43, 4 December 2012 (UTC)