Language recovery after left hemispherotomy for Rasmussen encephalitis

PURPOSE

Hemispherotomy (H) is the gold standard treatment to cure epilepsy in Rasmussen encephalitis (RE). Linguistic prognosis after surgery remains the main issue when the dominant hemisphere is involved. The topic of the present research is to specify the long-term linguistic profile of the right hemisphere after left dominant H for RE.

METHODS

We followed 6 children 8.4 to 14.6 years of age who underwent left H for RE. Preoperatively, four children experienced aphasia, but for two, worsening occurred after surgery. Age at H ranged from 4.1 to 8.4 years. The mean duration of epilepsy was 1.2 years and 5.6 years for follow-up. Neuropsychological evaluation included longitudinal follow-up of intellectual efficiency measurement and a long-term outcome of language using various components of receptive and expressive oral speech with computerized tasks.

KEY FINDINGS

Preoperatively, verbal comprehension index (VCI) was dramatically decreased in 4/6 patients, and performance reasoning index (PRI) was low in 5/6 participants, demonstrating a global impact of RE itself. Postoperatively, all children recovered sufficiently to attend a regular VCI (above 70) in a mean of 5 years after H, and 5/6 recovered normal or adapted school. There was a dissociation in favor of VCI, while PRI decreased in 5/6 patients. We found a specific linguistic profile for these children recovering language in the right hemisphere: normal verbal comprehension, and weakness of grammatical judgment, word repetition, statement production, semantic verbal fluency and metaphonological abilities. Language recovery scores were statistically correlated with those of Working Memory Index.

SIGNIFICANCE

This study emphasizes for the first time the ability of the right hemisphere to functionally reorganize language over a long period of time following left H for RE. Syntactic abilities and phonology remain low and support the hypothesis of an early left hemispheric specialization. Nevertheless, lexico-semantic processes recover in the right hemisphere that could reflect a pre-existing potential of both hemispheres. Our results support a decision to proceed to H in classical left RE disease until the late childhood even if there is no complete aphasia before surgery. These data should be taken in account in the overall postoperative follow-up and rehabilitation strategy.

Variation in homotopic areas' activity and inter-hemispheric intrinsic connectivity with type of language lateralization: an FMRI study of covert sentence generation in 297 healthy volunteers

We investigated the regional correlates of differences in hemispheric lateralization in 297 healthy volunteers [including 153 left-handers (LH)] previously classified into three types of language lateralization according to their hemispheric functional lateralization index measured with fMRI during covert sentence production versus word list production (PRODSENT-LIST): 250 leftward asymmetrical Typicals, 10 rightward asymmetrical Strong-atypicals (only LH), and 37 Ambilaterals with weak lateralization. Using a functionally driven homotopic atlas (AICHA), we compared patterns of regional asymmetry during PRODSENT-LIST in these three groups. Among the 192 homotopic regions of interest (hROIs) of the AICHA atlas, 58 exhibited a significant effect of the type of lateralization on their BOLD signal variation during PRODSENT-LIST. The analyses of patterns of asymmetry of these 58 hROIs showed that (1) hROIs asymmetries in Strong-atypicals were significantly negatively correlated with those observed in Typicals, which indicates that their regional pattern of rightward asymmetries was comparable to the regional pattern of leftward language asymmetries of Typicals; (2) right- and left-handed Typicals had identical profiles, whereas left-handed Ambilaterals exhibited reduced leftward asymmetry as compared either to right-handed Ambilaterals or to Typicals. Moreover, left-handed Ambilaterals pattern of hROIs asymmetries significantly positively correlated with those of both Typicals and Strong-atypicals. In 291 of the participants, we tested the hypothesis that differences in language lateralization were associated with differences in inter-hemispheric connectivity during resting state by measuring their regional homotopic inter-hemispheric intrinsic connectivity coefficient (rHIICC) in 36 of the 58 hROIs known to be connected via the corpus callosum. Mean rHIICCs were negatively correlated with task-induced functional asymmetries, suggesting that enhanced inter-hemispheric cooperation at rest translates into increased inter-hemispheric cooperation during language production. In addition, the left-handed Ambilaterals exhibited a significantly larger rHIICC compared with right-handed Ambilaterals and Typicals, confirming a difference in inter-hemispheric organization in this group.

The interaction of process and domain in prefrontal cortex during inductive reasoning

Inductive reasoning is an everyday process that allows us to make sense of the world by creating rules from a series of instances. Consistent with accounts of process-based fractionations of the prefrontal cortex (PFC) along the left-right axis, inductive reasoning has been reliably localized to left PFC. However, these results may be confounded by the task domain, which is typically verbal. Indeed, some studies show that right PFC activation is seen with spatial tasks. This study used fMRI to examine the effects of process and domain on the brain regions recruited during a novel pattern discovery task. Twenty healthy young adult participants were asked to discover the rule underlying the presentation of a series of letters in varied spatial locations. The rules were either verbal (pertaining to a single semantic category) or spatial (geometric figures). Bilateral ventrolateral PFC activations were seen for the spatial domain, while the verbal domain showed only left ventrolateral PFC. A conjunction analysis revealed that the two domains recruited a common region of left ventrolateral PFC. The data support a central role of left PFC in inductive reasoning. Importantly, they also suggest that both process and domain shape the localization of reasoning in the brain.

Reading direction shifts visuospatial attention: an Interactive Account of attentional biases

A growing amount of evidence confirms the influence of reading and writing habits on visuospatial processing, although this phenomenon has been so far testified mainly as a lateralized shift of a single behavioral sign (e.g., line bisection), with lack of proof from pure right-to-left readers. The present study contributed to this issue by analyzing multiple attentional and motor indexes in monolingual Italian (i.e., reading from left-to-right), and monolingual (i.e., reading from right-to-left) and bilingual Israeli (i.e., reading from right-to-left in Hebrew but also from left-to-right in English) participants' visuospatial performance. Subjects were administered a computerized standard star cancellation task and a modified version in which English letters and words were replaced by Hebrew ones. Tasks were presented on a graphics tablet, allowing recording of both chronometric and spatial parameters (i.e., measured in (x, y) vector coordinates). Results showed that reading direction modulated the on-line visuomotor performance (i.e., left-to-right vs. right-to-left shifts) from the beginning (i.e., first mark) to the end of the task (i.e., spatial distribution of omissions and subjective epicenter). Additionally, the spatial bias observed in a computerized line bisection task was also related to the participants' habitual reading direction. Overall, the results favor the proposal of an Interactive Account of visuospatial asymmetries, according to which both cultural factors, such as the directional scanning associated with language processing, and biological factors, such as hemispheric specialization, modulate visuospatial processing. Results are discussed in light of recent behavioral and neuroanatomical findings.

An ERP investigation of the co-development of hemispheric lateralization of face and word recognition

The adult human brain would appear to have specialized and independent neural systems for the visual processing of words and faces. Extensive evidence has demonstrated greater selectivity for written words in the left over right hemisphere, and, conversely, greater selectivity for faces in the right over left hemisphere. This study examines the emergence of these complementary neural profiles, as well as the possible relationship between them. Using behavioral and neurophysiological measures, in adults, we observed the standard finding of greater accuracy and a larger N170 ERP component in the left over right hemisphere for words, and conversely, greater accuracy and a larger N170 in the right over the left hemisphere for faces. We also found that although children aged 7-12 years revealed the adult hemispheric pattern for words, they showed neither a behavioral nor a neural hemispheric superiority for faces. Of particular interest, the magnitude of their N170 for faces in the right hemisphere was related to that of the N170 for words in their left hemisphere. These findings suggest that the hemispheric organization of face recognition and of word recognition does not develop independently, and that word lateralization may precede and drive later face lateralization. A theoretical account for the findings, in which competition for visual representations unfolds over the course of development, is discussed.

Children below 9 years use both verbal cues and lateralized cues to orient their attention in an emotional dichotic listening task

The current study aimed to demonstrate that children below 9 years of age efficiently orient their auditory attention with both verbal cues and lateralized cues to identify emotional stimuli. The use of emotional stimuli is an optimal condition according to the assumption that a multi-component task calling on different resources from the two cerebral hemispheres is easier than a multi-component task requiring resources from the same hemisphere. A sample of 103 right-handed children from 7 to 12 years of age was required to identify emotional speech made up of pseudowords preceded by a binaural verbal cue or by a lateralized tone cue. As expected, we observed better performance for the skilled ear (i.e., the left ear for emotional processing) and an improving effect of verbal cues. According to our success criterion (mean correct report rates significantly different from chance), an efficient control of orienting attention was observed in all groups of children. This means that children from 7 to 8 years of age were able to efficiently orient their attention to identify emotional stimuli. Results are discussed in relation to the hemispheric lateralization of emotions.

Comparison of two models of hemispheric specialization with unilaterally lesioned patients: material-specific impairment vs response-bias distortion

Validity of two models of hemispheric specialization was compared. The "material-specific impairment" model was radicalized as postulating that left hemisphere (LH) lesions impair processing of verbal material and that right hemisphere (RH) lesions impair processing of visuospatial material, independently of response-bias distortions. The "response-bias distortion" model was radicalized as postulating that LH lesions distort response style toward omissiveness and that RH lesions distort response style toward commissiveness, regardless of material-specific impairments. Participants had comparable left (N=27) or right (N=24) hemisphere cortical lesions having occurred between birth and early adolescence. Four cognitive neuropsychological tests were adjusted to optimize applicability and comparability of the two theoretical models: Rey Complex Figure, Kimura's Recurring Figures, the Story Recall subtest of the Children's Memory Scale, and the California Verbal Learning Test. Both models significantly, independently, and equally distinguished the LH from the RH patients. Both these forms of hemispheric specialization seemed to be implemented very early in life and very rigidly. Intrahemispheric lesion sites, e.g., frontal vs nonfrontal, held no significant relation to the effects described above.

Tonkean macaques communicate with their right hand

There are two conflicting hypotheses to explain the origins of language. Vocal origin theory states that language results from the gradual evolution of animals' vocal communication, but gestural origin theory considers that language evolved from gestures, with the initial left-hemispheric control of manual gestures gradually encompassing vocalizations. To contribute to this debate, we investigated functional hemispheric specialization related to hand biases when grasping or showing an object through manual gesture in Tonkean macaques. The results of this study, the first quantitative study on Tonkean macaques' handedness, showed a remarkable convergence of the Tonkean macaques' handedness patterns with those of baboons and human infants, with hand preferences for manual communicative gestures significantly favoring the use of the right hand. Our findings support the hypothesis that left hemispheric lateralization for language is derived from a gestural communication system that was present in the common ancestor of macaques, baboons and humans.