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Structural Organization of the Laryngeal Motor Cortical Network and Its Implication for Evolution of Speech Production. J Neurosci 2016; 36:4170-81. [PMID: 27076417 DOI: 10.1523/jneurosci.3914-15.2016] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 02/28/2016] [Indexed: 11/21/2022] Open
Abstract
UNLABELLED The laryngeal motor cortex (LMC) is essential for the production of learned vocal behaviors because bilateral damage to this area renders humans unable to speak but has no apparent effect on innate vocalizations such as human laughing and crying or monkey calls. Several hypotheses have been put forward attempting to explain the evolutionary changes from monkeys to humans that potentially led to enhanced LMC functionality for finer motor control of speech production. These views, however, remain limited to the position of the larynx area within the motor cortex, as well as its connections with the phonatory brainstem regions responsible for the direct control of laryngeal muscles. Using probabilistic diffusion tractography in healthy humans and rhesus monkeys, we show that, whereas the LMC structural network is largely comparable in both species, the LMC establishes nearly 7-fold stronger connectivity with the somatosensory and inferior parietal cortices in humans than in macaques. These findings suggest that important "hard-wired" components of the human LMC network controlling the laryngeal component of speech motor output evolved from an already existing, similar network in nonhuman primates. However, the evolution of enhanced LMC-parietal connections likely allowed for more complex synchrony of higher-order sensorimotor coordination, proprioceptive and tactile feedback, and modulation of learned voice for speech production. SIGNIFICANCE STATEMENT The role of the primary motor cortex in the formation of a comprehensive network controlling speech and language has been long underestimated and poorly studied. Here, we provide comparative and quantitative evidence for the significance of this region in the control of a highly learned and uniquely human behavior: speech production. From the viewpoint of structural network organization, we discuss potential evolutionary advances of enhanced temporoparietal cortical connections with the laryngeal motor cortex in humans compared with nonhuman primates that may have contributed to the development of finer vocal motor control necessary for speech production.
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The value of preoperative functional cortical mapping using navigated TMS. Neurophysiol Clin 2016; 46:125-33. [PMID: 27229765 DOI: 10.1016/j.neucli.2016.05.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 05/02/2016] [Indexed: 01/29/2023] Open
Abstract
The surgical removal of brain tumours in so-called eloquent regions is frequently associated with a high risk of causing disabling postoperative deficits. Among the preoperative techniques proposed to help neurosurgical planning and procedure, navigated transcranial magnetic stimulation (nTMS) is increasingly performed. A high level of evidence is now available in the literature regarding the anatomical and functional accuracy of this mapping technique. This article presents the principles and facts demonstrating the value of using nTMS in clinical practice to preserve motor or language functions from deleterious lesions secondary to brain tumour resection or epilepsy surgery.
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Englot DJ, Nagarajan SS, Wang DD, Rolston JD, Mizuiri D, Honma SM, Mantle M, Tarapore PE, Knowlton RC, Chang EF, Kirsch HE. The sensitivity and significance of lateralized interictal slow activity on magnetoencephalography in focal epilepsy. Epilepsy Res 2016; 121:21-8. [PMID: 26871959 DOI: 10.1016/j.eplepsyres.2016.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 01/16/2016] [Accepted: 01/28/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Asymmetric large-amplitude slow activity is sometimes observed on interictal electroencephalography (EEG) in epilepsy. However, few studies have examined slowing during magnetoencephalography (MEG) recordings, which are performed primarily to localize interictal spikes. Also, no prior investigations have compared the sensitivity of MEG to scalp EEG in detecting slow rhythms. METHODS We performed a retrospective cohort study of focal epilepsy patients who received MEG followed by surgical resection at our institution. We examined MEG, simultaneous EEG, and long-term EEG recordings for prominent asymmetric slow activity (delta-range, 1-4 Hz), and evaluated post-operative seizure outcomes. RESULTS We studied 132 patients with ≥ 1 year post-operative follow-up (mean, 3.6 years). Mean age was 27 (range, 3-68) years, and 55% of patients were male. Asymmetric large-amplitude slow wave activity was observed on interictal MEG in 21 of 132 (16%) patients. Interictal slowing lateralized to the hemisphere of resection in all but one (95%) patient. Among the 21 patients with interictal MEG slowing, 11 (52%) individuals had similarly lateralized EEG slowing, 7 patients had no EEG slowing, and 3 had bilateral symmetric EEG slowing. Meanwhile, none of the 111 patients without lateralized MEG slowing had asymmetric EEG slowing, suggesting significantly higher sensitivity of MEG versus EEG in detecting asymmetric slowing (χ(2)=63.4, p<0.001). MEG slowing was associated with shorter epilepsy duration with an odds ratio of 5.4 (1.7-17.0, 95% confidence interval). At last follow-up, 92 (70%) patients were seizure free (Engel I outcome), with no difference in seizure freedom rates between patients with (71%) or without (69%) asymmetric MEG slowing (χ(2)=0.4, p=0.99). SIGNIFICANCE MEG has higher sensitivity than scalp EEG in detecting asymmetric slow activity in focal epilepsy, which reliably lateralizes to the epileptogenic hemisphere. Other uses of MEG beyond spike localization may further improve presurgical evaluations in epilepsy.
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Affiliation(s)
- Dario J Englot
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Srikantan S Nagarajan
- Biomagnetic Imaging Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Doris D Wang
- Department of Neurological Surgery, University of California, San Francisco, CA, USA; Biomagnetic Imaging Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - John D Rolston
- Department of Neurological Surgery, University of California, San Francisco, CA, USA; Biomagnetic Imaging Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Danielle Mizuiri
- Biomagnetic Imaging Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Susanne M Honma
- Biomagnetic Imaging Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Mary Mantle
- Biomagnetic Imaging Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Phiroz E Tarapore
- Department of Neurological Surgery, University of California, San Francisco, CA, USA; Biomagnetic Imaging Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Robert C Knowlton
- Department of Neurology, University of California, San Francisco, CA, USA; Biomagnetic Imaging Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, CA, USA; Biomagnetic Imaging Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Heidi E Kirsch
- Department of Neurology, University of California, San Francisco, CA, USA; Biomagnetic Imaging Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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Pirmoradi M, Jemel B, Gallagher A, Tremblay J, D’Hondt F, Nguyen DK, Béland R, Lassonde M. Verbal memory and verbal fluency tasks used for language localization and lateralization during magnetoencephalography. Epilepsy Res 2016; 119:1-9. [DOI: 10.1016/j.eplepsyres.2015.11.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/02/2015] [Accepted: 11/13/2015] [Indexed: 11/27/2022]
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Ille S, Sollmann N, Hauck T, Maurer S, Tanigawa N, Obermueller T, Negwer C, Droese D, Zimmer C, Meyer B, Ringel F, Krieg SM. Combined noninvasive language mapping by navigated transcranial magnetic stimulation and functional MRI and its comparison with direct cortical stimulation. J Neurosurg 2015; 123:212-25. [DOI: 10.3171/2014.9.jns14929] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECT
Repetitive navigated transcranial magnetic stimulation (rTMS) is now increasingly used for preoperative language mapping in patients with lesions in language-related areas of the brain. Yet its correlation with intraoperative direct cortical stimulation (DCS) has to be improved. To increase rTMS's specificity and positive predictive value, the authors aim to provide thresholds for rTMS's positive language areas. Moreover, they propose a protocol for combining rTMS with functional MRI (fMRI) to combine the strength of both methods.
METHODS
The authors performed multimodal language mapping in 35 patients with left-sided perisylvian lesions by using rTMS, fMRI, and DCS. The rTMS mappings were conducted with a picture-to-trigger interval (PTI, time between stimulus presentation and stimulation onset) of either 0 or 300 msec. The error rates (ERs; that is, the number of errors per number of stimulations) were calculated for each region of the cortical parcellation system (CPS). Subsequently, the rTMS mappings were analyzed through different error rate thresholds (ERT; that is, the ER at which a CPS region was defined as language positive in terms of rTMS), and the 2-out-of-3 rule (a stimulation site was defined as language positive in terms of rTMS if at least 2 out of 3 stimulations caused an error). As a second step, the authors combined the results of fMRI and rTMS in a predefined protocol of combined noninvasive mapping. To validate this noninvasive protocol, they correlated its results to DCS during awake surgery.
RESULTS
The analysis by different rTMS ERTs obtained the highest correlation regarding sensitivity and a low rate of false positives for the ERTs of 15%, 20%, 25%, and the 2-out-of-3 rule. However, when comparing the combined fMRI and rTMS results with DCS, the authors observed an overall specificity of 83%, a positive predictive value of 51%, a sensitivity of 98%, and a negative predictive value of 95%.
CONCLUSIONS
In comparison with fMRI, rTMS is a more sensitive but less specific tool for preoperative language mapping than DCS. Moreover, rTMS is most reliable when using ERTs of 15%, 20%, 25%, or the 2-out-of-3 rule and a PTI of 0 msec. Furthermore, the combination of fMRI and rTMS leads to a higher correlation to DCS than both techniques alone, and the presented protocols for combined noninvasive language mapping might play a supportive role in the language-mapping assessment prior to the gold-standard intraoperative DCS.
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Affiliation(s)
| | | | | | | | - Noriko Tanigawa
- 5Faculty of Linguistics, Philology, & Phonetics, University of Oxford, United Kingdom
| | | | | | - Doris Droese
- 4Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; and
| | - Claus Zimmer
- 2TUM-Neuroimaging Center
- 3Section of Neuroradiology, Department of Radiology; and
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Kharkar S, Knowlton R. Magnetoencephalography in the presurgical evaluation of epilepsy. Epilepsy Behav 2015; 46:19-26. [PMID: 25555504 DOI: 10.1016/j.yebeh.2014.11.029] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 11/24/2014] [Accepted: 11/27/2014] [Indexed: 11/27/2022]
Abstract
Magnetoencephalography (MEG) is an important tool in the presurgical evaluation of patients with medically refractory epilepsy. The appropriate utilization and interpretation of MEG studies can increase the proportion of patients who may be able to further pursue surgical evaluation, refine surgical planning, and potentially increase the probability of seizure freedom after surgery. The aim of this paper is to provide the reader with a comprehensive but accessible guide to MEG, with particular emphasis on acquiring a working knowledge of MEG analysis, identifying patient groups that are most likely to benefit, and clarifying the limitations of this technology.
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Affiliation(s)
| | - Robert Knowlton
- Department of Neurology, University of California at San Francisco, USA; Department of Radiology, University of California at San Francisco, USA; Department of Neurological Surgery, University of California at San Francisco, USA
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Simonyan K, Fuertinger S. Speech networks at rest and in action: interactions between functional brain networks controlling speech production. J Neurophysiol 2015; 113:2967-78. [PMID: 25673742 DOI: 10.1152/jn.00964.2014] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/06/2015] [Indexed: 01/08/2023] Open
Abstract
Speech production is one of the most complex human behaviors. Although brain activation during speaking has been well investigated, our understanding of interactions between the brain regions and neural networks remains scarce. We combined seed-based interregional correlation analysis with graph theoretical analysis of functional MRI data during the resting state and sentence production in healthy subjects to investigate the interface and topology of functional networks originating from the key brain regions controlling speech, i.e., the laryngeal/orofacial motor cortex, inferior frontal and superior temporal gyri, supplementary motor area, cingulate cortex, putamen, and thalamus. During both resting and speaking, the interactions between these networks were bilaterally distributed and centered on the sensorimotor brain regions. However, speech production preferentially recruited the inferior parietal lobule (IPL) and cerebellum into the large-scale network, suggesting the importance of these regions in facilitation of the transition from the resting state to speaking. Furthermore, the cerebellum (lobule VI) was the most prominent region showing functional influences on speech-network integration and segregation. Although networks were bilaterally distributed, interregional connectivity during speaking was stronger in the left vs. right hemisphere, which may have underlined a more homogeneous overlap between the examined networks in the left hemisphere. Among these, the laryngeal motor cortex (LMC) established a core network that fully overlapped with all other speech-related networks, determining the extent of network interactions. Our data demonstrate complex interactions of large-scale brain networks controlling speech production and point to the critical role of the LMC, IPL, and cerebellum in the formation of speech production network.
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Affiliation(s)
- Kristina Simonyan
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York; Department Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stefan Fuertinger
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
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Stippich C, Blatow M, Garcia M. Task-Based Presurgical Functional MRI in Patients with Brain Tumors. CLINICAL FUNCTIONAL MRI 2015. [DOI: 10.1007/978-3-662-45123-6_4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Miller ZA, Hinkley LB, Herman A, Honma S, Findlay A, Block N, Ketelle R, Rabinovici G, Rosen H, Nagarajan SS, Miller BL, Gorno-Tempini ML. Anomalous functional language lateralization in semantic variant PPA. Neurology 2014; 84:204-6. [PMID: 25471393 DOI: 10.1212/wnl.0000000000001131] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Zachary A Miller
- From the UCSF Memory and Aging Center (Z.A.M., N.B., R.K., G.D.R., H.R., B.L.M., M.L.G.-T.) and the UCSF Biomagnetic Imaging Lab (L.B.H., A.H., S.H., A.F., S.S.N.), San Francisco, CA.
| | - Leighton B Hinkley
- From the UCSF Memory and Aging Center (Z.A.M., N.B., R.K., G.D.R., H.R., B.L.M., M.L.G.-T.) and the UCSF Biomagnetic Imaging Lab (L.B.H., A.H., S.H., A.F., S.S.N.), San Francisco, CA
| | - Alex Herman
- From the UCSF Memory and Aging Center (Z.A.M., N.B., R.K., G.D.R., H.R., B.L.M., M.L.G.-T.) and the UCSF Biomagnetic Imaging Lab (L.B.H., A.H., S.H., A.F., S.S.N.), San Francisco, CA
| | - Susanne Honma
- From the UCSF Memory and Aging Center (Z.A.M., N.B., R.K., G.D.R., H.R., B.L.M., M.L.G.-T.) and the UCSF Biomagnetic Imaging Lab (L.B.H., A.H., S.H., A.F., S.S.N.), San Francisco, CA
| | - Anne Findlay
- From the UCSF Memory and Aging Center (Z.A.M., N.B., R.K., G.D.R., H.R., B.L.M., M.L.G.-T.) and the UCSF Biomagnetic Imaging Lab (L.B.H., A.H., S.H., A.F., S.S.N.), San Francisco, CA
| | - Nikolas Block
- From the UCSF Memory and Aging Center (Z.A.M., N.B., R.K., G.D.R., H.R., B.L.M., M.L.G.-T.) and the UCSF Biomagnetic Imaging Lab (L.B.H., A.H., S.H., A.F., S.S.N.), San Francisco, CA
| | - Robin Ketelle
- From the UCSF Memory and Aging Center (Z.A.M., N.B., R.K., G.D.R., H.R., B.L.M., M.L.G.-T.) and the UCSF Biomagnetic Imaging Lab (L.B.H., A.H., S.H., A.F., S.S.N.), San Francisco, CA
| | - Gil Rabinovici
- From the UCSF Memory and Aging Center (Z.A.M., N.B., R.K., G.D.R., H.R., B.L.M., M.L.G.-T.) and the UCSF Biomagnetic Imaging Lab (L.B.H., A.H., S.H., A.F., S.S.N.), San Francisco, CA
| | - Howard Rosen
- From the UCSF Memory and Aging Center (Z.A.M., N.B., R.K., G.D.R., H.R., B.L.M., M.L.G.-T.) and the UCSF Biomagnetic Imaging Lab (L.B.H., A.H., S.H., A.F., S.S.N.), San Francisco, CA
| | - Srikantan S Nagarajan
- From the UCSF Memory and Aging Center (Z.A.M., N.B., R.K., G.D.R., H.R., B.L.M., M.L.G.-T.) and the UCSF Biomagnetic Imaging Lab (L.B.H., A.H., S.H., A.F., S.S.N.), San Francisco, CA
| | - Bruce L Miller
- From the UCSF Memory and Aging Center (Z.A.M., N.B., R.K., G.D.R., H.R., B.L.M., M.L.G.-T.) and the UCSF Biomagnetic Imaging Lab (L.B.H., A.H., S.H., A.F., S.S.N.), San Francisco, CA
| | - Maria Luisa Gorno-Tempini
- From the UCSF Memory and Aging Center (Z.A.M., N.B., R.K., G.D.R., H.R., B.L.M., M.L.G.-T.) and the UCSF Biomagnetic Imaging Lab (L.B.H., A.H., S.H., A.F., S.S.N.), San Francisco, CA
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Carey DP, Johnstone LT. Quantifying cerebral asymmetries for language in dextrals and adextrals with random-effects meta analysis. Front Psychol 2014; 5:1128. [PMID: 25408673 PMCID: PMC4219560 DOI: 10.3389/fpsyg.2014.01128] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 09/16/2014] [Indexed: 12/31/2022] Open
Abstract
Speech and language-related functions tend to depend on the left hemisphere more than the right in most right-handed (dextral) participants. This relationship is less clear in non-right handed (adextral) people, resulting in surprisingly polarized opinion on whether or not they are as lateralized as right handers. The present analysis investigates this issue by largely ignoring methodological differences between the different neuroscientific approaches to language lateralization, as well as discrepancies in how dextral and adextral participants were recruited or defined. Here we evaluate the tendency for dextrals to be more left hemisphere dominant than adextrals, using random effects meta analyses. In spite of several limitations, including sample size (in the adextrals in particular), missing details on proportions of groups who show directional effects in many experiments, and so on, the different paradigms all point to proportionally increased left hemispheric dominance in the dextrals. These results are analyzed in light of the theoretical importance of these subtle differences for understanding the cognitive neuroscience of language, as well as the unusual asymmetry in most adextrals.
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Affiliation(s)
- David P Carey
- Perception, Action and Memory Research Group, School of Psychology, Bangor University Bangor, UK
| | - Leah T Johnstone
- Perception, Action and Memory Research Group, School of Psychology, Bangor University Bangor, UK
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62
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Optimal timing of pulse onset for language mapping with navigated repetitive transcranial magnetic stimulation. Neuroimage 2014; 100:219-36. [DOI: 10.1016/j.neuroimage.2014.06.016] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 04/21/2014] [Accepted: 06/06/2014] [Indexed: 11/22/2022] Open
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Rezaie R, Narayana S, Schiller K, Birg L, Wheless JW, Boop FA, Papanicolaou AC. Assessment of hemispheric dominance for receptive language in pediatric patients under sedation using magnetoencephalography. Front Hum Neurosci 2014; 8:657. [PMID: 25191260 PMCID: PMC4140211 DOI: 10.3389/fnhum.2014.00657] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 08/06/2014] [Indexed: 12/11/2022] Open
Abstract
Non-invasive assessment of hemispheric dominance for receptive language using magnetoencephalography (MEG) is now a well-established procedure used across several epilepsy centers in the context of pre-surgical evaluation of children and adults while awake, alert and attentive. However, the utility of MEG for the same purpose, in cases of sedated patients, is contested. Establishment of the efficiency of MEG is especially important in the case of children who, for a number of reasons, must be assessed under sedation. Here we explored the efficacy of MEG language mapping under sedation through retrospective review of 95 consecutive pediatric patients, who underwent our receptive language test as part of routine clinical evaluation. Localization of receptive language cortex and subsequent determination of laterality was successfully completed in 78% (n = 36) and 55% (n = 27) of non-sedated and sedated patients, respectively. Moreover, the proportion of patients deemed left hemisphere dominant for receptive language did not differ between non-sedated and sedated patients, exceeding 90% in both groups. Considering the challenges associated with assessing brain function in pediatric patients, the success of passive MEG in the context of the cases reviewed in this study support the utility of this method in pre-surgical receptive language mapping.
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Affiliation(s)
- Roozbeh Rezaie
- Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center Memphis, TN, USA ; Neuroscience Institute, Le Bonheur Children's Hospital Memphis, TN, USA
| | - Shalini Narayana
- Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center Memphis, TN, USA ; Neuroscience Institute, Le Bonheur Children's Hospital Memphis, TN, USA
| | | | - Liliya Birg
- Neuroscience Institute, Le Bonheur Children's Hospital Memphis, TN, USA
| | - James W Wheless
- Neuroscience Institute, Le Bonheur Children's Hospital Memphis, TN, USA ; Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center Memphis, TN, USA
| | - Frederick A Boop
- Neuroscience Institute, Le Bonheur Children's Hospital Memphis, TN, USA ; Department of Neurosurgery, University of Tennessee Health Science Center Memphis, TN, USA
| | - Andrew C Papanicolaou
- Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center Memphis, TN, USA ; Neuroscience Institute, Le Bonheur Children's Hospital Memphis, TN, USA
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64
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Papanicolaou AC, Rezaie R, Narayana S, Choudhri AF, Wheless JW, Castillo EM, Baumgartner JE, Boop FA. Is it time to replace the Wada test and put awake craniotomy to sleep? Epilepsia 2014; 55:629-632. [DOI: 10.1111/epi.12569] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Andrew C. Papanicolaou
- Department of Pediatrics; Division of Clinical Neurosciences; University of Tennessee Health Science Center; Memphis Tennessee U.S.A
- Neuroscience Institute; Le Bonheur Children's Hospital; Memphis Tennessee U.S.A
| | - Roozbeh Rezaie
- Department of Pediatrics; Division of Clinical Neurosciences; University of Tennessee Health Science Center; Memphis Tennessee U.S.A
- Neuroscience Institute; Le Bonheur Children's Hospital; Memphis Tennessee U.S.A
| | - Shalini Narayana
- Department of Pediatrics; Division of Clinical Neurosciences; University of Tennessee Health Science Center; Memphis Tennessee U.S.A
- Neuroscience Institute; Le Bonheur Children's Hospital; Memphis Tennessee U.S.A
| | - Asim F. Choudhri
- Neuroscience Institute; Le Bonheur Children's Hospital; Memphis Tennessee U.S.A
- Department of Radiology; University of Tennessee Health Science Center; Memphis Tennessee U.S.A
- Department of Neurosurgery; University of Tennessee Health Science Center; Memphis Tennessee U.S.A
| | - James W. Wheless
- Neuroscience Institute; Le Bonheur Children's Hospital; Memphis Tennessee U.S.A
- Department of Pediatrics; Division of Pediatric Neurology; University of Tennessee Health Science Center; Memphis Tennessee U.S.A
| | - Eduardo M. Castillo
- Magnetoencephalography Laboratory; Florida Hospital for Children; Orlando Florida U.S.A
| | - James E. Baumgartner
- Comprehensive Epilepsy Center at Florida Hospital for Children; Orlando Florida U.S.A
| | - Frederick A. Boop
- Department of Neurosurgery; University of Tennessee Health Science Center; Memphis Tennessee U.S.A
- Department of Pediatrics; Division of Pediatric Neurology; University of Tennessee Health Science Center; Memphis Tennessee U.S.A
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65
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Magnetoencephalography in the Preoperative Evaluation for Epilepsy Surgery. Curr Neurol Neurosci Rep 2014; 14:446. [DOI: 10.1007/s11910-014-0446-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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66
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Abstract
PURPOSE OF REVIEW This article outlines indications for neurosurgical treatment of epilepsy, describes the presurgical workup, summarizes surgical approaches, and details expected risks and benefits. RECENT FINDINGS There is class I evidence for the efficacy of temporal lobectomy in treating intractable seizures, and accumulating documentation that successful surgical treatment reverses much of the disability, morbidity, and excess mortality of chronic epilepsy. SUMMARY Chronic, uncontrolled focal epilepsy causes progressive disability and increased mortality, but these can be reversed with seizure control. Vigorous efforts to stop seizures are warranted. If two well-chosen and tolerated medication trials do not achieve seizure control, an early workup for epilepsy surgery should be arranged. If this workup definitively identifies the brain region from which the seizures arise, and this region can be removed with a low risk of disabling neurologic deficits, neurosurgery will have a much better chance of stopping seizures than further medication trials.
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Affiliation(s)
- John W Miller
- Miller, Harborview Medical Center, Box 359745, 325 Ninth Avenue, Seattle, WA 98104, USA.
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Tarapore PE, Findlay AM, Honma SM, Mizuiri D, Houde JF, Berger MS, Nagarajan SS. Language mapping with navigated repetitive TMS: proof of technique and validation. Neuroimage 2013; 82:260-72. [PMID: 23702420 DOI: 10.1016/j.neuroimage.2013.05.018] [Citation(s) in RCA: 156] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 04/15/2013] [Accepted: 05/05/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Lesion-based mapping of speech pathways has been possible only during invasive neurosurgical procedures using direct cortical stimulation (DCS). However, navigated transcranial magnetic stimulation (nTMS) may allow for lesion-based interrogation of language pathways noninvasively. Although not lesion-based, magnetoencephalographic imaging (MEGI) is another noninvasive modality for language mapping. In this study, we compare the accuracy of nTMS and MEGI with DCS. METHODS Subjects with lesions around cortical language areas underwent preoperative nTMS and MEGI for language mapping. nTMS maps were generated using a repetitive TMS protocol to deliver trains of stimulations during a picture naming task. MEGI activation maps were derived from adaptive spatial filtering of beta-band power decreases prior to overt speech during picture naming and verb generation tasks. The subjects subsequently underwent awake language mapping via intraoperative DCS. The language maps obtained from each of the 3 modalities were recorded and compared. RESULTS nTMS and MEGI were performed on 12 subjects. nTMS yielded 21 positive language disruption sites (11 speech arrest, 5 anomia, and 5 other) while DCS yielded 10 positive sites (2 speech arrest, 5 anomia, and 3 other). MEGI isolated 32 sites of peak activation with language tasks. Positive language sites were most commonly found in the pars opercularis for all three modalities. In 9 instances the positive DCS site corresponded to a positive nTMS site, while in 1 instance it did not. In 4 instances, a positive nTMS site corresponded to a negative DCS site, while 169 instances of negative nTMS and DCS were recorded. The sensitivity of nTMS was therefore 90%, specificity was 98%, the positive predictive value was 69% and the negative predictive value was 99% as compared with intraoperative DCS. MEGI language sites for verb generation and object naming correlated with nTMS sites in 5 subjects, and with DCS sites in 2 subjects. CONCLUSION Maps of language function generated with nTMS correlate well with those generated by DCS. Negative nTMS mapping also correlates with negative DCS mapping. In our study, MEGI lacks the same level of correlation with intraoperative mapping; nevertheless it provides useful adjunct information in some cases. nTMS may offer a lesion-based method for noninvasively interrogating language pathways and be valuable in managing patients with peri-eloquent lesions.
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Affiliation(s)
- Phiroz E Tarapore
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., San Francisco, CA 94143, USA.
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