101
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Trébuchon A, Liégeois-Chauvel C, Gonzalez-Martinez JA, Alario FX. Contributions of electrophysiology for identifying cortical language systems in patients with epilepsy. Epilepsy Behav 2020; 112:107407. [PMID: 33181892 DOI: 10.1016/j.yebeh.2020.107407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 11/26/2022]
Abstract
A crucial element of the surgical treatment of medically refractory epilepsy is to delineate cortical areas that must be spared in order to avoid clinically relevant neurological and neuropsychological deficits postoperatively. For each patient, this typically necessitates determining the language lateralization between hemispheres and language localization within hemisphere. Understanding cortical language systems is complicated by two primary challenges: the extent of the neural tissue involved and the substantial variability across individuals, especially in pathological populations. We review the contributions made through the study of electrophysiological activity to address these challenges. These contributions are based on the techniques of magnetoencephalography (MEG), intracerebral recordings, electrical-cortical stimulation (ECS), and the electrovideo analyses of seizures and their semiology. We highlight why no single modality alone is adequate to identify cortical language systems and suggest avenues for improving current practice.
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Affiliation(s)
- Agnès Trébuchon
- Aix-Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Catherine Liégeois-Chauvel
- Aix-Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France; Department of Neurological Surgery, School of Medicine, University of Pittsburgh (PA), USA
| | | | - F-Xavier Alario
- Department of Neurological Surgery, School of Medicine, University of Pittsburgh (PA), USA; Aix-Marseille Univ, CNRS, LPC, Marseille, France.
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102
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Zheng W, Minama Reddy GK, Dai F, Chandramani A, Brang D, Hunter S, Kohrman MH, Rose S, Rossi M, Tao J, Wu S, Byrne R, Frim DM, Warnke P, Towle VL. Chasing language through the brain: Successive parallel networks. Clin Neurophysiol 2020; 132:80-93. [PMID: 33360179 DOI: 10.1016/j.clinph.2020.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/06/2020] [Accepted: 10/11/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the spatio-temporal dynamics and interactions during linguistic and memory tasks. METHODS Event-related electrocorticographic (ECoG) spectral patterns obtained during cognitive tasks from 26 epilepsy patients (aged: 9-60 y) were analyzed in order to examine the spatio-temporal patterns of activation of cortical language areas. ECoGs (1024 Hz/channel) were recorded from 1567 subdural electrodes and 510 depth electrodes chronically implanted over or within the frontal, parietal, occipital and/or temporal lobes as part of their surgical work-up for intractable seizures. Six language/memory tasks were performed, which required responding verbally to auditory or visual word stimuli. Detailed analysis of electrode locations allowed combining results across patients. RESULTS Transient increases in induced ECoG gamma power (70-100 Hz) were observed in response to hearing words (central superior temporal gyrus), reading text and naming pictures (occipital and fusiform cortex) and speaking (pre-central, post-central and sub-central cortex). CONCLUSIONS Between these activations there was widespread spatial divergence followed by convergence of gamma activity that reliably identified cortical areas associated with task-specific processes. SIGNIFICANCE The combined dataset supports the concept of functionally-specific locally parallel language networks that are widely distributed, partially interacting in succession to serve the cognitive and behavioral demands of the tasks.
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Affiliation(s)
- Weili Zheng
- Department of Engineering, The University of Illinois, Chicago, IL, USA
| | | | - Falcon Dai
- Department of Neurology, The University of Chicago, Chicago, IL, USA
| | | | - David Brang
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Scott Hunter
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Michael H Kohrman
- Department of Pediatrics, The University of Chicago, Chicago, IL 60487, USA
| | - Sandra Rose
- Department of Neurology, The University of Chicago, Chicago, IL, USA
| | - Marvin Rossi
- Department of Neurology, Rush University, Chicago, IL, USA
| | - James Tao
- Department of Neurology, The University of Chicago, Chicago, IL, USA
| | - Shasha Wu
- Department of Neurology, The University of Chicago, Chicago, IL, USA
| | - Richard Byrne
- Department of Surgery, Rush University, Chicago, IL, USA
| | - David M Frim
- Department of Surgery, The University of Chicago, 5841 S. Maryland Ave, 60487 Chicago, IL, USA
| | - Peter Warnke
- Department of Surgery, The University of Chicago, 5841 S. Maryland Ave, 60487 Chicago, IL, USA
| | - Vernon L Towle
- Department of Neurology, The University of Chicago, Chicago, IL, USA.
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103
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Baurès R, Fourteau M, Thébault S, Gazard C, Pasquio L, Meneghini G, Perrin J, Rosito M, Durand JB, Roux FE. Time-to-contact perception in the brain. J Neurosci Res 2020; 99:455-466. [PMID: 33070400 DOI: 10.1002/jnr.24740] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/14/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022]
Abstract
Time-to-contact (TTC) perception refers to the ability of an observer to estimate the remaining time before an object reaches a point in the environment, and is of crucial importance in daily life. Noninvasive correlational approaches have identified several brain areas sensitive to TTC information. Here we report the results of two studies, including one during an awake brain surgery, that aimed to identify the specific areas causally engaged in the TTC estimation process. In Study 1, we tested 40 patients with brain tumor in a TTC estimation task. The results showed that four of the six patients with impaired performance had tumors in right upper parietal cortex, although this tumoral location represented only six over 40 patients. In Study 2, 15 patients underwent awake brain surgery electrostimulation mapping to examine the implication of various brain areas in the TTC estimation process. We acquired and normalized to MNI space the coordinates of the functional areas that influenced task performance. Our results seem to demonstrate that the early stage of the TTC estimation process involved specific cortical territories in the ventral region of the right intraparietal sulcus. Downstream processing of TTC could also involve the frontal eye field (middle frontal gyrus) related to ocular search. We also found that deactivating language areas in the left hemisphere interfered with the TTC estimation process. These findings demonstrate a fine grained, cortical representation of TTC processing close to the ventral right intraparietal sulcus and complement those described in other human studies.
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Affiliation(s)
- Robin Baurès
- CerCo, Université de Toulouse, CNRS, UPS, CHU Purpan, Toulouse Cedex 9, France
| | - Marie Fourteau
- CerCo, Université de Toulouse, CNRS, UPS, CHU Purpan, Toulouse Cedex 9, France
| | - Salomé Thébault
- CerCo, Université de Toulouse, CNRS, UPS, CHU Purpan, Toulouse Cedex 9, France
| | - Chloé Gazard
- CerCo, Université de Toulouse, CNRS, UPS, CHU Purpan, Toulouse Cedex 9, France
| | - Léa Pasquio
- CerCo, Université de Toulouse, CNRS, UPS, CHU Purpan, Toulouse Cedex 9, France
| | - Giulia Meneghini
- CerCo, Université de Toulouse, CNRS, UPS, CHU Purpan, Toulouse Cedex 9, France
| | - Juliette Perrin
- CerCo, Université de Toulouse, CNRS, UPS, CHU Purpan, Toulouse Cedex 9, France
| | - Maxime Rosito
- CerCo, Université de Toulouse, CNRS, UPS, CHU Purpan, Toulouse Cedex 9, France
| | | | - Franck-Emmanuel Roux
- CerCo, Université de Toulouse, CNRS, UPS, CHU Purpan, Toulouse Cedex 9, France.,Pôle Neurosciences (Neurochirurgie), Centres Hospitalo-Universitaires, Toulouse, France
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104
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Roux FE, Djidjeli I, Quéhan R, Réhault E, Giussani C, Durand JB. Intraoperative electrostimulation for awake brain mapping: how many positive interference responses are required for reliability? J Neurosurg 2020; 133:1191-1201. [PMID: 31597115 DOI: 10.3171/2019.6.jns19925] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/13/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this study was to characterize the reproducibility of language trials within and between brain mapping sessions. METHODS Brain mapping and baseline testing data from 200 adult patients who underwent resection of left-hemisphere tumors were evaluated. Data from 11 additional patients who underwent a second resection for recurrence were analyzed separately to investigate reproducibility over time. In all cases, a specific protocol of electrostimulation brain mapping with a controlled naming task was used to detect language areas, and the results were statistically compared with preoperative and intraoperative baseline naming error rates. All patients had normal preoperative error rates, controlled for educational level and age (mean 8.92%, range 0%-16.25%). Intraoperative baseline error rates within the normal range were highly correlated with preoperative ones (r = 0.74, p < 10-10), although intraoperative rates were usually higher (mean 13.30%, range 0%-26.67%). Initially, 3 electrostimulation trials were performed in each cortical area. If 2 of 3 trials showed language interference, 1 or 2 additional trials were performed (depending on results). RESULTS In the main group of 200 patients, there were 82 single interferences (i.e., positive results in 1 of 3 trials), 227 double interferences (2/3), and 312 full interferences (3/3). Binomial statistics revealed that full interferences were statistically significant (vs intraoperative baseline) in 92.7% of patients, while double interferences were significant only in 38.5% of patients, those with the lowest error rates. On further testing, one-third of the 2/3 trials became 2/4 trials, which was significant in only one-quarter of patients. Double interference could be considered significant for most patients (> 90%) when confirmed by 2 subsequent positive trials (4/5). In the 11 patients who were operated on twice, only 26% of areas that tested positive in the initial operation tested positive in the second and showed the same type of interference and the same current threshold (i.e., met all 3 criteria). CONCLUSIONS Electrostimulation trials in awake brain mapping produced graded patterns of positive reproducibility levels, and their significance varied with the baseline error rates. The results suggest that caution is warranted when 2 of 3 trials are positive, although the need for additional trials depends on the individual patients' baseline error rates. Reproducibility issues should be considered in the interpretation of data from awake brain mapping.
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Affiliation(s)
- Franck-Emmanuel Roux
- 1Pôle Neuroscience (Neurochirurgie), Centre Hospitalo-Universitaires de Toulouse
- 2Université de Toulouse, Université Paul Sabatier, Toulouse
- 3Centre de Recherche Cerveau et Cognition (CNRS; CerCo), Toulouse, France; and
| | - Imène Djidjeli
- 1Pôle Neuroscience (Neurochirurgie), Centre Hospitalo-Universitaires de Toulouse
- 2Université de Toulouse, Université Paul Sabatier, Toulouse
- 3Centre de Recherche Cerveau et Cognition (CNRS; CerCo), Toulouse, France; and
| | - Romain Quéhan
- 1Pôle Neuroscience (Neurochirurgie), Centre Hospitalo-Universitaires de Toulouse
| | - Emilie Réhault
- 1Pôle Neuroscience (Neurochirurgie), Centre Hospitalo-Universitaires de Toulouse
| | - Carlo Giussani
- 4Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Ospedale San Gerardo, Monza, Italy
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105
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Olulade OA, Seydell-Greenwald A, Chambers CE, Turkeltaub PE, Dromerick AW, Berl MM, Gaillard WD, Newport EL. The neural basis of language development: Changes in lateralization over age. Proc Natl Acad Sci U S A 2020; 117:23477-23483. [PMID: 32900940 PMCID: PMC7519388 DOI: 10.1073/pnas.1905590117] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We have long known that language is lateralized to the left hemisphere (LH) in most neurologically healthy adults. In contrast, findings on lateralization of function during development are more complex. As in adults, anatomical, electrophysiological, and neuroimaging studies in infants and children indicate LH lateralization for language. However, in very young children, lesions to either hemisphere are equally likely to result in language deficits, suggesting that language is distributed symmetrically early in life. We address this apparent contradiction by examining patterns of functional MRI (fMRI) language activation in children (ages 4 through 13) and adults (ages 18 through 29). In contrast to previous studies, we focus not on lateralization per se but rather on patterns of left-hemisphere (LH) and right-hemisphere (RH) activation across individual participants over age. Our analyses show significant activation not only in the LH language network but also in their RH homologs in all of the youngest children (ages 4 through 6). The proportion of participants showing significant RH activation decreases over age, with over 60% of adults lacking any significant RH activation. A whole-brain correlation analysis revealed an age-related decrease in language activation only in the RH homolog of Broca's area. This correlation was independent of task difficulty. We conclude that, while language is left-lateralized throughout life, the RH contribution to language processing is also strong early in life and decreases through childhood. Importantly, this early RH language activation may represent a developmental mechanism for recovery following early LH injury.
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Affiliation(s)
- Olumide A Olulade
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center and MedStar National Rehabilitation Hospital, Washington, DC 20057
| | - Anna Seydell-Greenwald
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center and MedStar National Rehabilitation Hospital, Washington, DC 20057
| | - Catherine E Chambers
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center and MedStar National Rehabilitation Hospital, Washington, DC 20057
| | - Peter E Turkeltaub
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center and MedStar National Rehabilitation Hospital, Washington, DC 20057
| | - Alexander W Dromerick
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center and MedStar National Rehabilitation Hospital, Washington, DC 20057
| | - Madison M Berl
- Center for Neuroscience and Behavioral Health, Children's National Hospital, Washington, DC 20010
| | - William D Gaillard
- Center for Neuroscience and Behavioral Health, Children's National Hospital, Washington, DC 20010
| | - Elissa L Newport
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center and MedStar National Rehabilitation Hospital, Washington, DC 20057;
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106
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Roux F, Niare M, Charni S, Giussani C, Durand J. Functional architecture of the motor homunculus detected by electrostimulation. J Physiol 2020; 598:5487-5504. [DOI: 10.1113/jp280156] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/21/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Franck‐Emmanuel Roux
- CNRS (CERCO) UMR Unité 5549 Université Paul Sabatier Toulouse France
- Pôle Neurosciences (Neurochirurgie) Centres Hospitalo‐Universitaires Toulouse France
| | - Mahamadou Niare
- CNRS (CERCO) UMR Unité 5549 Université Paul Sabatier Toulouse France
- Pôle Neurosciences (Neurochirurgie) Centres Hospitalo‐Universitaires Toulouse France
| | - Saloua Charni
- CNRS (CERCO) UMR Unité 5549 Université Paul Sabatier Toulouse France
- Pôle Neurosciences (Neurochirurgie) Centres Hospitalo‐Universitaires Toulouse France
| | - Carlo Giussani
- Neurosurgery School of Medicine Ospedale San Gerardo Università degli Studi di Milano Bicocca Monza Italy
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107
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Grechuta K, Rubio Ballester B, Espín Munné R, Usabiaga Bernal T, Molina Hervás B, Mohr B, Pulvermüller F, San Segundo RM, Verschure PFMJ. Multisensory cueing facilitates naming in aphasia. J Neuroeng Rehabil 2020; 17:122. [PMID: 32907594 PMCID: PMC7487671 DOI: 10.1186/s12984-020-00751-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Impaired naming is a ubiquitous symptom in all types of aphasia, which often adversely impacts independence, quality of life, and recovery of affected individuals. Previous research has demonstrated that naming can be facilitated by phonological and semantic cueing strategies that are largely incorporated into the treatment of anomic disturbances. Beneficial effects of cueing, whereby naming becomes faster and more accurate, are often attributed to the priming mechanisms occurring within the distributed language network. OBJECTIVE We proposed and explored two novel cueing techniques: (1) Silent Visuomotor Cues (SVC), which provided articulatory information of target words presented in the form of silent videos, and (2) Semantic Auditory Cues (SAC), which consisted of acoustic information semantically relevant to target words (ringing for "telephone"). Grounded in neurophysiological evidence, we hypothesized that both SVC and SAC might aid communicative effectiveness possibly by triggering activity in perceptual and semantic language regions, respectively. METHODS Ten participants with chronic non-fluent aphasia were recruited for a longitudinal clinical intervention. Participants were split into dyads (i.e., five pairs of two participants) and required to engage in a turn-based peer-to-peer language game using the Rehabilitation Gaming System for aphasia (RGSa). The objective of the RGSa sessions was to practice communicative acts, such as making a request. We administered SVCs and SACs in a pseudorandomized manner at the moment when the active player selected the object to be requested from the interlocutor. For the analysis, we compared the times from selection to the reception of the desired object between cued and non-cued trials. RESULTS Naming accuracy, as measured by a standard clinical scale, significantly improved for all stimuli at each evaluation point, including the follow-up. Moreover, the results yielded beneficial effects of both SVC and SAC cues on word naming, especially at the early intervention sessions when the exposure to the target lexicon was infrequent. CONCLUSIONS This study supports the efficacy of the proposed cueing strategies which could be integrated into the clinic or mobile technology to aid naming even at the chronic stages of aphasia. These findings are consistent with sensorimotor accounts of language processing, suggesting a coupling between language, motor, and semantic brain regions. TRIAL REGISTRATION NCT02928822 . Registered 30 May 2016.
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Affiliation(s)
- Klaudia Grechuta
- Institute for Bioengineering of Catalonia (IBEC), Av. d'Eduard Maristany 16, 08019, Barcelona, Spain
| | - Belén Rubio Ballester
- Institute for Bioengineering of Catalonia (IBEC), Av. d'Eduard Maristany 16, 08019, Barcelona, Spain
| | - Rosa Espín Munné
- Servei de Medicina Física i Rehabilitació de l'Hospital Univ. de Tarragona, 43-005, Tarragona, Spain
| | - Teresa Usabiaga Bernal
- Servei de Medicina Física i Rehabilitació de l'Hospital Univ. de Tarragona, 43-005, Tarragona, Spain
| | - Begoña Molina Hervás
- Servei de Medicina Física i Rehabilitació de l'Hospital Univ. de Tarragona, 43-005, Tarragona, Spain
| | - Bettina Mohr
- Charite Universitätsmedizin Berlin, 10-117, Berlin, Germany
| | - Friedemann Pulvermüller
- Freie University Berlin, Brain Language Laboratory, DPH, WE4, 14-195, Berlin, Germany
- Humboldt Universität, BSMB, 10-099, Berlin, Germany
- Einstein Center for Neurosciences, 10-117, Berlin, Germany
| | - Rosa Maria San Segundo
- Servei de Medicina Física i Rehabilitació de l'Hospital Univ. de Tarragona, 43-005, Tarragona, Spain
| | - Paul F M J Verschure
- Institute for Bioengineering of Catalonia (IBEC), Av. d'Eduard Maristany 16, 08019, Barcelona, Spain.
- Institució Catalana de Recerca i Estudis Avançats, 08-010, Barcelona, Spain.
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108
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Mankin EA, Fried I. Modulation of Human Memory by Deep Brain Stimulation of the Entorhinal-Hippocampal Circuitry. Neuron 2020; 106:218-235. [PMID: 32325058 DOI: 10.1016/j.neuron.2020.02.024] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/13/2020] [Accepted: 01/27/2020] [Indexed: 01/02/2023]
Abstract
Neurological disorders affecting human memory present a major scientific, medical, and societal challenge. Direct or indirect deep brain stimulation (DBS) of the entorhinal-hippocampal system, the brain's major memory hub, has been studied in people with epilepsy or Alzheimer's disease, intending to enhance memory performance or slow memory decline. Variability in the spatiotemporal parameters of stimulation employed to date notwithstanding, it is likely that future DBS for memory will employ closed-loop, nuanced approaches that are synergistic with native physiological processes. The potential for editing human memory-decoding, enhancing, incepting, or deleting specific memories-suggests exciting therapeutic possibilities but also raises considerable ethical concerns.
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Affiliation(s)
- Emily A Mankin
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Itzhak Fried
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA 90095, USA; Tel Aviv Medical Center and Tel Aviv University, Tel Aviv, Israel.
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109
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Binder JR, Tong JQ, Pillay SB, Conant LL, Humphries CJ, Raghavan M, Mueller WM, Busch RM, Allen L, Gross WL, Anderson CT, Carlson CE, Lowe MJ, Langfitt JT, Tivarus ME, Drane DL, Loring DW, Jacobs M, Morgan VL, Allendorfer JB, Szaflarski JP, Bonilha L, Bookheimer S, Grabowski T, Vannest J, Swanson SJ. Temporal lobe regions essential for preserved picture naming after left temporal epilepsy surgery. Epilepsia 2020; 61:1939-1948. [PMID: 32780878 DOI: 10.1111/epi.16643] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/10/2020] [Accepted: 07/20/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To define left temporal lobe regions where surgical resection produces a persistent postoperative decline in naming visual objects. METHODS Pre- and postoperative brain magnetic resonance imaging data and picture naming (Boston Naming Test) scores were obtained prospectively from 59 people with drug-resistant left temporal lobe epilepsy. All patients had left hemisphere language dominance at baseline and underwent surgical resection or ablation in the left temporal lobe. Postoperative naming assessment occurred approximately 7 months after surgery. Surgical lesions were mapped to a standard template, and the relationship between presence or absence of a lesion and the degree of naming decline was tested at each template voxel while controlling for effects of overall lesion size. RESULTS Patients declined by an average of 15% in their naming score, with wide variation across individuals. Decline was significantly related to damage in a cluster of voxels in the ventral temporal lobe, located mainly in the fusiform gyrus approximately 4-6 cm posterior to the temporal tip. Extent of damage to this region explained roughly 50% of the variance in outcome. Picture naming decline was not related to hippocampal or temporal pole damage. SIGNIFICANCE The results provide the first statistical map relating lesion location in left temporal lobe epilepsy surgery to picture naming decline, and they support previous observations of transient naming deficits from electrical stimulation in the basal temporal cortex. The critical lesion is relatively posterior and could be avoided in many patients undergoing left temporal lobe surgery for intractable epilepsy.
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Affiliation(s)
- Jeffrey R Binder
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jia-Qing Tong
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sara B Pillay
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lisa L Conant
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Colin J Humphries
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Manoj Raghavan
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Wade M Mueller
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Robyn M Busch
- Department of Neurology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Linda Allen
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - William L Gross
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Chad E Carlson
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mark J Lowe
- Department of Radiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - John T Langfitt
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | - Madalina E Tivarus
- Department of Imaging Sciences, University of Rochester, Rochester, New York, USA
| | - Daniel L Drane
- Department of Neurology and Pediatrics, Emory University, Atlanta, Georgia, USA
| | - David W Loring
- Department of Neurology and Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Monica Jacobs
- Department of Psychology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Victoria L Morgan
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Susan Bookheimer
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Thomas Grabowski
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Jennifer Vannest
- Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Sara J Swanson
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Duffau H. What Direct Electrostimulation of the Brain Taught Us About the Human Connectome: A Three-Level Model of Neural Disruption. Front Hum Neurosci 2020; 14:315. [PMID: 32848678 PMCID: PMC7427088 DOI: 10.3389/fnhum.2020.00315] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/16/2020] [Indexed: 11/13/2022] Open
Abstract
For a long time, the relevance of the information provided by direct electrostimulation (DES) for mapping brain functions was debated. Recently, major advances in intraoperative DES for guiding resection of cerebral tumors in awake patients enabled the validation of this method and its increased utilization in basic neurosciences. Indeed, in addition to the cortical stimulation used for many decades in epilepsy surgery, axonal mapping was developed thanks to DES of the white matter tracts, giving original insights into the neural connectivity. Moreover, functional results collected during intrasurgical mapping have been correlated with neuropsychological performances before and after DES-guided resection, and with perioperative neuroimaging data. Thus, it was evidenced that DES offers the unique opportunity to identify both cortical and subcortical structures critical for cerebral functions. Here, the first aim is to propose a three-level model of DES-generated functional disruption, able to explain the behavioral consequences elicited during awake surgery, i.e., (i) DES of an input/output unimodal (e.g., somatosensory or motor) network inducing "positive" responses (as involuntary movement); (ii) DES of a distributed specialized network inducing a within-system disruption leading to specific "negative" disorders (e.g., exclusive language deficit with no other disorders); (iii) DES generating an inter-system disruption leading to more complex behavioral disturbances (e.g., the inability to perform dual-task while each function can be performed separately). Second, in light of this model, original findings gained from DES concerning the human connectome, complementary to those provided by functional neuroimaging (FNI), are reviewed. Further longitudinal multimodal investigations are needed to explore neuroplasticity mechanisms.
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Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, Montpellier University Medical Center, Montpellier, France.,Institute of Functional Genomics, INSERM U-1191, University of Montpellier, Montpellier, France
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Awake Craniotomy in a Child: Assessment of Eligibility with a Simulated Theatre Experience. Case Rep Anesthesiol 2020; 2020:6902075. [PMID: 32695521 PMCID: PMC7361895 DOI: 10.1155/2020/6902075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/08/2020] [Accepted: 06/11/2020] [Indexed: 12/28/2022] Open
Abstract
Background Awake craniotomy is a useful surgical approach to identify and preserve eloquent areas during tumour resection, during surgery for arteriovenous malformation resections and for resective epilepsy surgery. With decreasing age, a child's ability to cooperate and mange an awake craniotomy becomes increasingly relevant. Preoperative screening is essential to identify the child who can undergo the procedure safely. Case Description. A 11-year-old female patient presented with a tumour in her right motor cortex, presumed to be a dysembryoplastic neuroepithelial tumour (DNET). We had concerns regarding the feasibility of performing awake surgery in this patient as psychological testing revealed easy distractibility and an inability to follow commands repetitively. We devised a simulated surgical experience to assess her ability to manage such a procedure. During the simulated theatre experience, attempts were made to replicate the actual theatre experience as closely as possible. The patient was dressed in theatre attire and brought into the theatre on a theatre trolley. She was then transferred onto the theatre bed and positioned in the same manner as she would be for the actual surgery. Her head was placed on a horseshoe headrest, and she was made to lie in a semilateral position, as required for the surgery. A blood pressure cuff, pulse oximeter, nasal cannula with oxygen flow, and calf pumps were applied. She was then draped precisely as she would have been for the procedure. Theatre lighting was set as it would be for the surgical case. The application of the monitoring devices, nasal cannula, and draping was meant not only to prepare her for the procedure but to induce a mild degree of stress such that we could assess the child's coping skills and ability to undergo the procedure. The child performed well throughout the simulated run, and surgery was thus offered. An asleep-awake-asleep technique was planned and employed for surgical removal of the tumour. Cortical and subcortical mapping was used to identify the eloquent tissue. Throughout the procedure, the child was cooperative and anxiety free. Follow-up MRI revealed gross total removal of the lesion. Conclusion A simulated theatre experience allowed us to accurately determine that this young patient, despite relative contraindications, was indeed eligible for awake surgery. We will continue to use this technique for all our young patients in assessing their eligibility for these procedures.
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ReFaey K, Tripathi S, Bhargav AG, Grewal SS, Middlebrooks EH, Sabsevitz DS, Jentoft M, Brunner P, Wu A, Tatum WO, Ritaccio A, Chaichana KL, Quinones-Hinojosa A. Potential differences between monolingual and bilingual patients in approach and outcome after awake brain surgery. J Neurooncol 2020; 148:587-598. [PMID: 32524393 DOI: 10.1007/s11060-020-03554-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/01/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION 20.8% of the United States population and 67% of the European population speak two or more languages. Intraoperative different languages, mapping, and localization are crucial. This investigation aims to address three questions between BL and ML patients: (1) Are there differences in complications (i.e. seizures) and DECS techniques during intra-operative brain mapping? (2) Is EOR different? and (3) Are there differences in the recovery pattern post-surgery? METHODS Data from 56 patients that underwent left-sided awake craniotomy for tumors infiltrating possible dominant hemisphere language areas from September 2016 to June 2019 were identified and analyzed in this study; 14 BL and 42 ML control patients. Patient demographics, education level, and the age of language acquisition were documented and evaluated. fMRI was performed on all participants. RESULTS 0 (0%) BL and 3 (7%) ML experienced intraoperative seizures (P = 0.73). BL patients received a higher direct DECS current in comparison to the ML patients (average = 4.7, 3.8, respectively, P = 0.03). The extent of resection was higher in ML patients in comparison to the BL patients (80.9 vs. 64.8, respectively, P = 0.04). The post-operative KPS scores were higher in BL patients in comparison to ML patients (84.3, 77.4, respectively, P = 0.03). BL showed lower drop in post-operative KPS in comparison to ML patients (- 4.3, - 8.7, respectively, P = 0.03). CONCLUSION We show that BL patients have a lower incidence of intra-operative seizures, lower EOR, higher post-operative KPS and tolerate higher DECS current, in comparison to ML patients.
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Affiliation(s)
- Karim ReFaey
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Shashwat Tripathi
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA.,Department of Mathematics, University of Texas at Austin, Austin, TX, USA
| | - Adip G Bhargav
- Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
| | - Sanjeet S Grewal
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Erik H Middlebrooks
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA.,Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - David S Sabsevitz
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA.,Department of Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Mark Jentoft
- Department of Pathology, Mayo Clinic, Jacksonville, FL, USA
| | - Peter Brunner
- Albany Medical College, Albany, NY, USA.,National Center for Adaptive Neurotechnologies, Albany, NY, USA
| | - Adela Wu
- Department of Neurologic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | | | | | - Alfredo Quinones-Hinojosa
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA. .,Brain Tumor Stem Cell Laboratory, Department of Neurologic Surgery, Mayo Clinic, 4500 San Pablo Rd. S, FloridaJacksonville, FL, 32224, USA.
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Isitan C, Yan Q, Spencer DD, Alkawadri R. Brief history of electrical cortical stimulation: A journey in time from Volta to Penfield. Epilepsy Res 2020; 166:106363. [PMID: 32673971 DOI: 10.1016/j.eplepsyres.2020.106363] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/26/2020] [Accepted: 05/05/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To recount the evolution of Electrical Cortical Stimulation (ECS) in localizing brain functions with an emphasis on epilepsy, and a discussion of related instruments and personnel. DESIGN/METHODS Literature review through historical archives implementing chain-referral sampling. RESULTS There were important milestones leading to the incorporation of ECS into practice: 1. Aldini's (1802) first known stimulation of exposed brain to defend Galvani's views on excitability in the frog-leg experiment against Volta's, ironically by employing the Voltaic pile. 2. Animal experiments in the 19th-century to study the brain and to optimize the procedure: Rolando (1809) reported on motor induction, Fritsch and Hitzig (ca. 1870) introduced the concepts of bipolar and threshold stimulation, and Ferrier (1873) generated reproducible homunculi in animals. 3. Parallel to 2, advances were made based on clinical observations by Bravais, Todd, Jackson, and Broca among others. 4. First known stimulation in conscious humans by Bartholow (1874) led to catastrophic outcomes. Horsley (1886) performed first intraoperative stimulation on Jackson's epileptic patient. 5. Advances accelerated in the first-half of the 20th century with Cushing (1909) performing first awake-craniotomy eliciting sensory responses to Penfield's work culminating in standardization of clinical use and generation of detailed maps including the famous sensory-motor homunculi. Parallel advances in instrumentation were made from the Leyden jar (1745) to present customizable current-controlled stimulators. CONCLUSIONS ECS is commonly used in neurosurgery for localization of brain functions and is the benchmark for research studies. Significant leaps have been made since ECS first used in the 19th century. It evolved to remain the gold standard for localization of human brain functions in the 21st century.
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Affiliation(s)
- Cigdem Isitan
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States; Human Brain Mapping Program, Yale University, New Haven, CT, United States
| | - Qi Yan
- Comprehensive Epilepsy Center, Yale University, New Haven, CT, United States; Human Brain Mapping Program, Yale University, New Haven, CT, United States
| | - Dennis D Spencer
- Comprehensive Epilepsy Center, Yale University, New Haven, CT, United States; Department of Neurosurgery, Yale University, New Haven, CT, United States
| | - Rafeed Alkawadri
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States; Comprehensive Epilepsy Center, Yale University, New Haven, CT, United States; Human Brain Mapping Program, Yale University, New Haven, CT, United States.
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The effects of direct brain stimulation in humans depend on frequency, amplitude, and white-matter proximity. Brain Stimul 2020; 13:1183-1195. [PMID: 32446925 DOI: 10.1016/j.brs.2020.05.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Researchers have used direct electrical brain stimulation to treat a range of neurological and psychiatric disorders. However, for brain stimulation to be maximally effective, clinicians and researchers should optimize stimulation parameters according to desired outcomes. OBJECTIVE The goal of our large-scale study was to comprehensively evaluate the effects of stimulation at different parameters and locations on neuronal activity across the human brain. METHODS To examine how different kinds of stimulation affect human brain activity, we compared the changes in neuronal activity that resulted from stimulation at a range of frequencies, amplitudes, and locations with direct human brain recordings. We recorded human brain activity directly with electrodes that were implanted in widespread regions across 106 neurosurgical epilepsy patients while systematically stimulating across a range of parameters and locations. RESULTS Overall, stimulation most often had an inhibitory effect on neuronal activity, consistent with earlier work. When stimulation excited neuronal activity, it most often occurred from high-frequency stimulation. These effects were modulated by the location of the stimulating electrode, with stimulation sites near white matter more likely to cause excitation and sites near gray matter more likely to inhibit neuronal activity. CONCLUSION By characterizing how different stimulation parameters produced specific neuronal activity patterns on a large scale, our results provide an electrophysiological framework that clinicians and researchers may consider when designing stimulation protocols to cause precisely targeted changes in human brain activity.
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RaviPrakash H, Korostenskaja M, Castillo EM, Lee KH, Salinas CM, Baumgartner J, Anwar SM, Spampinato C, Bagci U. Deep Learning Provides Exceptional Accuracy to ECoG-Based Functional Language Mapping for Epilepsy Surgery. Front Neurosci 2020; 14:409. [PMID: 32435182 PMCID: PMC7218144 DOI: 10.3389/fnins.2020.00409] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 04/03/2020] [Indexed: 12/02/2022] Open
Abstract
The success of surgical resection in epilepsy patients depends on preserving functionally critical brain regions, while removing pathological tissues. Being the gold standard, electro-cortical stimulation mapping (ESM) helps surgeons in localizing the function of eloquent cortex through electrical stimulation of electrodes placed directly on the cortical brain surface. Due to the potential hazards of ESM, including increased risk of provoked seizures, electrocorticography based functional mapping (ECoG-FM) was introduced as a safer alternative approach. However, ECoG-FM has a low success rate when compared to the ESM. In this study, we address this critical limitation by developing a new algorithm based on deep learning for ECoG-FM and thereby we achieve an accuracy comparable to ESM in identifying eloquent language cortex. In our experiments, with 11 epilepsy patients who underwent presurgical evaluation (through deep learning-based signal analysis on 637 electrodes), our proposed algorithm obtained an accuracy of 83.05% in identifying language regions, an exceptional 23% improvement with respect to the conventional ECoG-FM analysis (∼60%). Our findings have demonstrated, for the first time, that deep learning powered ECoG-FM can serve as a stand-alone modality and avoid likely hazards of the ESM in epilepsy surgery. Hence, reducing the potential for developing post-surgical morbidity in the language function.
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Affiliation(s)
- Harish RaviPrakash
- Center for Research in Computer Vision, University of Central Florida, Orlando, FL, United States
| | - Milena Korostenskaja
- Functional Brain Mapping and Brain Computer Interface Lab, AdventHealth Orlando, Orlando, FL, United States.,MEG Lab, AdventHealth Orlando, Orlando, FL, United States.,AdventHealth Medical Group Epilepsy at Orlando, AdventHealth Orlando, Orlando, FL, United States
| | - Eduardo M Castillo
- MEG Lab, AdventHealth Orlando, Orlando, FL, United States.,AdventHealth Medical Group Epilepsy at Orlando, AdventHealth Orlando, Orlando, FL, United States
| | - Ki H Lee
- AdventHealth Medical Group Epilepsy at Orlando, AdventHealth Orlando, Orlando, FL, United States
| | - Christine M Salinas
- AdventHealth Medical Group Epilepsy at Orlando, AdventHealth Orlando, Orlando, FL, United States
| | - James Baumgartner
- AdventHealth Medical Group Epilepsy at Orlando, AdventHealth Orlando, Orlando, FL, United States
| | - Syed M Anwar
- Center for Research in Computer Vision, University of Central Florida, Orlando, FL, United States
| | - Concetto Spampinato
- Center for Research in Computer Vision, University of Central Florida, Orlando, FL, United States.,Department of Electrical, Electronics and Computer Engineering, University of Catania, Catania, Italy
| | - Ulas Bagci
- Center for Research in Computer Vision, University of Central Florida, Orlando, FL, United States
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Iterative consensus spectral clustering improves detection of subject and group level brain functional modules. Sci Rep 2020; 10:7590. [PMID: 32371990 PMCID: PMC7200822 DOI: 10.1038/s41598-020-63552-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 03/31/2020] [Indexed: 11/29/2022] Open
Abstract
Specialized processing in the brain is performed by multiple groups of brain regions organized as functional modules. Although, in vivo studies of brain functional modules involve multiple functional Magnetic Resonance Imaging (fMRI) scans, the methods used to derive functional modules from functional networks of the brain ignore individual differences in the functional architecture and use incomplete functional connectivity information. To correct this, we propose an Iterative Consensus Spectral Clustering (ICSC) algorithm that detects the most representative modules from individual dense weighted connectivity matrices derived from multiple scans. The ICSC algorithm derives group-level modules from modules of multiple individuals by iteratively minimizing the consensus-cost between the two. We demonstrate that the ICSC algorithm can be used to derive biologically plausible group-level (for multiple subjects) and subject-level (for multiple subject scans) brain modules, using resting-state fMRI scans of 589 subjects from the Human Connectome Project. We employed a multipronged strategy to show the validity of the modularizations obtained from the ICSC algorithm. We show a heterogeneous variability in the modular structure across subjects where modules involved in visual and motor processing were highly stable across subjects. Conversely, we found a lower variability across scans of the same subject. The performance of our algorithm was compared with existing functional brain modularization methods and we show that our method detects group-level modules that are more representative of the modules of multiple individuals. Finally, the experiments on synthetic images quantitatively demonstrate that the ICSC algorithm detects group-level and subject-level modules accurately under varied conditions. Therefore, besides identifying functional modules for a population of subjects, the proposed method can be used for applications in personalized neuroscience. The ICSC implementation is available at https://github.com/SCSE-Biomedical-Computing-Group/ICSC.
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Awake brain surgery in children-a single-center experience. Childs Nerv Syst 2020; 36:967-974. [PMID: 32055975 DOI: 10.1007/s00381-020-04522-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 01/25/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Awake brain surgery (ABS) represents a rare surgical procedure in children as age and psychological aspects, which are considered to interfere with its feasibility and psychological outcome and limit its application. Only few pediatric case series have been reported so far, indicating a more complex translation of this surgical approach to children. However, the advances in neuropsychological testing and monitoring may have a substantial impact on ameliorating the eligibility of children undergoing awake procedures. This study addresses the condition of ABS in a pediatric cohort, focusing on its practicability and diversified outcome aspects. METHODS We performed a retrospective review and prospective outcome analysis of pediatric patients with CNS lesions undergoing ABS between 2005 and 2018, completed at the University of Lyon, France. RESULTS Eighteen children were considered for ABS with respect to the eloquent location of their CNS lesions documented in their pre-operative MRI. Seventeen of them underwent asleep-awake-asleep brain surgery. The cohort included 5 males and 12 females. The median age at surgery was 14.8 years, (range 9.4 to 17.6 years). Intraoperative testing included electrocortical stimulation while pursuing speech or motor activity. Most of the lesions were intrinsic tumors of glial origin. A complete tumor removal was achieved in 11 patients (65%). Post-operative neurological deficits were transiently observed in 2 patients, whereas severe psychological reactions occurred in 1 child. Persistent attention deficits were found in 2 patients. One patient experienced an infectious complication requiring antibiotic treatment. Two patients died during follow-up due to tumor progression. The mean duration of follow up was 22.2 months (range 3.4 to 46.8 months). CONCLUSIONS ABS was shown to be beneficial in terms of efficient tumor resection besides simultaneous preservation of neurological functions. Psychological preparation of the families and the children is essential to increase the number and age range of patients, who can benefit from this technique. Neuropsychological testing before and after surgery is essential to determine cognitive outcome, which can be altered in a minority of patients.
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Cognitive Functions in Repeated Glioma Surgery. Cancers (Basel) 2020; 12:cancers12051077. [PMID: 32357421 PMCID: PMC7281009 DOI: 10.3390/cancers12051077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/21/2020] [Indexed: 12/12/2022] Open
Abstract
Low-grade gliomas (LGG) are slow-growing brain tumors infiltrating the central nervous system which tend to recur, often with malignant degeneration after primary treatment. Re-operations are not always recommended due to an assumed higher risk of neurological and cognitive deficits. However, this assumption is relatively ungrounded due to a lack of extensive neuropsychological testing. We retrospectively examined a series of 40 patients with recurrent glioma in eloquent areas of the left hemisphere, who all completed comprehensive pre- (T3) and post-surgical (T4) neuropsychological assessments after a second surgery (4-month follow up). The lesions were most frequent in the left insular cortex and the inferior frontal gyrus. Among this series, in 17 patients the cognitive outcomes were compared before the first surgery (T1), 4 months after the first surgery (T2), and at T3 and T4. There was no significant difference either in the number of patients scoring within the normal range between T3 and T4, or in their level of performance. Further addressing the T1-T4 evolution, there was no significant difference in the number of patients scoring within the normal range. As to their level of performance, the only significant change was in phonological fluency. This longitudinal follow-up study showed that repeated glioma surgery is possible without major damage to cognitive functions in the short-term period (4 months) after surgery.
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119
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Awake glioma surgery: technical evolution and nuances. J Neurooncol 2020; 147:515-524. [PMID: 32270374 DOI: 10.1007/s11060-020-03482-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/01/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Multiple studies have demonstrated that improved extent of resection is associated with longer overall survival for patients with both high and low grade glioma. Awake craniotomy was developed as a technique for maximizing resection whilst preserving neurological function. METHODS We performed a comprehensive review of the literature describing the history, indications, techniques and outcomes of awake craniotomy for patients with glioma. RESULTS The technique of awake craniotomy evolved to become an essential tool for resection of glioma. Many perceived contraindications can now be managed. We describe in detail our preferred technique, the testing paradigms utilized, and critically review the literature regarding functional and oncological outcome. CONCLUSIONS Awake craniotomy with mapping has become the gold standard for safely maximizing extent of resection for tumor in or near eloquent brain. Cortical and subcortical mapping methods have been refined and the technique is associated with an extremely low rate of complications.
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120
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Hyslop A, Duchowny M. Electrical stimulation mapping in children. Seizure 2020; 77:59-63. [DOI: 10.1016/j.seizure.2019.07.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 12/01/2022] Open
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Surgery of the amygdala and uncus: a case series of glioneuronal tumors. Acta Neurochir (Wien) 2020; 162:795-801. [PMID: 31997072 PMCID: PMC7066292 DOI: 10.1007/s00701-020-04249-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/23/2020] [Indexed: 10/27/2022]
Abstract
BACKGROUND Patients with a lesion within the amygdala and uncus may develop temporal lobe epilepsy despite having functional mesial structures. Resection of functional hippocampus and surrounding structures may lead to unacceptable iatrogenic deficits. To our knowledge, there is limited descriptions of surgical techniques for selectively resecting the amygdala and uncus lesions while preserving the hippocampus in patients with language-dominant temporal lobe pathology. METHODS Thirteen patients with language-dominant temporal lobe epilepsy related to amygdala-centric lesions were identified. Patients with sclerosis of the mesial structures or evidence of pathology outside of the amygdala-uncus region were excluded. Neuropsychological evaluation confirmed normal function of the mesial structures ipsilateral to the lesion. All patients were worked up with video-EEG, high-resolution brain MRI, neuro-psychology evaluation, and either Wada or functional MRI testing. RESULTS All patients underwent selective resection of the lesion including amygdala and uncus with preservation of the hippocampus via a transcortical inferior temporal gyrus approach to the mesial temporal lobe. Pathology was compatible with glioneuronal tumors. Post-operative MRI demonstrated complete resection in all patients. Eight of the thirteen patients underwent post-operative neuropsychology evaluations and did not demonstrate any significant decline in tasks of delayed verbal recall or visual memory based on the Rey Auditory Verbal Learning Test (RAVLT). One patient showed a slight decrease in confrontation naming using the Boston Naming Test (BNT). Seizure freedom (Engel class I) was achieved in 12 of 13 patients. CONCLUSION Selective transcortical amygdala and uncus resection with hippocampus preservation may be a reasonable way to achieve seizure control while sparing functional mesial structures.
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Alcaraz García-Tejedor G, Echániz G, Strantzas S, Jalloh I, Rutka J, Drake J, Der T. Feasibility of awake craniotomy in the pediatric population. Paediatr Anaesth 2020; 30:480-489. [PMID: 31997512 DOI: 10.1111/pan.13833] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 01/13/2020] [Accepted: 01/18/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Awake craniotomy with direct cortical stimulation and mapping is the gold standard for resection of lesions near eloquent brain areas, as it can maximize the extent of resection while minimizing the risk of neurological damage. In contrast to the adult population, only small series of awake craniotomies have been reported in children. AIMS The aim of our study is to establish the feasibility of awake craniotomy in the pediatric population. METHODS We performed a retrospective observational study of children undergoing a supratentorial awake craniotomy between January 2009 and April 2019 in a pediatric tertiary care center. Our primary outcome was feasibility of awake craniotomy, defined as the ability to complete the procedure without conversion to general anesthesia. Our secondary outcomes were the incidence of serious intraoperative complications and the mapping completion rate. RESULTS Thirty procedures were performed in 28 children: 12 females and 16 males. The median age was 14 years (range 7-17). The primary diagnosis was tumor (83.3%), epilepsy (13.3%), and arterio-venous malformation (3.3%). The anesthetic techniques were asleep-awake-asleep (96.7%) and conscious sedation (3.3%), all cases supplemented with scalp block and pin-site infiltration. Awake craniotomy was feasible in 29 cases (96.7%), one patient converted to general anesthesia due to agitation. Serious complications occurred in six patients: agitation (6.7%), seizures (3.3%), increased intracranial pressure (3.3%), respiratory depression (3.3%), and bradycardia (3.3%). All complications were quickly resolved and without major consequences. Cortical mapping was completed in 96.6% cases. New neurological deficits occurred in six patients (20%)-moderate in one case and mild in 5-being all absent at 6 months of follow-up. CONCLUSION Awake craniotomy with intraoperative mapping can be successfully performed in children. Adequate patient selection and close cooperation between neurosurgeons, anesthesiologists, neuropsychologists, and neurophysiologists is paramount. Further studies are needed to determine the best anesthetic technique in this population group.
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Affiliation(s)
| | - Gastón Echániz
- Department of Anesthesia, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Samuel Strantzas
- Department of Neurophysiology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Ibrahim Jalloh
- Department of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - James Rutka
- Department of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - James Drake
- Department of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Tara Der
- Department of Anesthesia, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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de Haan EHF, Fabri M, Dijkerman HC, Foschi N, Lattanzi S, Pinto Y. Unified tactile detection and localisation in split-brain patients. Cortex 2020; 124:217-223. [PMID: 31923846 PMCID: PMC7061321 DOI: 10.1016/j.cortex.2019.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/08/2019] [Accepted: 11/18/2019] [Indexed: 02/04/2023]
Abstract
In 'split-brain' patients, the corpus callosum has been surgically severed to alleviate medically intractable, severe epilepsy. The classic claim is that after removal of the corpus callosum an object presented in the right visual field will be identified correctly verbally and with the right hand but not with the left hand. When the object is presented in the left visual field the patient verbally states that he saw nothing but nevertheless identifies it accurately with the left hand. This interaction suggests that perception, recognition and responding are separated in the two isolated hemispheres. However, there is now accumulating evidence that this interaction is not absolute. Recently, we (Pinto et al., 2017) showed that accurate detection and location of stimuli anywhere in the visual field could be performed with both hands. In this study, we explored detection and localisation of tactile stimulation on the body. In line with our previous results, we observed that split-brain patients can signal detection and localisation with either hand anywhere on the body (be it the arm or the leg) but they remain unable to match positions touched on both arms or legs simultaneously. These results add to the evidence suggesting that the effects of removal of the corpus callosum may be less severe than sometimes claimed.
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Affiliation(s)
- Edward H F de Haan
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Brain & Cognition (ABC) Center, University of Amsterdam, the Netherlands.
| | - Mara Fabri
- Department of Experimental and Clinical Medicine, Marche Politechnical University, Ancona, Italy
| | | | - Nicoletta Foschi
- Epilepsy Center-Neurological Clinic, Azienda 'Ospedali Riuniti', Ancona, Italy
| | - Simona Lattanzi
- Department of Experimental and Clinical Medicine, Marche Politechnical University, Ancona, Italy
| | - Yair Pinto
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Brain & Cognition (ABC) Center, University of Amsterdam, the Netherlands
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Herbet G, Duffau H. Revisiting the Functional Anatomy of the Human Brain: Toward a Meta-Networking Theory of Cerebral Functions. Physiol Rev 2020; 100:1181-1228. [PMID: 32078778 DOI: 10.1152/physrev.00033.2019] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
For more than one century, brain processing was mainly thought in a localizationist framework, in which one given function was underpinned by a discrete, isolated cortical area, and with a similar cerebral organization across individuals. However, advances in brain mapping techniques in humans have provided new insights into the organizational principles of anatomo-functional architecture. Here, we review recent findings gained from neuroimaging, electrophysiological, as well as lesion studies. Based on these recent data on brain connectome, we challenge the traditional, outdated localizationist view and propose an alternative meta-networking theory. This model holds that complex cognitions and behaviors arise from the spatiotemporal integration of distributed but relatively specialized networks underlying conation and cognition (e.g., language, spatial cognition). Dynamic interactions between such circuits result in a perpetual succession of new equilibrium states, opening the door to considerable interindividual behavioral variability and to neuroplastic phenomena. Indeed, a meta-networking organization underlies the uniquely human propensity to learn complex abilities, and also explains how postlesional reshaping can lead to some degrees of functional compensation in brain-damaged patients. We discuss the major implications of this approach in fundamental neurosciences as well as for clinical developments, especially in neurology, psychiatry, neurorehabilitation, and restorative neurosurgery.
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Affiliation(s)
- Guillaume Herbet
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France; Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors," INSERM U1191, Institute of Functional Genomics, Montpellier, France; and University of Montpellier, Montpellier, France
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France; Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors," INSERM U1191, Institute of Functional Genomics, Montpellier, France; and University of Montpellier, Montpellier, France
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125
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Muh CR, Chou ND, Rahimpour S, Komisarow JM, Spears TG, Fuchs HE, Serafini S, Grant GA. Cortical stimulation mapping for localization of visual and auditory language in pediatric epilepsy patients. J Neurosurg Pediatr 2020; 25:168-177. [PMID: 31703207 DOI: 10.3171/2019.8.peds1922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 08/28/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine resection margins near eloquent tissue, electrical cortical stimulation (ECS) mapping is often used with visual naming tasks. In recent years, auditory naming tasks have been found to provide a more comprehensive map. Differences in modality-specific language sites have been found in adult patients, but there is a paucity of research on ECS language studies in pediatric patients. The goals of this study were to evaluate word-finding distinctions between visual and auditory modalities and identify which cortical subregions most often contain critical language function in a pediatric population. METHODS Twenty-one pediatric patients with epilepsy or temporal lobe pathology underwent ECS mapping using visual (n = 21) and auditory (n = 14) tasks. Fisher's exact test was used to determine whether the frequency of errors in the stimulated trials was greater than the patient's baseline error rate for each tested modality and subregion. RESULTS While the medial superior temporal gyrus was a common language site for both visual and auditory language (43.8% and 46.2% of patients, respectively), other subregions showed significant differences between modalities, and there was significant variability between patients. Visual language was more likely to be located in the anterior temporal lobe than was auditory language. The pediatric patients exhibited fewer parietal language sites and a larger range of sites overall than did adult patients in previously published studies. CONCLUSIONS There was no single area critical for language in more than 50% of patients tested in either modality for which more than 1 patient was tested (n > 1), affirming that language function is plastic in the setting of dominant-hemisphere pathology. The high rates of language function throughout the left frontal, temporal, and anterior parietal regions with few areas of overlap between modalities suggest that ECS mapping with both visual and auditory testing is necessary to obtain a comprehensive language map prior to epileptic focus or tumor resection.
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Affiliation(s)
- Carrie R Muh
- 1Department of Neurosurgery, Duke University Hospital, and
- 2Department of Neurosurgery, Maria Fareri Children's Hospital, Westchester Medical Center, Valhalla, New York; and
| | - Naomi D Chou
- 1Department of Neurosurgery, Duke University Hospital, and
| | | | | | - Tracy G Spears
- 3Duke Clinical Research Institute, Durham, North Carolina
| | | | | | - Gerald A Grant
- 4Department of Neurosurgery, Stanford University Hospital, Stanford, California
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126
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Bass DI, Shurtleff H, Warner M, Knott D, Poliakov A, Friedman S, Collins MJ, Lopez J, Lockrow JP, Novotny EJ, Ojemann JG, Hauptman JS. Awake Mapping of the Auditory Cortex during Tumor Resection in an Aspiring Musical Performer: A Case Report. Pediatr Neurosurg 2020; 55:351-358. [PMID: 33260181 DOI: 10.1159/000509328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/09/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Preoperative functional MRI (fMRI) and intraoperative awake cortical mapping are established strategies to identify and preserve critical language structures during neurosurgery. There is growing appreciation for the need to similarly identify and preserve eloquent tissue critical for music production. CASE REPORT A 19-year-old female musician, with a 3- to 4-year history of events concerning for musicogenic seizures, was found to have a right posterior temporal tumor, concerning for a low-grade glial neoplasm. Preoperative fMRI assessing passive and active musical tasks localized areas of activation directly adjacent to the tumor margin. Cortical stimulation during various musical tasks did not identify eloquent tissue near the surgical site. A gross total tumor resection was achieved without disruption of singing ability. At 9-month follow-up, the patient continued to have preserved musical ability with full resolution of seizures and without evidence of residual lesion or recurrence. CONCLUSION A novel strategy for performing an awake craniotomy, incorporating preoperative fMRI data for music processing with intraoperative cortical stimulation, interpreted with the assistance of a musician expert and facilitated gross total resection of the patient's tumor without comprising her musical abilities.
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Affiliation(s)
- David I Bass
- Department of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA,
| | - Hillary Shurtleff
- Department of Neurology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Molly Warner
- Department of Neurology, Seattle Children's Hospital, Seattle, Washington, USA
| | - David Knott
- Department of Music Therapy, Seattle Children's Hospital, Seattle, Washington, USA
| | - Andrew Poliakov
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Seth Friedman
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Michael J Collins
- Department of Anesthesiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jonathan Lopez
- Department of Neurology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jason P Lockrow
- Department of Neurology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Edward J Novotny
- Department of Neurology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jeffrey G Ojemann
- Department of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jason S Hauptman
- Department of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA
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127
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Bai H, Yang R. Maximal safe resection of diffuse low-grade gliomas within/near motor areas using awake craniotomy with intraoperative cortical/subcortical mapping via direct electrical stimulation: A narrative review. GLIOMA 2020. [DOI: 10.4103/glioma.glioma_14_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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128
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Charbonnier L, Raemaekers MAH, Cornelisse PA, Verwoert M, Braun KPJ, Ramsey NF, Vansteensel MJ. A Functional Magnetic Resonance Imaging Approach for Language Laterality Assessment in Young Children. Front Pediatr 2020; 8:587593. [PMID: 33313027 PMCID: PMC7707083 DOI: 10.3389/fped.2020.587593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/03/2020] [Indexed: 11/23/2022] Open
Abstract
Functional magnetic resonance imaging (fMRI) is a usable technique to determine hemispheric dominance of language function, but high-quality fMRI images are difficult to acquire in young children. Here we aimed to develop and validate an fMRI approach to reliably determine hemispheric language dominance in young children. We designed two new tasks (story, SR; Letter picture matching, LPM) that aimed to match the interests and the levels of cognitive development of young children. We studied 32 healthy children (6-10 years old, median age 8.7 years) and seven children with epilepsy (7-11 years old, median age 8.6 years) and compared the lateralization index of the new tasks with those of a well-validated task (verb generation, VG) and with clinical measures of hemispheric language dominance. A conclusive assessment of hemispheric dominance (lateralization index ≤-0.2 or ≥0.2) was obtained for 94% of the healthy participants who performed both new tasks. At least one new task provided conclusive language laterality assessment in six out of seven participants with epilepsy. The new tasks may contribute to assessing language laterality in young and preliterate children and may benefit children who are scheduled for surgical treatment of disorders such as epilepsy.
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Affiliation(s)
- Lisette Charbonnier
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mathijs A H Raemaekers
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Philippe A Cornelisse
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Maxime Verwoert
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Kees P J Braun
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Nick F Ramsey
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mariska J Vansteensel
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
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129
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Rigolo L, Essayed WI, Tie Y, Norton I, Mukundan S, Golby A. Intraoperative Use of Functional MRI for Surgical Decision Making after Limited or Infeasible Electrocortical Stimulation Mapping. J Neuroimaging 2019; 30:184-191. [PMID: 31867823 DOI: 10.1111/jon.12683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/09/2019] [Accepted: 11/11/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND PURPOSE Functional magnetic resonance imaging (fMRI) is becoming widely recognized as a key component of preoperative neurosurgical planning, although intraoperative electrocortical stimulation (ECS) is considered the gold standard surgical brain mapping method. However, acquiring and interpreting ECS results can sometimes be challenging. This retrospective study assesses whether intraoperative availability of fMRI impacted surgical decision-making when ECS was problematic or unobtainable. METHODS Records were reviewed for 191 patients who underwent presurgical fMRI with fMRI loaded into the neuronavigation system. Four patients were excluded as a bur-hole biopsy was performed. Imaging was acquired at 3 Tesla and analyzed using the general linear model with significantly activated pixels determined via individually determined thresholds. fMRI maps were displayed intraoperatively via commercial neuronavigation systems. RESULTS Seventy-one cases were planned ECS; however, 18 (25.35%) of these procedures were either not attempted or aborted/limited due to: seizure (10), patient difficulty cooperating with the ECS mapping (4), scarring/limited dural opening (3), or dural bleeding (1). In all aborted/limited ECS cases, the surgeon continued surgery using fMRI to guide surgical decision-making. There was no significant difference in the incidence of postoperative deficits between cases with completed ECS and those with limited/aborted ECS. CONCLUSIONS Preoperative fMRI allowed for continuation of surgery in over one-fourth of patients in which planned ECS was incomplete or impossible, without a significantly different incidence of postoperative deficits compared to the patients with completed ECS. This demonstrates additional value of fMRI beyond presurgical planning, as fMRI data served as a backup method to ECS.
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Affiliation(s)
- Laura Rigolo
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Walid Ibn Essayed
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Yanmei Tie
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Isaiah Norton
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Srinivasan Mukundan
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alexandra Golby
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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130
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Nakai T, Okanoya K. Cortical collateralization induced by language and arithmetic in non-right-handers. Cortex 2019; 124:154-166. [PMID: 31901561 DOI: 10.1016/j.cortex.2019.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/26/2019] [Accepted: 11/20/2019] [Indexed: 11/18/2022]
Abstract
The functional overlap of language and arithmetic is debatable. Although some studies have reported independent representations of arithmetic and language in the brain, other studies have reported shared activity of the two cognitive domains in the inferior frontal gyrus. Although most previous studies have evaluated right-handed individuals, variability of hemispheric dominance in non-right-handed individuals should provide important information on the functional collateralization of these two cognitive domains. The present study evaluated the cortical lateralization patterns of the two cognitive domains using functional magnetic resonance imaging in 30 non-right-handed participants who performed language and arithmetic tasks. We found that language and arithmetic tasks demonstrated shared activity in the bilateral inferior frontal gyrus (IFG). Furthermore, the lateralization patterns of language and arithmetic tasks were correlated with each other. Most participants with language dominance in the left hemisphere also exhibited dominance of arithmetic tasks in the left hemisphere; similarly, most participants with language dominance in the right hemisphere exhibited dominance of arithmetic tasks in the right hemisphere. Among all the brain regions, the precentral gyrus, which is located slightly posterior to the IFG, exhibited the highest correlation coefficient between laterality indices of language and arithmetic tasks. These results suggest a shared functional property between language and arithmetic in the brain.
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Affiliation(s)
- Tomoya Nakai
- Center for Information and Neural Networks (CiNet), National Institute of Information and Communication Technology, Osaka University, Osaka, Japan; The University of Tokyo, Graduate School of Arts and Sciences, Tokyo, Japan; National Rehabilitation Center For Persons with Disabilities, Saitama, Japan
| | - Kazuo Okanoya
- The University of Tokyo, Graduate School of Arts and Sciences, Tokyo, Japan; Center for Evolutionary Cognitive Science, The University of Tokyo, Tokyo, Japan.
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131
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Hsu AL, Chen HSM, Hou P, Wu CW, Johnson JM, Noll KR, Prabhu SS, Ferguson SD, Kumar VA, Schomer DF, Chen JH, Liu HL. Presurgical resting-state functional MRI language mapping with seed selection guided by regional homogeneity. Magn Reson Med 2019; 84:375-383. [PMID: 31793025 DOI: 10.1002/mrm.28107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/24/2019] [Accepted: 11/14/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE Resting-state functional MRI (rs-FMRI) has shown potential for presurgical mapping of eloquent cortex when a patient's performance on task-based FMRI is compromised. The seed-based analysis is a practical approach for detecting rs-FMRI functional networks; however, seed localization remains challenging for presurgical language mapping. Therefore, we proposed a data-driven approach to guide seed localization for presurgical rs-FMRI language mapping. METHODS Twenty-six patients with brain tumors located in left perisylvian regions had undergone task-based FMRI and rs-FMRI before tumor resection. For the seed-based rs-FMRI language mapping, a seeding approach that integrates regional homogeneity and meta-analysis maps (RH+MA) was proposed to guide the seed localization. Canonical and task-based seeding approaches were used for comparison. The performance of the 3 seeding approaches was evaluated by calculating the Dice coefficients between each rs-FMRI language mapping result and the result from task-based FMRI. RESULTS With the RH+MA approach, selecting among the top 6 seed candidates resulted in the highest Dice coefficient for 81% of patients (21 of 26) and the top 9 seed candidates for 92% of patients (24 of 26). The RH+MA approach yielded rs-FMRI language mapping results that were in greater agreement with the results of task-based FMRI, with significantly higher Dice coefficients (P < .05) than that of canonical and task-based approaches within putative language regions. CONCLUSION The proposed RH+MA approach outperformed the canonical and task-based seed localization for rs-FMRI language mapping. The results suggest that RH+MA is a robust and feasible method for seed-based functional connectivity mapping in clinical practice.
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Affiliation(s)
- Ai-Ling Hsu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Henry Szu-Meng Chen
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ping Hou
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Changwei W Wu
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan.,Brain and Consciousness Research Center, Shuang Ho Hospital, New Taipei, Taiwan
| | - Jason M Johnson
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kyle R Noll
- Section of Neuropsychology, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sherise D Ferguson
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vinodh A Kumar
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Donald F Schomer
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jyh-Horng Chen
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Ho-Ling Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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132
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Hacker CD, Roland JL, Kim AH, Shimony JS, Leuthardt EC. Resting-state network mapping in neurosurgical practice: a review. Neurosurg Focus 2019; 47:E15. [PMID: 31786561 PMCID: PMC9841914 DOI: 10.3171/2019.9.focus19656] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/12/2019] [Indexed: 01/18/2023]
Abstract
Resting-state functional MRI (rs-fMRI) is a well-established method for studying intrinsic connectivity and mapping the topography of functional networks in the human brain. In the clinical setting, rs-fMRI has been used to define functional topography, typically language and motor systems, in the context of preoperative planning for neurosurgery. Intraoperative mapping of critical speech and motor areas with electrocortical stimulation (ECS) remains standard practice, but preoperative noninvasive mapping has the potential to reduce operative time and provide functional localization when awake mapping is not feasible. Task-based fMRI has historically been used for this purpose, but it can be limited by the young age of the patient, cognitive impairment, poor cooperation, and need for sedation. Resting-state fMRI allows reliable analysis of all functional networks with a single study and is inherently independent of factors affecting task performance. In this review, the authors provide a summary of the theory and methods for resting-state network mapping. They provide case examples illustrating clinical implementation and discuss limitations of rs-fMRI and review available data regarding performance in comparison to ECS. Finally, they discuss novel opportunities for future clinical applications and prospects for rs-fMRI beyond mapping of regions to avoid during surgery but, instead, as a tool to guide novel network-based therapies.
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Affiliation(s)
- Carl D. Hacker
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Jarod L. Roland
- Department of Neurosurgery, University of California, San Francisco, California
| | - Albert H. Kim
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Joshua S. Shimony
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Eric C. Leuthardt
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
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133
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Rolston JD, Chang EF. Critical Language Areas Show Increased Functional Connectivity in Human Cortex. Cereb Cortex 2019; 28:4161-4168. [PMID: 29045564 DOI: 10.1093/cercor/bhx271] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Indexed: 11/13/2022] Open
Abstract
Electrocortical stimulation (ECS) mapping is routinely used to identify critical language sites before resective neurosurgery. The precise locations of these sites are highly variable across patients, occurring in the frontal, temporal, and parietal lobes-it is this variability that necessitates individual patient mapping. But why these particular anatomical sites are so privileged in each patient is unknown. We hypothesized that critical language sites have greater functional connectivity with nearby cortex than sites without critical functions, since they serve as central nodes within the language network. Functional connectivity across language, motor, and cleared sites was measured in 15 patients undergoing electrocortiographic (ECoG) mapping for epilepsy surgery. Critical language sites had significantly higher connectivity than sites without critical functions (P = 0.001), and this also held for motor sites (P = 0.022). These data support the hypothesis that critical language sites are highly connected within the local cortical network, perhaps explaining why their disruption with ECS leads to transient disturbances in language function. It is our hope that improved understanding of the mechanisms of ECS will permit improved surgical planning and perhaps contribute to the understanding of normal language physiology.
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Affiliation(s)
- John D Rolston
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
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134
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Babajani-Feremi A, Fulton SP, Holder CM, Choudhri AF, Boop FA, Wheless JW. Localization of Expressive Language Cortex in a 2-Year-Old Child Using High-Gamma Electrocorticography. J Child Neurol 2019; 34:837-841. [PMID: 31339411 DOI: 10.1177/0883073819863999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cortical stimulation mapping is the gold standard for presurgical language mapping; however, it cannot be reliably performed in very young patients. Language mapping using noninvasive modalities is also challenging in very young patients. Although utility of language mapping using power of high-gamma in electrocorticographic recordings was demonstrated in adults and older children, there is a gap of knowledge in the ability of this procedure for localizing language-specific cortex in very young patients. We describe a case of a 2-year-old patient who, to our knowledge, is the youngest person to undergo successful high-gamma electrocorticographic presurgical language mapping for localization of the expressive language cortex (Broca area). The surgical plan was to resect a cortical tuber within the left inferior frontal gyrus and there was a strong concern about postoperative language deficit after resection. Presurgical language mapping using noninvasive modalities were attempted without success. Cortical stimulation mapping was not feasible in this patient. Therefore, high-gamma electrocorticography was the only viable option for language mapping, and it successfully localized the expressive language cortex. The patient underwent surgery for resection of the IFG tuber based on results of high-gamma electrocorticography and had no postoperative language deficit. High-gamma electrocorticography can be used for localizing language-specific cortex, especially Broca's area, in very young patients.
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Affiliation(s)
- Abbas Babajani-Feremi
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.,Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA.,Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Stephen P Fulton
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.,Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Christen M Holder
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.,Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Asim F Choudhri
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.,Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Frederick A Boop
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.,Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - James W Wheless
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.,Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
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135
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Krivosheya D, Rao G, Tummala S, Kumar V, Suki D, Bastos DCA, Prabhu SS. Impact of Multi-modality Monitoring Using Direct Electrical Stimulation to Determine Corticospinal Tract Shift and Integrity in Tumors using the Intraoperative MRI. J Neurol Surg A Cent Eur Neurosurg 2019; 82:375-380. [PMID: 31659724 DOI: 10.1055/s-0039-1698383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Preserving the integrity of the corticospinal tract (CST) while maximizing the extent of tumor resection is one of the key principles of brain tumor surgery to prevent new neurologic deficits. Our goal was to determine the impact of the use of perioperative diffusion tensor imaging (DTI) fiber-tracking protocols for location of the CSTs, in conjunction with intraoperative direct electrical stimulation (DES) on patient neurologic outcomes. The role of combining DES and CST shift in intraoperative magnetic resonance imaging (iMRI) to enhance extent of resection (EOR) has not been studied previously. METHODS A total of 53 patients underwent resection of tumors adjacent to the motor gyrus and the underlying CST between June 5, 2009, and April 16, 2013. All cases were performed in the iMRI (BrainSuite 1.5 T). Preoperative DTI mapping and intraoperative cortical and subcortical DES including postoperative DTI mapping were performed in all patients. There were 32 men and 21 women with 40 high-grade gliomas (76%), 4 low-grade gliomas (8%), and 9 (17%) metastases. Thirty-four patients (64%) were newly diagnosed, and 19 (36%) had a previous resection. There were 31 (59%) right-sided and 22 (42%) left-sided tumors. Eighteen patients (34%) had a re-resection after the first intraoperative scan. Most patients had motor-only mapping, and one patient had both speech and motor mapping. Relative to the resection margin, the CST after the first iMRI was designated as having an outward shift (OS), inward shift (IS), or no shift (NS). RESULTS A gross total resection (GTR) was achieved in 41 patients (77%), subtotal resection in 4 (7.5%), and a partial resection in 8 (15%). Eighteen patients had a re-resection, and the mean EOR increased from 84% to 95% (p = 0.002). Of the 18 patients, 7 had an IS, 8 an OS, and in 3 NS was noted. More patients in the OS group had a GTR compared with the IS or NS groups (p = 0.004). Patients were divided into four groups based on the proximity of the tumor to the CST as measured from the preoperative scan. Group 1 (32%) included patients whose tumors were 0 to 5 mm from the CST based on preoperative scans; group 2 (28%), 6 to 10 mm; group 3 (13%), 11 to 15 mm; and group 4 (26%), 16 to 20 mm, respectively. Patients in group 4 had fewer neurologic complications compared with other groups at 1 and 3 months postoperatively (p = 0.001 and p = 0.007, respectively) despite achieving a similar degree of resection (p = 0.61). Furthermore, the current of intraoperative DES was correlated to the distance of the tumor to the CST, and the regression equation showed a close linear relationship between the two parameters. CONCLUSIONS Combining information about intraoperative CST and DES in the iMRI can enhance resection in brain tumors (77% had a GTR). The relative relationship between the positions of the CST to the resection cavity can be a dynamic process that could further influence the surgeon's decision about the stimulation parameters and EOR. Also, the patients with an OS of the CST relative to the resection cavity had a GTR comparable with the other groups.
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Affiliation(s)
- Daria Krivosheya
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, United States
| | - Ganesh Rao
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Sudhakar Tummala
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Vinodh Kumar
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Dima Suki
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Dheigo C A Bastos
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Sujit S Prabhu
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
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136
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Neshige S, Kobayashi K, Matsuhashi M, Togo M, Sakamoto M, Shimotake A, Hitomi T, Kikuchi T, Yoshida K, Kunieda T, Matsumoto R, Maruyama H, Takahashi R, Miyamoto S, Ikeda A. A score to map the lateral nonprimary motor area: Multispectrum intrinsic brain activity versus cortical stimulation. Epilepsia 2019; 60:2294-2305. [PMID: 31612479 DOI: 10.1111/epi.16367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 09/13/2019] [Accepted: 09/15/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Multispectrum electrocorticographic components are critical for mapping the nonprimary motor area (NPMA). The objective of this study was to derive and validate a reliable scoring system for electrocorticography-based NPMA mapping (NPMA score) to replace electrical cortical stimulation (ECS) during brain surgery. METHODS We analyzed 14 consecutive epilepsy patients with subdural electrodes implanted in the frontal lobe at Kyoto University Hospital. The NPMA score was retrospectively derived from multivariate analysis in the derivation group (patients = 7, electrodes = 713, during 2010-2013) and validated in the validation group (patients = 7, electrodes = 772, during 2014-2017). We assessed the accuracy and reliability of the score relative to ECS in determining the NPMA and predicting postoperative functional outcomes. RESULTS Multivariate analysis in the derivation group led to an 8-point score for predicting ECS-based NPMA (1 point for anatomical localization of the electrode and 1 or 2 points for movement-related electrocorticographic components regardless of somatotopy in very slow cortical potential shifts [<0.5 Hz], 40-80-Hz band power increase, and 8-24-Hz band power decrease), which was validated in the validation group. The area under the receiver operating characteristic curve (AUC) was 0.89 in the derivation group. Good prediction (specificity = 94%, sensitivity = 100%) and discrimination (AUC = 0.87) were reproduced in the validation group. Overall, higher NPMA scores identified 2 patients with postoperative deficits after frontal lobe resection. SIGNIFICANCE The NPMA score is reliable for NPMA mapping, potentially replacing ECS. It is a potential prognostic marker for postoperative functional deficits.
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Affiliation(s)
- Shuichiro Neshige
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Katsuya Kobayashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masao Matsuhashi
- Department of Epilepsy, Movement Disorders, and Physiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masaya Togo
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mitsuhiro Sakamoto
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihiro Shimotake
- Department of Epilepsy, Movement Disorders, and Physiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takefumi Hitomi
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazumichi Yoshida
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeharu Kunieda
- Department of Neurosurgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Riki Matsumoto
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akio Ikeda
- Department of Epilepsy, Movement Disorders, and Physiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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137
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Martino J, Gomez E, de Lucas EM, Mato D, Vázquez-Bourgon J. Intraoperative Identification and Preservation of Verbal Memory in Diffuse Gliomas: A Matched-Pair Cohort Study. Neurosurgery 2019; 83:1209-1218. [PMID: 29351666 DOI: 10.1093/neuros/nyx617] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 12/08/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recent glioma surgery series with intraoperative electrical stimulation (IES) language mapping have demonstrated high rates of postoperative memory impairment, raising a question regarding the efficacy of this approach to preserve memory. OBJECTIVE To evaluate if intraoperative identification and preservation of verbal memory sites with IES mapping in diffuse gliomas in eloquent areas consistently protect patients from long-term postoperative decline in short-term memory. METHODS A cohort of 16 subjects with diffuse low-grade or anaplastic gliomas that were operated with IES and intraoperative evaluation of language and verbal memory (cohort A) was matched by tumor side, pathology, and radiotherapy with a cohort of 16 subjects that were operated with IES and evaluation of language (cohort B). Detailed neuropsychological assessment was performed before and 6 mo after surgery. RESULTS Intraoperative memory mapping was a strong predictor of verbal memory prognosis. In cohort A, 4 patients (26.7%) had a decline of at least one of the 4 short-term memory tests evaluated. In cohort B, 11 patients (73.3%) had a decline of at least one of the 4 tests. This difference was statistically significant in multivariate analysis (P = .022; odds ratio = 9.88; 95% confidence interval = 1.39-70.42). CONCLUSION Verbal memory areas identified intraoperatively with the current paradigm are critically involved in verbal memory, as memory impairment can be significantly reduced by adapting the resection to avoid those memory areas. Incorporation of verbal memory evaluation in stimulation mapping protocols might assist in reducing postoperative sequelae and preserving the patient's quality of life.
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Affiliation(s)
- Juan Martino
- Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla (HUMV), Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Avda, Valdecilla s/n, Santander, Cantabria, Spain
| | - Elsa Gomez
- Department of Psychiatry, Hospital Universitario Marqués de Valdecilla (HUMV), Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL) and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Avda, Valdecilla s/n, Santander, Cantabria, Spain
| | - Enrique Marco de Lucas
- Department of Radiology, Hospital Universitario Marqués de Valdecilla (HUMV), Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Avda, Valdecilla s/n, Santander, Cantabria, Spain
| | - David Mato
- Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla (HUMV), Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Avda, Valdecilla s/n, Santander, Cantabria, Spain
| | - Javier Vázquez-Bourgon
- Department of Psychiatry, Hospital Universitario Marqués de Valdecilla (HUMV), Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL) and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Avda, Valdecilla s/n, Santander, Cantabria, Spain
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138
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Miller KJ. A library of human electrocorticographic data and analyses. Nat Hum Behav 2019; 3:1225-1235. [PMID: 31451738 DOI: 10.1038/s41562-019-0678-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 07/05/2019] [Indexed: 11/09/2022]
Abstract
Electrophysiological data from implanted electrodes in the human brain are rare, and therefore scientific access to such data has remained somewhat exclusive. Here we present a freely available curated library of implanted electrocorticographic data and analyses for 16 behavioural experiments, with 204 individual datasets from 34 patients recorded with the same amplifiers and at the same settings. For each dataset, electrode positions were carefully registered to brain anatomy. A large set of fully annotated analysis scripts with which to interpret these data is embedded in the library alongside them. All data, anatomical locations and analysis files (MATLAB code) are provided in a shared file structure at https://searchworks.stanford.edu/view/zk881ps0522.
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Affiliation(s)
- Kai J Miller
- Department of Neurosurgery, Stanford University, Stanford, CA, USA. .,Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
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139
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Caldwell DJ, Ojemann JG, Rao RPN. Direct Electrical Stimulation in Electrocorticographic Brain-Computer Interfaces: Enabling Technologies for Input to Cortex. Front Neurosci 2019; 13:804. [PMID: 31440127 PMCID: PMC6692891 DOI: 10.3389/fnins.2019.00804] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/18/2019] [Indexed: 12/22/2022] Open
Abstract
Electrocorticographic brain computer interfaces (ECoG-BCIs) offer tremendous opportunities for restoring function in individuals suffering from neurological damage and for advancing basic neuroscience knowledge. ECoG electrodes are already commonly used clinically for monitoring epilepsy and have greater spatial specificity in recording neuronal activity than techniques such as electroencephalography (EEG). Much work to date in the field has focused on using ECoG signals recorded from cortex as control outputs for driving end effectors. An equally important but less explored application of an ECoG-BCI is directing input into cortex using ECoG electrodes for direct electrical stimulation (DES). Combining DES with ECoG recording enables a truly bidirectional BCI, where information is both read from and written to the brain. We discuss the advantages and opportunities, as well as the barriers and challenges presented by using DES in an ECoG-BCI. In this article, we review ECoG electrodes, the physics and physiology of DES, and the use of electrical stimulation of the brain for the clinical treatment of disorders such as epilepsy and Parkinson’s disease. We briefly discuss some of the translational, regulatory, financial, and ethical concerns regarding ECoG-BCIs. Next, we describe the use of ECoG-based DES for providing sensory feedback and for probing and modifying cortical connectivity. We explore future directions, which may draw on invasive animal studies with penetrating and surface electrodes as well as non-invasive stimulation methods such as transcranial magnetic stimulation (TMS). We conclude by describing enabling technologies, such as smaller ECoG electrodes for more precise targeting of cortical areas, signal processing strategies for simultaneous stimulation and recording, and computational modeling and algorithms for tailoring stimulation to each individual brain.
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Affiliation(s)
- David J Caldwell
- Department of Bioengineering, University of Washington, Seattle, WA, United States.,Medical Scientist Training Program, University of Washington, Seattle, WA, United States.,Center for Neurotechnology, University of Washington, Seattle, WA, United States
| | - Jeffrey G Ojemann
- Center for Neurotechnology, University of Washington, Seattle, WA, United States.,Department of Neurological Surgery, University of Washington, Seattle, WA, United States
| | - Rajesh P N Rao
- Department of Bioengineering, University of Washington, Seattle, WA, United States.,Center for Neurotechnology, University of Washington, Seattle, WA, United States.,Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA, United States
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140
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Puglisi G, Sciortino T, Rossi M, Leonetti A, Fornia L, Conti Nibali M, Casarotti A, Pessina F, Riva M, Cerri G, Bello L. Preserving executive functions in nondominant frontal lobe glioma surgery: an intraoperative tool. J Neurosurg 2019; 131:474-480. [PMID: 30265193 DOI: 10.3171/2018.4.jns18393] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/23/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The goal of surgery for gliomas is maximal tumor removal while preserving the patient's full functional integrity. At present during frontal tumor removal, this goal is mostly achieved, although the risk of impairing the executive functions (EFs), and thus the quality of life, remains significant. The authors investigated the accuracy of an intraoperative version of the Stroop task (iST), adapted for intraoperative mapping, to detect EF-related brain sites by evaluating the impact of the iST brain mapping on preserving functional integrity following a maximal tumor resection. METHODS Forty-five patients with nondominant frontal gliomas underwent awake surgery; brain mapping was used to establish the functional boundaries for the resection. In 18 patients language, praxis, and motor functions, but not EFs (control group), were mapped intraoperatively at the cortical-subcortical level. In 27 patients, in addition to language, praxis, and motor functions, EFs were mapped with the iST at the cortical-subcortical level (Stroop group). In both groups the EF performance was evaluated preoperatively, at 7 days and 3 months after surgery. RESULTS The iST was successfully administered in all patients. Consistent interferences, such as color-word inversion/latency, were obtained by stimulating precise white matter sites below the inferior and middle frontal gyri, anterior to the insula and over the putamen, and these were used to establish the posterior functional limit of the resection. Procedures implemented with iST dramatically reduced the EF deficits at 3 months. The EOR was similar in Stroop and control groups. CONCLUSIONS Brain mapping with the iST allows identification and preservation of the frontal lobe structures involved in inhibition of automatic responses, reducing the incidence of postoperative EF deficits and enhancing the further posterior and inferior margin of tumor resection.
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Affiliation(s)
- Guglielmo Puglisi
- 2Laboratory of Motor Control, Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, and Humanitas Research Hospital, IRCCS, Milano, Italy
- 3Neurosurgical Oncology Unit, Humanitas Research Hospital, IRCCS, Milano, Italy; and
| | - Tommaso Sciortino
- 1Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, and Humanitas Research Hospital, IRCCS, Milano, Italy
| | - Marco Rossi
- 1Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, and Humanitas Research Hospital, IRCCS, Milano, Italy
| | - Antonella Leonetti
- 2Laboratory of Motor Control, Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, and Humanitas Research Hospital, IRCCS, Milano, Italy
- 3Neurosurgical Oncology Unit, Humanitas Research Hospital, IRCCS, Milano, Italy; and
| | - Luca Fornia
- 2Laboratory of Motor Control, Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, and Humanitas Research Hospital, IRCCS, Milano, Italy
| | - Marco Conti Nibali
- 1Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, and Humanitas Research Hospital, IRCCS, Milano, Italy
| | - Alessandra Casarotti
- 3Neurosurgical Oncology Unit, Humanitas Research Hospital, IRCCS, Milano, Italy; and
| | - Federico Pessina
- 3Neurosurgical Oncology Unit, Humanitas Research Hospital, IRCCS, Milano, Italy; and
| | - Marco Riva
- 3Neurosurgical Oncology Unit, Humanitas Research Hospital, IRCCS, Milano, Italy; and
- 4Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, and Humanitas Research Hospital, IRCCS, Milano, Italy
| | - Gabriella Cerri
- 2Laboratory of Motor Control, Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, and Humanitas Research Hospital, IRCCS, Milano, Italy
| | - Lorenzo Bello
- 1Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, and Humanitas Research Hospital, IRCCS, Milano, Italy
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141
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Characterising neural plasticity at the single patient level using connectivity fingerprints. NEUROIMAGE-CLINICAL 2019; 24:101952. [PMID: 31357148 PMCID: PMC6664196 DOI: 10.1016/j.nicl.2019.101952] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/11/2019] [Accepted: 07/19/2019] [Indexed: 02/07/2023]
Abstract
The occurrence of wide-scale neuroplasticity in the injured human brain raises hopes for biomarkers to guide personalised treatment. At the individual level, functional reorganisation has proven challenging to quantify using current techniques that are optimised for population-based analyses. In this cross-sectional study, we acquired functional MRI scans in 44 patients (22 men, 22 women, mean age: 39.4 ± 14 years) with a language-dominant hemisphere brain tumour prior to surgery and 23 healthy volunteers (11 men, 12 women, mean age: 36.3 ± 10.9 years) during performance of a verbal fluency task. We applied a recently developed approach to characterise the normal range of functional connectivity patterns during task performance in healthy controls. Next, we statistically quantified differences from the normal in individual patients and evaluated factors driving these differences. We show that the functional connectivity of brain regions involved in language fluency identifies “fingerprints” of brain plasticity in individual patients, not detected using standard task-evoked analyses. In contrast to healthy controls, patients with a tumour in their language dominant hemisphere showed highly variable fingerprints that uniquely distinguished individuals. Atypical fingerprints were influenced by tumour grade and tumour location relative to the typical fluency-activated network. Our findings show how alterations in brain networks can be visualised and statistically quantified from connectivity fingerprints in individual brains. We propose that connectivity fingerprints offer a statistical metric of individually-specific network organisation through which behaviourally-relevant adaptations could be formally quantified and monitored across individuals, treatments and time. Personalised treatment awaits individualised measures of brain adaptation. Connectivity patterns from FMRI offer unique “fingerprints” of brain networks. Individual brain tumours disrupt the language fluency network in unique ways. By fingerprint matching, networks can be tested and visualised in single patients.
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142
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Kucewicz MT, Berry BM, Miller LR, Khadjevand F, Ezzyat Y, Stein JM, Kremen V, Brinkmann BH, Wanda P, Sperling MR, Gorniak R, Davis KA, Jobst BC, Gross RE, Lega B, Van Gompel J, Stead SM, Rizzuto DS, Kahana MJ, Worrell GA. Evidence for verbal memory enhancement with electrical brain stimulation in the lateral temporal cortex. Brain 2019; 141:971-978. [PMID: 29324988 DOI: 10.1093/brain/awx373] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 12/21/2017] [Indexed: 11/13/2022] Open
Abstract
Direct electrical stimulation of the human brain can elicit sensory and motor perceptions as well as recall of memories. Stimulating higher order association areas of the lateral temporal cortex in particular was reported to activate visual and auditory memory representations of past experiences (Penfield and Perot, 1963). We hypothesized that this effect could be used to modulate memory processing. Recent attempts at memory enhancement in the human brain have been focused on the hippocampus and other mesial temporal lobe structures, with a few reports of memory improvement in small studies of individual brain regions. Here, we investigated the effect of stimulation in four brain regions known to support declarative memory: hippocampus, parahippocampal neocortex, prefrontal cortex and temporal cortex. Intracranial electrode recordings with stimulation were used to assess verbal memory performance in a group of 22 patients (nine males). We show enhanced performance with electrical stimulation in the lateral temporal cortex (paired t-test, P = 0.0067), but not in the other brain regions tested. This selective enhancement was observed both on the group level, and for two of the four individual subjects stimulated in the temporal cortex. This study shows that electrical stimulation in specific brain areas can enhance verbal memory performance in humans.awx373media15704855796001.
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Affiliation(s)
- Michal T Kucewicz
- Mayo Clinic, Department of Neurology, Rochester MN, USA.,Mayo Clinic, Department of Physiology and Biomedical Engineering, Rochester MN, USA
| | - Brent M Berry
- Mayo Clinic, Department of Neurology, Rochester MN, USA.,Mayo Clinic, Department of Physiology and Biomedical Engineering, Rochester MN, USA
| | - Laura R Miller
- Mayo Clinic, Department of Neurology, Rochester MN, USA.,Mayo Clinic, Department of Physiology and Biomedical Engineering, Rochester MN, USA
| | - Fatemeh Khadjevand
- Mayo Clinic, Department of Neurology, Rochester MN, USA.,Mayo Clinic, Department of Physiology and Biomedical Engineering, Rochester MN, USA
| | - Youssef Ezzyat
- University of Pennsylvania, Department of Psychology, Philadelphia PA, USA
| | - Joel M Stein
- University of Pennsylvania Hospital, Department of Radiology, Philadelphia PA, USA
| | - Vaclav Kremen
- Mayo Clinic, Department of Neurology, Rochester MN, USA.,Mayo Clinic, Department of Physiology and Biomedical Engineering, Rochester MN, USA.,Czech Technical University, Czech Institute of Informatics, Robotics and Cybernetics, Prague, Czech Republic
| | - Benjamin H Brinkmann
- Mayo Clinic, Department of Neurology, Rochester MN, USA.,Mayo Clinic, Department of Physiology and Biomedical Engineering, Rochester MN, USA
| | - Paul Wanda
- University of Pennsylvania, Department of Psychology, Philadelphia PA, USA
| | - Michael R Sperling
- Thomas Jefferson University Hospital, Department of Neurology, Philadelphia PA, USA
| | - Richard Gorniak
- Thomas Jefferson University Hospital, Department of Radiology, Philadelphia PA, USA
| | - Kathryn A Davis
- University of Pennsylvania Hospital, Department of Neurology, Philadelphia PA, USA
| | - Barbara C Jobst
- Dartmouth-Hitchcock Medical Center, Department of Neurology, Lebanon NH, USA
| | - Robert E Gross
- Emory University, Department of Neurosurgery, Atlanta GA, USA
| | - Bradley Lega
- UT Southwestern Medical Center, Department of Neurosurgery, Dallas TX, USA
| | | | - S Matt Stead
- Mayo Clinic, Department of Neurology, Rochester MN, USA.,Mayo Clinic, Department of Physiology and Biomedical Engineering, Rochester MN, USA
| | - Daniel S Rizzuto
- University of Pennsylvania, Department of Psychology, Philadelphia PA, USA
| | - Michael J Kahana
- University of Pennsylvania, Department of Psychology, Philadelphia PA, USA
| | - Gregory A Worrell
- Mayo Clinic, Department of Neurology, Rochester MN, USA.,Mayo Clinic, Department of Physiology and Biomedical Engineering, Rochester MN, USA
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143
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Ni B, Wang X, Yu T, Wu R, Wang B. Pre-surgical Language Mapping in Epilepsy: Using fMRI in Chinese-Speaking Patients. Front Hum Neurosci 2019; 13:183. [PMID: 31231201 PMCID: PMC6560162 DOI: 10.3389/fnhum.2019.00183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 05/20/2019] [Indexed: 11/15/2022] Open
Abstract
Accurate localization of language processing areas is critical in patients undergoing epilepsy surgery. In this study, we aimed to use functional magnetic resonance imaging (fMRI), which is a non-invasive mapping method, to establish a panel of tasks investigating patients’ language function. We developed six tasks, including a series of progressive comprehension tasks from words, sentence to text, a verb generation task that can detect subtle left-brain activation, an auditory comprehension task that explored the temporal language-related areas, and a visual object-naming task provided for poorly educated patients. We successfully located the language cortex in 40 patients, and subsequently determined hemispheric dominance for the Chinese language. Our results showed a concordance between fMRI tasks and electrical cortical stimulation. The consistency across tasks revealed by the laterality index, as well as the concordance between the surgical outcomes and the results of localization, suggested the validity of our fMRI tasks. Our fMRI tasks also corroborate and extend the finding that the left middle frontal area (BA 9) plays an important role in reading Chinese.
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Affiliation(s)
- Bing Ni
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xueyuan Wang
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tao Yu
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ruijie Wu
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,Beijing MR Center for Brain Research, Beijing, China
| | - Bo Wang
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,Beijing MR Center for Brain Research, Beijing, China
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144
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Leonard MK, Cai R, Babiak MC, Ren A, Chang EF. The peri-Sylvian cortical network underlying single word repetition revealed by electrocortical stimulation and direct neural recordings. BRAIN AND LANGUAGE 2019; 193:58-72. [PMID: 27450996 PMCID: PMC5790638 DOI: 10.1016/j.bandl.2016.06.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/23/2016] [Accepted: 06/15/2016] [Indexed: 06/02/2023]
Abstract
Verbal repetition requires the coordination of auditory, memory, linguistic, and motor systems. To date, the basic dynamics of neural information processing in this deceptively simple behavior are largely unknown. Here, we examined the neural processes underlying verbal repetition using focal interruption (electrocortical stimulation) in 58 patients undergoing awake craniotomies, and neurophysiological recordings (electrocorticography) in 8 patients while they performed a single word repetition task. Electrocortical stimulation revealed that sub-components of the left peri-Sylvian network involved in single word repetition could be differentially interrupted, producing transient perceptual deficits, paraphasic errors, or speech arrest. Electrocorticography revealed the detailed spatio-temporal dynamics of cortical activation, involving a highly-ordered, but overlapping temporal progression of cortical high gamma (75-150Hz) activity throughout the peri-Sylvian cortex. We observed functionally distinct serial and parallel cortical processing corresponding to successive stages of general auditory processing (posterior superior temporal gyrus), speech-specific auditory processing (middle and posterior superior temporal gyrus), working memory (inferior frontal cortex), and motor articulation (sensorimotor cortex). Together, these methods reveal the dynamics of coordinated activity across peri-Sylvian cortex during verbal repetition.
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Affiliation(s)
- Matthew K Leonard
- Department of Neurological Surgery, University of California, San Francisco, United States; Center for Integrative Neuroscience, University of California, San Francisco, United States
| | - Ruofan Cai
- Department of Neurological Surgery, University of California, San Francisco, United States; Center for Integrative Neuroscience, University of California, San Francisco, United States
| | - Miranda C Babiak
- Department of Neurological Surgery, University of California, San Francisco, United States; Center for Integrative Neuroscience, University of California, San Francisco, United States
| | - Angela Ren
- Department of Neurological Surgery, University of California, San Francisco, United States; Center for Integrative Neuroscience, University of California, San Francisco, United States
| | - Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, United States; Center for Integrative Neuroscience, University of California, San Francisco, United States; Department of Physiology, University of California, San Francisco, United States.
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145
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Sakreida K, Blume-Schnitzler J, Heim S, Willmes K, Clusmann H, Neuloh G. Phonological picture–word interference in language mapping with transcranial magnetic stimulation: an objective approach for functional parcellation of Broca’s region. Brain Struct Funct 2019; 224:2027-2044. [DOI: 10.1007/s00429-019-01891-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 05/11/2019] [Indexed: 10/26/2022]
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146
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Chernoff BL, Sims MH, Smith SO, Pilcher WH, Mahon BZ. Direct electrical stimulation of the left frontal aslant tract disrupts sentence planning without affecting articulation. Cogn Neuropsychol 2019; 36:178-192. [PMID: 31210568 PMCID: PMC6744286 DOI: 10.1080/02643294.2019.1619544] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 02/22/2019] [Accepted: 04/26/2019] [Indexed: 10/26/2022]
Abstract
Sentence production involves mapping from deep structures that specify meaning and thematic roles to surface structures that specify the order and sequencing of production ready elements. We propose that the frontal aslant tract is a key pathway for sequencing complex actions with deep hierarchical structure. In the domain of language, and primarily with respect to the left FAT, we refer to this as the 'Syntagmatic Constraints On Positional Elements' (SCOPE) hypothesis. One prediction made by the SCOPE hypothesis is that disruption of the frontal aslant tract should disrupt sentence production at grammatical phrase boundaries, with no disruption of articulatory processes. We test this prediction in a patient undergoing direct electrical stimulation mapping of the frontal aslant tract during an awake craniotomy to remove a left frontal brain tumor. We found that stimulation of the left FAT prolonged inter-word durations at the start of grammatical phrases, while inter-word durations internal to noun phrases were unaffected, and there was no effect on intra-word articulatory duration. These results provide initial support for the SCOPE hypothesis, and motivate novel directions for future research to explore the functions of this recently discovered component of the language system.
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Affiliation(s)
| | - Max H. Sims
- Department of Neurology, University of Rochester, USA
| | - Susan O. Smith
- Department of Neurosurgery, University of Rochester Medical Center, USA
| | | | - Bradford Z. Mahon
- Department of Psychology, Carnegie Mellon University, USA
- Department of Neurology, University of Rochester, USA
- Department of Neurosurgery, University of Rochester Medical Center, USA
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147
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Romanelli P, Piangerelli M, Ratel D, Gaude C, Costecalde T, Puttilli C, Picciafuoco M, Benabid A, Torres N. A novel neural prosthesis providing long-term electrocorticography recording and cortical stimulation for epilepsy and brain-computer interface. J Neurosurg 2019; 130:1166-1179. [PMID: 29749917 DOI: 10.3171/2017.10.jns17400] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 10/16/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Wireless technology is a novel tool for the transmission of cortical signals. Wireless electrocorticography (ECoG) aims to improve the safety and diagnostic gain of procedures requiring invasive localization of seizure foci and also to provide long-term recording of brain activity for brain-computer interfaces (BCIs). However, no wireless devices aimed at these clinical applications are currently available. The authors present the application of a fully implantable and externally rechargeable neural prosthesis providing wireless ECoG recording and direct cortical stimulation (DCS). Prolonged wireless ECoG monitoring was tested in nonhuman primates by using a custom-made device (the ECoG implantable wireless 16-electrode [ECOGIW-16E] device) containing a 16-contact subdural grid. This is a preliminary step toward large-scale, long-term wireless ECoG recording in humans. METHODS The authors implanted the ECOGIW-16E device over the left sensorimotor cortex of a nonhuman primate (Macaca fascicularis), recording ECoG signals over a time span of 6 months. Daily electrode impedances were measured, aiming to maintain the impedance values below a threshold of 100 KΩ. Brain mapping was obtained through wireless cortical stimulation at fixed intervals (1, 3, and 6 months). After 6 months, the device was removed. The authors analyzed cortical tissues by using conventional histological and immunohistological investigation to assess whether there was evidence of damage after the long-term implantation of the grid. RESULTS The implant was well tolerated; no neurological or behavioral consequences were reported in the monkey, which resumed his normal activities within a few hours of the procedure. The signal quality of wireless ECoG remained excellent over the 6-month observation period. Impedance values remained well below the threshold value; the average impedance per contact remains approximately 40 KΩ. Wireless cortical stimulation induced movements of the upper and lower limbs, and elicited fine movements of the digits as well. After the monkey was euthanized, the grid was found to be encapsulated by a newly formed dural sheet. The grid removal was performed easily, and no direct adhesions of the grid to the cortex were found. Conventional histological studies showed no cortical damage in the brain region covered by the grid, except for a single microscopic spot of cortical necrosis (not visible to the naked eye) in a region that had undergone repeated procedures of electrical stimulation. Immunohistological studies of the cortex underlying the grid showed a mild inflammatory process. CONCLUSIONS This preliminary experience in a nonhuman primate shows that a wireless neuroprosthesis, with related long-term ECoG recording (up to 6 months) and multiple DCSs, was tolerated without sequelae. The authors predict that epilepsy surgery could realize great benefit from this novel prosthesis, providing an extended time span for ECoG recording.
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Affiliation(s)
| | - Marco Piangerelli
- 2Computer Science Division, School of Science and Technology, University of Camerino, Italy; and
| | - David Ratel
- 3Biomedical Research Center, Polygone Scientifique Grenoble (CLINATEC Campus), University of Grenoble Alpes, Grenoble, France
| | - Christophe Gaude
- 3Biomedical Research Center, Polygone Scientifique Grenoble (CLINATEC Campus), University of Grenoble Alpes, Grenoble, France
| | - Thomas Costecalde
- 3Biomedical Research Center, Polygone Scientifique Grenoble (CLINATEC Campus), University of Grenoble Alpes, Grenoble, France
| | | | | | - Alim Benabid
- 3Biomedical Research Center, Polygone Scientifique Grenoble (CLINATEC Campus), University of Grenoble Alpes, Grenoble, France
| | - Napoleon Torres
- 3Biomedical Research Center, Polygone Scientifique Grenoble (CLINATEC Campus), University of Grenoble Alpes, Grenoble, France
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148
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Ries SK, Piai V, Perry D, Griffin S, Jordan K, Henry R, Knight RT, Berger MS. Roles of ventral versus dorsal pathways in language production: An awake language mapping study. BRAIN AND LANGUAGE 2019; 191:17-27. [PMID: 30769167 PMCID: PMC6402581 DOI: 10.1016/j.bandl.2019.01.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 01/09/2019] [Accepted: 01/09/2019] [Indexed: 06/09/2023]
Abstract
Human language is organized along two main processing streams connecting posterior temporal cortex and inferior frontal cortex in the left hemisphere, travelling dorsal and ventral to the Sylvian fissure. Some views propose a dorsal motor versus ventral semantic division. Others propose division by combinatorial mechanism, with the dorsal stream responsible for combining elements into a sequence and the ventral stream for forming semantic dependencies independent of sequential order. We acquired data from direct cortical stimulation in the left hemisphere in 17 neurosurgical patients and subcortical resection in a subset of 10 patients as part of awake language mapping. Two language tasks were employed: a sentence generation (SG) task tested the ability to form sequential and semantic dependencies, and a picture-word interference (PWI) task manipulated semantic interference. Results show increased error rates in the SG versus PWI task during subcortical testing in the dorsal stream territory, and high error rates in both tasks in the ventral stream territory. Connectivity maps derived from diffusion imaging and seeded in the tumor sites show that patients with more errors in the SG than in the PWI task had tumor locations associated with a dorsal stream connectivity pattern. Patients with the opposite pattern of results had tumor locations associated with a more ventral stream connectivity pattern. These findings provide initial evidence using fiber tract disruption with electrical stimulation that the dorsal pathways are critical for organizing words in a sequence necessary for sentence generation, and the ventral pathways are critical for processing semantic dependencies.
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Affiliation(s)
- S K Ries
- School of Speech, Language, and Hearing Sciences, San Diego State University, United States; Center for Clinical and Cognitive Neuroscience, San Diego State University, United States; Joint Doctoral Program in Language and Communicative Disorders, San Diego State University and University of California San Diego, United States.
| | - V Piai
- Radboud University, Donders Institute for Brain Cognition and Behaviour, Donders Centre for Cognition, Nijmegen, the Netherlands; Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Department of Medical Psychology, Nijmegen, the Netherlands
| | - D Perry
- University of California San Francisco, Department of Neurological Surgery, United States
| | - S Griffin
- University of California Berkeley, Department of Psychology and the Helen Wills Neuroscience Institute, United States
| | - K Jordan
- University of California San Francisco, Department of Neurology, United States; Joint Doctoral Program in Bioengineering, University of California San Francisco and Berkeley, United States
| | - R Henry
- University of California San Francisco, Department of Neurology, United States
| | - R T Knight
- University of California Berkeley, Department of Psychology and the Helen Wills Neuroscience Institute, United States
| | - M S Berger
- University of California San Francisco, Department of Neurological Surgery, United States
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149
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Van Patten R, Greif T, Britton K, Tremont G. Single-photon emission computed tomography (SPECT) perfusion and neuropsychological performance in mild cognitive impairment. J Clin Exp Neuropsychol 2019; 41:530-543. [PMID: 30880594 DOI: 10.1080/13803395.2019.1586838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Single-photon emission computed tomography (SPECT) is an affordable neuroimaging technique that measures cerebral perfusion and has been utilized repeatedly in aging populations. However, we are aware of no studies to date examining relationships between SPECT imaging and comprehensive neuropsychological evaluations in a clinical sample of patients with mild cognitive impairment (MCI). Participants were 124 older adults with MCI (age, M = 75.07 years, SD = 7.65; years of education, M = 14.03, SD = 3.09; 60.2% female) who underwent neuropsychological evaluations and brain SPECT scans as part of their routine clinical care. Based on SPECT interpretations, participants were grouped by suspected etiology (i.e., the neuroradiologists noted that hypoperfusion patterns were most consistent with Alzheimer's disease, AD; frontotemporal lobar degeneration, FTLD; or other disease processes) and regional hypoperfusion (e.g., frontal, temporal, right/left hemisphere). Neuropsychological tests were grouped into domain scores (i.e., attention/processing speed, language, visuospatial, memory, executive; verbal/nonverbal). Consistent with a priori predictions, patients with an AD pattern of hypoperfusion scored lower than comparison groups on the attention/processing speed (partial χ2 = 0.10) and memory (partial χ2 = 0.07) composites. More patients with the AD-hypoperfusion signal met criteria for amnestic MCI (82%) than did those with a non-AD pattern (70%); this result approached statistical significance (p = .07). Contrary to hypotheses, patients whose SPECT scans were most consistent with FTLD did not underperform on the executive composite, and most regional analyses were nonsignificant. When integrating SPECT data into their clinical conceptualizations of MCI, neuropsychologists should place more weight on AD patterns of hypoperfusion, while de-emphasizing data suggestive of FTLD or regional pathology. Alternative neurodiagnostic markers may be more informative in these instances.
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Affiliation(s)
- Ryan Van Patten
- a Department of Psychiatry and Human Behavior, Warren Alpert Medical School , Brown University , Providence , RI , USA.,b Department of Psychiatry , Unviersity of California-San Diego , San Diego , CA , USA
| | - Taylor Greif
- c Department of Psychology , Saint Louis University , St. Louis , MO , USA
| | - Karysa Britton
- d Neuropsychology Program , Rhode Island Hospital , Providence , RI , USA
| | - Geoffrey Tremont
- a Department of Psychiatry and Human Behavior, Warren Alpert Medical School , Brown University , Providence , RI , USA.,d Neuropsychology Program , Rhode Island Hospital , Providence , RI , USA
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150
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Sarubbo S, Petit L, De Benedictis A, Chioffi F, Ptito M, Dyrby TB. Uncovering the inferior fronto-occipital fascicle and its topological organization in non-human primates: the missing connection for language evolution. Brain Struct Funct 2019; 224:1553-1567. [PMID: 30847641 DOI: 10.1007/s00429-019-01856-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 02/27/2019] [Indexed: 01/19/2023]
Abstract
Whether brain networks underlying the multimodal processing of language in humans are present in non-human primates is an unresolved question in primate evolution. Conceptual awareness in humans, which is the backbone of verbal and non-verbal semantic elaboration, involves intracerebral connectivity via the inferior fronto-occipital fascicle (IFOF). While non-human primates can communicate through visual information channels, there has been no formal demonstration that they possess a functional homologue of the human IFOF. Therefore, we undertook a post-mortem diffusion MRI tractography study in conjunction with Klingler micro-dissection to search for IFOF fiber tracts in brain of Old-World (vervet) monkeys. We found clear and concordant evidence from both techniques for the existence of bilateral fiber tracts connecting the frontal and occipital lobes. These tracts closely resembled the human IFOF with respect to trajectory, topological organization, and cortical terminal fields. Moreover, these fibers are clearly distinct from other bundles previously described in this region of monkey brain, i.e., the inferior longitudinal and uncinate fascicles, and the external and extreme capsules. This demonstration of an IFOF in brain of a species that diverged from the human lineage some 22 millions years ago enhances our comprehension about the evolution of language and social behavior.
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Affiliation(s)
- Silvio Sarubbo
- Division of Neurosurgery, Structural and Functional Connectivity Lab Project, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), 38122, Trento, Italy.
| | - Laurent Petit
- Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives, UMR 5293, CNRS, CEA University of Bordeaux, Bordeaux, France
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy
| | - Franco Chioffi
- Division of Neurosurgery, Structural and Functional Connectivity Lab Project, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), 38122, Trento, Italy
| | - Maurice Ptito
- École d'optométrie, Université de Montréal, Montreal, QC, Canada
| | - Tim B Dyrby
- Danish Research Centre for Magnetic Resonance, Center for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark
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