201
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Zanin E, Riva M, Bambini V, Cappa SF, Magrassi L, Moro A. The contribution of surgical brain mapping to the understanding of the anatomo-functional basis of syntax: A critical review. Neurol Sci 2017. [PMID: 28624915 DOI: 10.1007/s10072-017-3016-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A wide range of studies on language assessment during awake brain surgery is nowadays available. Yet, a consensus on a standardized protocol for intraoperative language mapping is still lacking. More specifically, very limited information is offered about intraoperative assessment of a crucial component of language such as syntax. This review aims at critically analyzing the intraoperative studies investigating the cerebral basis of syntactic processing. A comprehensive query was performed on the literature, returning a total of 18 studies. These papers were analyzed according to two complementary criteria, based on the distinction between morphosyntax and syntax. The first criterion focused on the tasks and stimuli employed intraoperatively. Studies were divided into three different groups: group 1 included those studies that overtly aimed at investigating morphosyntactic processes; group 2 included studies that did not explicitly focus on syntax, yet employed stimuli requiring morphosyntactic processing; and group 3 included studies reporting some generic form of syntactic deficit, although not further investigated. The second criterion focused on the syntactic structures of the sentences assessed intraoperatively, analyzing the canonicity of sentence structure (i.e., canonical versus non-canonical word order). The global picture emerging from our analysis indicates that what was investigated in the intraoperative literature is morphosyntactic processing, rather than pure syntax. The study of the neurobiology of syntax during awake surgery seems thus to be still at an early stage, in need of systematic, linguistically grounded investigations.
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Affiliation(s)
- Elia Zanin
- Neurocognition, Epistemogy and Theoretical Syntax Research Center (NETS), Scuola Universitaria Superiore IUSS Pavia, Piazza della Vittoria, 15, 27100, Pavia, Italy.
| | - Marco Riva
- Unit of Oncological Neurosurgery, Humanitas Research Hospital, 20089 Rozzano, Milan, Italy
| | - Valentina Bambini
- Neurocognition, Epistemogy and Theoretical Syntax Research Center (NETS), Scuola Universitaria Superiore IUSS Pavia, Piazza della Vittoria, 15, 27100, Pavia, Italy
| | - Stefano F Cappa
- Neurocognition, Epistemogy and Theoretical Syntax Research Center (NETS), Scuola Universitaria Superiore IUSS Pavia, Piazza della Vittoria, 15, 27100, Pavia, Italy.,IRCCS S. Cuore Fatebenefratelli, 25125, Brescia, Italy
| | - Lorenzo Magrassi
- Neurocognition, Epistemogy and Theoretical Syntax Research Center (NETS), Scuola Universitaria Superiore IUSS Pavia, Piazza della Vittoria, 15, 27100, Pavia, Italy.,Neurosurgery - Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100, Pavia, Italy.,Istituto di Genetica Molecolare - Consiglio Nazionale delle Ricerche, 27100, Pavia, Italy
| | - Andrea Moro
- Neurocognition, Epistemogy and Theoretical Syntax Research Center (NETS), Scuola Universitaria Superiore IUSS Pavia, Piazza della Vittoria, 15, 27100, Pavia, Italy
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202
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Groshev A, Padalia D, Patel S, Garcia-Getting R, Sahebjam S, Forsyth PA, Vrionis FD, Etame AB. Clinical outcomes from maximum-safe resection of primary and metastatic brain tumors using awake craniotomy. Clin Neurol Neurosurg 2017; 157:25-30. [DOI: 10.1016/j.clineuro.2017.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 03/03/2017] [Accepted: 03/18/2017] [Indexed: 10/19/2022]
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203
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Berger M. Foreword. Neurochirurgie 2017. [DOI: 10.1016/j.neuchi.2016.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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204
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Mauler J, Neuner I, Neuloh G, Fimm B, Boers F, Wiesmann M, Clusmann H, Langen KJ, Shah NJ. Dissociated Crossed Speech Areas in a Tumour Patient. Case Rep Neurol 2017. [PMID: 28626411 PMCID: PMC5471772 DOI: 10.1159/000475882] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In the past, the eloquent areas could be deliberately localised by the invasive Wada test. The very rare cases of dissociated crossed speech areas were accidentally found based on the clinical symptomatology. Today functional magnetic resonance imaging (fMRI)-based imaging can be employed to non-invasively localise the eloquent areas in brain tumour patients for therapy planning. A 41-year-old, left-handed man with a low-grade glioma in the left frontal operculum extending to the insular cortex, tension headaches, and anomic aphasia over 5 months underwent a pre-operative speech area localisation fMRI measurement, which revealed the evidence of the transhemispheric disposition, where the dominant Wernicke speech area is located on the left and the Broca's area is strongly lateralised to the right hemisphere. The outcome of the Wada test and the intraoperative cortico-subcortical stimulation mapping were congruent with this finding. After tumour removal, language area function was fully preserved. Upon the occurrence of brain tumours with a risk of impaired speech function, the rare dissociate crossed speech areas disposition may gain a clinically relevant meaning by allowing for more extended tumour removal. Hence, for its identification, diagnostics which take into account both brain hemispheres, such as fMRI, are recommended.
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Affiliation(s)
- Jörg Mauler
- Institute of Neuroscience and Medicine-4, Forschungszentrum Jülich, Jülich, Germany
| | - Irene Neuner
- Institute of Neuroscience and Medicine-4, Forschungszentrum Jülich, Jülich, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Georg Neuloh
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
| | - Bruno Fimm
- Department of Neurology, RWTH Aachen University, Aachen, Germany
| | - Frank Boers
- Institute of Neuroscience and Medicine-4, Forschungszentrum Jülich, Jülich, Germany
| | - Martin Wiesmann
- Department of Neuroradiology, RWTH Aachen University, Aachen, Germany
| | - Hans Clusmann
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine-4, Forschungszentrum Jülich, Jülich, Germany.,Jülich Aachen Research Alliance (JARA) - Translational Brain Medicine, Aachen and Jülich, Germany.,Department of Nuclear Medicine, RWTH Aachen University, Aachen, Germany
| | - N Jon Shah
- Institute of Neuroscience and Medicine-4, Forschungszentrum Jülich, Jülich, Germany.,Department of Neurology, RWTH Aachen University, Aachen, Germany.,Jülich Aachen Research Alliance (JARA) - Translational Brain Medicine, Aachen and Jülich, Germany
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205
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Torlay L, Perrone-Bertolotti M, Thomas E, Baciu M. Machine learning-XGBoost analysis of language networks to classify patients with epilepsy. Brain Inform 2017; 4:159-169. [PMID: 28434153 PMCID: PMC5563301 DOI: 10.1007/s40708-017-0065-7] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 04/13/2017] [Indexed: 11/30/2022] Open
Abstract
Our goal was to apply a statistical approach to allow the identification of atypical language patterns and to differentiate patients with epilepsy from healthy subjects, based on their cerebral activity, as assessed by functional MRI (fMRI). Patients with focal epilepsy show reorganization or plasticity of brain networks involved in cognitive functions, inducing ‘atypical’ (compared to ‘typical’ in healthy people) brain profiles. Moreover, some of these patients suffer from drug-resistant epilepsy, and they undergo surgery to stop seizures. The neurosurgeon should only remove the zone generating seizures and must preserve cognitive functions to avoid deficits. To preserve functions, one should know how they are represented in the patient’s brain, which is in general different from that of healthy subjects. For this purpose, in the pre-surgical stage, robust and efficient methods are required to identify atypical from typical representations. Given the frequent location of regions generating seizures in the vicinity of language networks, one important function to be considered is language. The risk of language impairment after surgery is determined pre-surgically by mapping language networks. In clinical settings, cognitive mapping is classically performed with fMRI. The fMRI analyses allowing the identification of atypical patterns of language networks in patients are not sufficiently robust and require additional statistic approaches. In this study, we report the use of a statistical nonlinear machine learning classification, the Extreme Gradient Boosting (XGBoost) algorithm, to identify atypical patterns and classify 55 participants as healthy subjects or patients with epilepsy. XGBoost analyses were based on neurophysiological features in five language regions (three frontal and two temporal) in both hemispheres and activated with fMRI for a phonological (PHONO) and a semantic (SEM) language task. These features were combined into 135 cognitively plausible subsets and further submitted to selection and binary classification. Classification performance was scored with the Area Under the receiver operating characteristic curve (AUC). Our results showed that the subset SEM_LH BA_47-21 (left fronto-temporal activation induced by the SEM task) provided the best discrimination between the two groups (AUC of 91 ± 5%). The results are discussed in the framework of the current debates of language reorganization in focal epilepsy.
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Affiliation(s)
- L Torlay
- CNRS LPNC UMR 5105, Univ. Grenoble Alpes, 380000, Grenoble, France
| | | | - E Thomas
- Laboratoire INSERM U1093, Université de Bourgogne, 21000, Dijon, France
| | - M Baciu
- CNRS LPNC UMR 5105, Univ. Grenoble Alpes, 380000, Grenoble, France.
- LPNC, UMR CNRS 5105, BSHM, Université Pierre Mendès-France, BP 47, 38040, Grenoble Cedex 09, France.
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206
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Katlowitz KA, Oya H, Howard MA, Greenlee JDW, Long MA. Paradoxical vocal changes in a trained singer by focally cooling the right superior temporal gyrus. Cortex 2017; 89:111-119. [PMID: 28282570 PMCID: PMC5421518 DOI: 10.1016/j.cortex.2017.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/26/2016] [Accepted: 01/30/2017] [Indexed: 11/24/2022]
Abstract
The production and perception of music is preferentially mediated by cortical areas within the right hemisphere, but little is known about how these brain regions individually contribute to this process. In an experienced singer undergoing awake craniotomy, we demonstrated that direct electrical stimulation to a portion of the right posterior superior temporal gyrus (pSTG) selectively interrupted singing but not speaking. We then focally cooled this region to modulate its activity during vocalization. In contrast to similar manipulations in left hemisphere speech production regions, pSTG cooling did not elicit any changes in vocal timing or quality. However, this manipulation led to an increase in the pitch of speaking with no such change in singing. Further analysis revealed that all vocalizations exhibited a cooling-induced increase in the frequency of the first formant, raising the possibility that potential pitch offsets may have been actively avoided during singing. Our results suggest that the right pSTG plays a key role in vocal sensorimotor processing whose impact is dependent on the type of vocalization produced.
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Affiliation(s)
- Kalman A Katlowitz
- NYU Neuroscience Institute, New York University Langone Medical Center, New York, NY, USA; Department of Otolaryngology, New York University Langone Medical Center, New York, NY, USA; Center for Neural Science, New York University, New York, NY, USA
| | - Hiroyuki Oya
- Human Brain Research Lab, Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Matthew A Howard
- Human Brain Research Lab, Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Jeremy D W Greenlee
- Human Brain Research Lab, Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Michael A Long
- NYU Neuroscience Institute, New York University Langone Medical Center, New York, NY, USA; Department of Otolaryngology, New York University Langone Medical Center, New York, NY, USA; Center for Neural Science, New York University, New York, NY, USA.
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207
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Papagno C, Comi A, Riva M, Bizzi A, Vernice M, Casarotti A, Fava E, Bello L. Mapping the brain network of the phonological loop. Hum Brain Mapp 2017; 38:3011-3024. [PMID: 28321956 DOI: 10.1002/hbm.23569] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 02/15/2017] [Accepted: 03/05/2017] [Indexed: 11/08/2022] Open
Abstract
The cortical and subcortical neural correlates underlying item and order information in verbal short-term memory (STM) were investigated by means of digit span in 29 patients with direct electrical stimulation during awake surgery for removal of a neoplastic lesion. Stimulation of left Broca's area interfered with span, producing significantly more item than order errors, as compared to the stimulation of the supramarginal/angular gyrus, which also interfered with span but, conversely, produced more order than item errors. Similarly, stimulation of the third segment of the left superior longitudinal fasciculus (SLF-III), also known as anterior segment of the arcuate fascicle (AF), produced more order than item errors. Therefore, we obtained two crucial results: first, we were able to distinguish between content and order information storage. Second, we demonstrated that the SLF-III is involved in transferring order information from Geschwind's area to Broca's area. In a few patients, we demonstrated that also order information of nonverbal material was disrupted by left supramarginal gyrus stimulation. Order information is thus likely stored in the supramarginal gyrus, possibly independently from the nature of the material. Hum Brain Mapp 38:3011-3024, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Costanza Papagno
- Dipartimento di Psicologia, Università di Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milano, 20126, Italy.,CIMeC and CeRiN, University of Trento and Rovereto, Rovereto, 38068, Italy
| | - Alessandro Comi
- Dipartimento di Psicologia, Università di Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milano, 20126, Italy
| | - Marco Riva
- Unit of Oncological Neurosurgery, Humanitas Research Hospital, via Manzoni 56, Rozzano, MI, 20089, Italy
| | - Alberto Bizzi
- Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Celoria 11, Milano, MI, 20133, Italy
| | - Mirta Vernice
- Dipartimento di Psicologia, Università di Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milano, 20126, Italy
| | - Alessandra Casarotti
- Unit of Oncological Neurosurgery, Humanitas Research Hospital, via Manzoni 56, Rozzano, MI, 20089, Italy
| | - Enrica Fava
- Unit of Oncological Neurosurgery, Humanitas Research Hospital, via Manzoni 56, Rozzano, MI, 20089, Italy
| | - Lorenzo Bello
- Unit of Oncological Neurosurgery, Humanitas Research Hospital, via Manzoni 56, Rozzano, MI, 20089, Italy.,Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, via Festa del Perdono 7, Milano, 20122, Italy
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208
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Riquin E, Dinomais M, Malka J, Lehousse T, Duverger P, Menei P, Delion M. Psychiatric and Psychologic Impact of Surgery While Awake in Children for Resection of Brain Tumors. World Neurosurg 2017; 102:400-405. [PMID: 28300707 DOI: 10.1016/j.wneu.2017.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/03/2017] [Accepted: 03/04/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intraoperative direct stimulation during surgery while awake is considered to be the gold standard for identifying eloquent cortical sites. Only a few studies have referenced the psychologic impact of this event in the pediatric population. OBJECTIVE The aim of this clinical study is to present the psychologic aspects of surgery while awake in children. We question the psychiatric contraindications and age limits, as well as the impact on children, with particular attention to the psychologic conditioning and experience of these patients. METHODS Seven patients aged 8-16 years old with brain lesions were operated on while awake between 2008 and 2015. Data collected included perception and memories of surgery and diagnosis and also their real-life experience after surgery. Symptoms of posttraumatic stress disorder or acute stress were investigated. RESULTS None of the children had initial psychiatric problems. No psychiatric diagnosis was made before surgery. The child psychiatrist did not contraindicate any child for this procedure. Patients experienced little anticipatory anxiety. No child presented symptoms of posttraumatic stress disorder or acute stress. CONCLUSIONS The results are encouraging, allowing us to contemplate using brain surgery while awake for children without particular worries about the psychologic aspect.
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Affiliation(s)
- Elise Riquin
- Department of Child and Adolescent Psychiatry, University Hospital of Angers, Angers, France.
| | - Mickael Dinomais
- Physical and Rehabilitation Medicine, University Hospital of Angers, Angers, France
| | - Jean Malka
- Department of Child and Adolescent Psychiatry, University Hospital of Angers, Angers, France
| | - Thierry Lehousse
- Department of Anesthesiology, University Hospital of Angers, Angers, France
| | - Philippe Duverger
- Department of Child and Adolescent Psychiatry, University Hospital of Angers, Angers, France
| | - Philippe Menei
- Department of Neurosurgery, University Hospital of Angers, Angers, France
| | - Matthieu Delion
- Department of Neurosurgery, University Hospital of Angers, Angers, France; Anatomy Laboratory, LUNAM, University of Angers, Angers, France
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209
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Anesthesia for awake craniotomy: a how-to guide for the occasional practitioner. Can J Anaesth 2017; 64:517-529. [DOI: 10.1007/s12630-017-0840-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 12/15/2016] [Accepted: 01/31/2017] [Indexed: 12/24/2022] Open
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210
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Kajić I, Gosmann J, Stewart TC, Wennekers T, Eliasmith C. A Spiking Neuron Model of Word Associations for the Remote Associates Test. Front Psychol 2017; 8:99. [PMID: 28210234 PMCID: PMC5288385 DOI: 10.3389/fpsyg.2017.00099] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 01/16/2017] [Indexed: 11/13/2022] Open
Abstract
Generating associations is important for cognitive tasks including language acquisition and creative problem solving. It remains an open question how the brain represents and processes associations. The Remote Associates Test (RAT) is a task, originally used in creativity research, that is heavily dependent on generating associations in a search for the solutions to individual RAT problems. In this work we present a model that solves the test. Compared to earlier modeling work on the RAT, our hybrid (i.e., non-developmental) model is implemented in a spiking neural network by means of the Neural Engineering Framework (NEF), demonstrating that it is possible for spiking neurons to be organized to store the employed representations and to manipulate them. In particular, the model shows that distributed representations can support sophisticated linguistic processing. The model was validated on human behavioral data including the typical length of response sequences and similarity relationships in produced responses. These data suggest two cognitive processes that are involved in solving the RAT: one process generates potential responses and a second process filters the responses.
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Affiliation(s)
- Ivana Kajić
- School of Computing, Electronics and Mathematics, University of PlymouthPlymouth, UK
- Centre for Theoretical Neuroscience, University of WaterlooWaterloo, ON, Canada
| | - Jan Gosmann
- Centre for Theoretical Neuroscience, University of WaterlooWaterloo, ON, Canada
| | - Terrence C. Stewart
- Centre for Theoretical Neuroscience, University of WaterlooWaterloo, ON, Canada
| | - Thomas Wennekers
- School of Computing, Electronics and Mathematics, University of PlymouthPlymouth, UK
| | - Chris Eliasmith
- Centre for Theoretical Neuroscience, University of WaterlooWaterloo, ON, Canada
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211
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Successful Insular Glioma Removal in a Deaf Signer Patient During an Awake Craniotomy Procedure. World Neurosurg 2017; 98:883.e1-883.e5. [DOI: 10.1016/j.wneu.2016.08.098] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/20/2016] [Accepted: 08/23/2016] [Indexed: 11/20/2022]
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212
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Shimada S, Kunii N, Kawai K, Matsuo T, Ishishita Y, Ibayashi K, Saito N. Impact of volume-conducted potential in interpretation of cortico-cortical evoked potential: Detailed analysis of high-resolution electrocorticography using two mathematical approaches. Clin Neurophysiol 2017; 128:549-557. [PMID: 28226289 DOI: 10.1016/j.clinph.2017.01.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/22/2016] [Accepted: 01/15/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Cortico-cortical evoked potential (CCEP) has been utilized to evaluate connectivity between cortices. However, previous reports have rarely referred to the impact of volume-conducted potential (VCP) which must be a confounding factor of large potential around the stimulation site. To address this issue, we challenged the null hypothesis that VCP accounts for the majority of the recorded potential, particularly around the stimulation site. METHODS CCEP was recorded with high-density intracranial electrodes in 8 patients with intractable epilepsy. First, we performed regression analysis for describing the relationship between the distance and potential of each electrode. Second, we performed principal component analysis (PCA) to reveal the temporal features of recorded waveforms. RESULTS The regression curve, declining by the inverse square of the distance, fitted tightly to the plots (R2: 0.878-0.991) with outliers. PCA suggested the responses around the stimulation site had the same temporal features. We also observed the continuous declination over the anatomical gap and the phase reversal phenomena around the stimulation site. CONCLUSIONS These results were consistent with the null hypothesis. SIGNIFICANCE This study highlighted the risk of misinterpreting CCEP mapping, and proposed mathematical removal of VCP, which could lead to more reliable mapping based on CCEP.
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Affiliation(s)
- Seijiro Shimada
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Naoto Kunii
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Kensuke Kawai
- Department of Neurosurgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Takeshi Matsuo
- Department of Neurosurgery, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Yohei Ishishita
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kenji Ibayashi
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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213
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Pinto Y, Neville DA, Otten M, Corballis PM, Lamme VAF, de Haan EHF, Foschi N, Fabri M. Split brain: divided perception but undivided consciousness. Brain 2017; 140:1231-1237. [DOI: 10.1093/brain/aww358] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 11/30/2016] [Indexed: 11/12/2022] Open
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214
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Preoperative rTMS Language Mapping in Speech-Eloquent Brain Lesions Resected Under General Anesthesia: A Pair-Matched Cohort Study. World Neurosurg 2017; 100:425-433. [PMID: 28109861 DOI: 10.1016/j.wneu.2017.01.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The value of preoperative repetitive transcranial magnetic stimulation (rTMS) language mapping for function preservation in surgery of speech-eloquent lesions under general anesthesia remains to be determined. METHODS We prospectively enrolled 20 consecutive right-handed patients with a malignant, left-sided perisylvian language-eloquent brain tumor. All patients were subjected to surgical resection under general anesthesia guided by preoperative rTMS language mapping (rTMS group, 2014-2016). A matched-pair analysis with 20 patients who also underwent surgical resection under general anesthesia in the pre-rTMS era (pre-rTMS group, 2009-2013) was performed. Language performance status was ranked from grade 0 to grade 3 (none, mild, medium, severe). RESULTS Rates of gross total resection, tumor residual, and complications were equal in both groups. Duration of surgery (P = 0.039) and inpatient stay (P = 0.001) were significantly shorter in the rTMS group. Preoperatively, 14 patients in the rTMS and 13 patients in the pre-rTMS group had language deficits (P = 0.380). One week after surgery, 8/14 patients (57.1%) in the rTMS group but only 1/13 patients (7.7%) in the pre-rTMS group experienced improvement of language performance status (P = 0.013). At 6 weeks follow-up, language performance status was significantly better in the rTMS group (P = 0.048). However, at 3 months follow-up, the rTMS and pre-rTMS groups showed an equal language performance status. CONCLUSIONS Implementation of preoperative rTMS language mapping seems to provide a favorable early language outcome in patients undergoing surgical resection of language-eloquent lesions under general anesthesia.
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215
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Chang EF, Breshears JD, Raygor KP, Lau D, Molinaro AM, Berger MS. Stereotactic probability and variability of speech arrest and anomia sites during stimulation mapping of the language dominant hemisphere. J Neurosurg 2017; 126:114-121. [DOI: 10.3171/2015.10.jns151087] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Functional mapping using direct cortical stimulation is the gold standard for the prevention of postoperative morbidity during resective surgery in dominant-hemisphere perisylvian regions. Its role is necessitated by the significant interindividual variability that has been observed for essential language sites. The aim in this study was to determine the statistical probability distribution of eliciting aphasic errors for any given stereotactically based cortical position in a patient cohort and to quantify the variability at each cortical site.
METHODS
Patients undergoing awake craniotomy for dominant-hemisphere primary brain tumor resection between 1999 and 2014 at the authors' institution were included in this study, which included counting and picture-naming tasks during dense speech mapping via cortical stimulation. Positive and negative stimulation sites were collected using an intraoperative frameless stereotactic neuronavigation system and were converted to Montreal Neurological Institute coordinates. Data were iteratively resampled to create mean and standard deviation probability maps for speech arrest and anomia. Patients were divided into groups with a “classic” or an “atypical” location of speech function, based on the resultant probability maps. Patient and clinical factors were then assessed for their association with an atypical location of speech sites by univariate and multivariate analysis.
RESULTS
Across 102 patients undergoing speech mapping, the overall probabilities of speech arrest and anomia were 0.51 and 0.33, respectively. Speech arrest was most likely to occur with stimulation of the posterior inferior frontal gyrus (maximum probability from individual bin = 0.025), and variance was highest in the dorsal premotor cortex and the posterior superior temporal gyrus. In contrast, stimulation within the posterior perisylvian cortex resulted in the maximum mean probability of anomia (maximum probability = 0.012), with large variance in the regions surrounding the posterior superior temporal gyrus, including the posterior middle temporal, angular, and supramarginal gyri. Patients with atypical speech localization were far more likely to have tumors in canonical Broca's or Wernicke's areas (OR 7.21, 95% CI 1.67–31.09, p < 0.01) or to have multilobar tumors (OR 12.58, 95% CI 2.22–71.42, p < 0.01), than were patients with classic speech localization.
CONCLUSIONS
This study provides statistical probability distribution maps for aphasic errors during cortical stimulation mapping in a patient cohort. Thus, the authors provide an expected probability of inducing speech arrest and anomia from specific 10-mm2 cortical bins in an individual patient. In addition, they highlight key regions of interindividual mapping variability that should be considered preoperatively. They believe these results will aid surgeons in their preoperative planning of eloquent cortex resection.
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Affiliation(s)
- Edward F. Chang
- Departments of 1Neurological Surgery,
- 2Physiology, and
- 3Center for Integrative Neuroscience, University of California, San Francisco; and
- 4Center for Neural Engineering and Prostheses, University of California, Berkeley, and University of California, San Francisco, California
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216
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Multi-factorial modulation of hemispheric specialization and plasticity for language in healthy and pathological conditions: A review. Cortex 2017; 86:314-339. [DOI: 10.1016/j.cortex.2016.05.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/16/2016] [Accepted: 05/13/2016] [Indexed: 12/16/2022]
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217
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Parker Jones O, Voets NL, Adcock JE, Stacey R, Jbabdi S. Resting connectivity predicts task activation in pre-surgical populations. NEUROIMAGE-CLINICAL 2016; 13:378-385. [PMID: 28123949 PMCID: PMC5222953 DOI: 10.1016/j.nicl.2016.12.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/26/2016] [Accepted: 12/22/2016] [Indexed: 12/02/2022]
Abstract
Injury and disease affect neural processing and increase individual variations in patients when compared with healthy controls. Understanding this increased variability is critical for identifying the anatomical location of eloquent brain areas for pre-surgical planning. Here we show that precise and reliable language maps can be inferred in patient populations from resting scans of idle brain activity. We trained a predictive model on pairs of resting-state and task-evoked data and tested it to predict activation of unseen patients and healthy controls based on their resting-state data alone. A well-validated language task (category fluency) was used in acquiring the task-evoked fMRI data. Although patients showed greater variation in their actual language maps, our models successfully learned variations in both patient and control responses from the individual resting-connectivity features. Importantly, we further demonstrate that a model trained exclusively on the more-homogenous control group can be used to predict task activations in patients. These results are the first to show that resting connectivity robustly predicts individual differences in neural response in cases of pathological variability. A method for identifying eloquent areas in the brain from resting fMRI is proposed. It uses supervised learning to predict task contrasts from resting connectivity. Good predictions were obtained in controls and in pre-surgical patient populations. Patient diagnoses included epilepsy, tumours, and vascular lesions. Language maps in patients could be predicted from models trained on controls.
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Affiliation(s)
- O Parker Jones
- FMRIB Centre, NDCN, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
| | - N L Voets
- FMRIB Centre, NDCN, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK; Oxford Epilepsy Research Group, NDCN, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - J E Adcock
- Oxford Epilepsy Research Group, NDCN, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK; Department of Neurology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
| | - R Stacey
- Department of Neurosurgery, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
| | - S Jbabdi
- FMRIB Centre, NDCN, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
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218
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A contemporary framework of language processing in the human brain in the context of preoperative and intraoperative language mapping. Neuroradiology 2016; 59:69-87. [PMID: 28005160 DOI: 10.1007/s00234-016-1772-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 12/05/2016] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The emergence of advanced in vivo neuroimaging methods has redefined the understanding of brain function with a shift from traditional localizationist models to more complex and widely distributed neural networks. In human language processing, the traditional localizationist models of Wernicke and Broca have fallen out of favor for a dual-stream processing system involving complex networks organized over vast areas of the dominant hemisphere. The current review explores the cortical function and white matter connections of human language processing, as well as their relevance to surgical planning. METHODS We performed a systematic review of the literature with narrative data analysis. RESULTS Although there is significant heterogeneity in the literature over the past century of exploration, modern evidence provides new insight into the true cortical function and white matter anatomy of human language. Intraoperative data and postoperative outcome studies confirm a widely distributed language network extending far beyond the traditional cortical areas of Wernicke and Broca. CONCLUSIONS The anatomic distribution of language networks, based on current theories, is explored to present a modern and clinically relevant interpretation of language function. Within this framework, we present current knowledge regarding the known effects of damage to both cortical and subcortical components of these language networks. Ideally, we hope this framework will provide a common language for which to base future clinical studies in human language function.
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219
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Winawer J, Parvizi J. Linking Electrical Stimulation of Human Primary Visual Cortex, Size of Affected Cortical Area, Neuronal Responses, and Subjective Experience. Neuron 2016; 92:1213-1219. [PMID: 27939584 PMCID: PMC5182175 DOI: 10.1016/j.neuron.2016.11.008] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 10/28/2016] [Accepted: 11/01/2016] [Indexed: 01/23/2023]
Abstract
Electrical brain stimulation (EBS) complements neural measurements by probing the causal relationship between brain and perception, cognition, and action. Many fundamental questions about EBS remain unanswered, including the spatial extent of cortex responsive to stimulation, and the relationship between the circuitry engaged by EBS and the types of neural responses elicited by sensory stimulation. Here, we measured neural responses and the effects of EBS in primary visual cortex in four patients implanted with intracranial electrodes. Using stimulation, behavior, and retinotopic mapping, we show the relationship between the size of affected cortical area and the magnitude of electrical charge. Furthermore, we show that the spatial location of electrically induced visual sensations is matched to the receptive field of the cortical site measured with broadband field potentials, and less so with event related potentials. Together, these findings broaden our knowledge about the mechanism of EBS and the neuromodulation of the human brain.
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Affiliation(s)
- Jonathan Winawer
- New York University, New York, NY 10003, USA; Stanford Human Intracranial Cognitive Electrophysiology Program (SHICEP), Stanford, CA 94305, USA.
| | - Josef Parvizi
- Stanford University, Stanford, CA 94305, USA; Stanford Human Intracranial Cognitive Electrophysiology Program (SHICEP), Stanford, CA 94305, USA.
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220
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Mathias RN, de Aguiar PHP, da Luz Oliveira EP, Verst SM, Vieira V, Docema MF, Calfat Maldaun MV. "Next Door" intraoperative magnetic resonance imaging for awake craniotomy: Preliminary experience and technical note. Surg Neurol Int 2016; 7:S1021-S1027. [PMID: 28144477 PMCID: PMC5234280 DOI: 10.4103/2152-7806.195587] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 10/12/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND During glioma surgery "maximal safe resection" must be the main goal. Intraoperative magnetic resonance imaging (iMRI) associated with awake craniotomy (AC) is a valuable tool to achieve this objective. In this article, AC with a "next-door" iMRI concept is described in a stepwise protocol. METHODS This is a retrospective analysis of 18 patients submitted to AC using iMRI; a stepwise protocol is also discussed. RESULTS The mean age was 41.7 years. Hemiparesis, aphasia, and seizures were the main initial symptoms of the patients. Sixty-six percent of the tumors were located in the left hemisphere. All tumors were near or within eloquent areas. Fifty-three percent of the cases were glioblastomas multiforme and 47% of the patients had low grade gliomas. The mean surgical time and iMRI time were 4 h 4 min and 30 min, respectively. New resection was performed in 33% after iMRI. Extent of resection (EOR) higher than 95% was possible in 66.7% of the patients. The main reason of EOR lower than 95% was positive mapping of eloquent areas (6 patients). Eighty percent of the patients experienced improvement of their deficits immediately after the surgery or had a stable clinical status whereas 20% had neurological deterioration, however, all of them improved after 30 days. CONCLUSION AC associated with "next-door" iMRI is a complex procedure, but if performed using a meticulous technique, it may improve the overall tumor resection and safety of the patients.
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Affiliation(s)
- Roger Neves Mathias
- Neurosurgery Division, State University of Campinas, Unicamp, Sírio-Libranês, Brazil; Neurosurgery Division, Sírio-Libranês Hospital, Sírio-Libranês, Brazil
| | - Paulo Henrique Pires de Aguiar
- Neurosurgery Division, Sírio-Libranês Hospital, Sírio-Libranês, Brazil; Neurosurgery Division, Santa Paula Hospital, Santa Paula, USA
| | | | | | - Vinícius Vieira
- Department of Anesthesiology, Sírio-Libranês Hospital, Sírio-Libranês, Brazil
| | | | - Marcos Vinícius Calfat Maldaun
- Neurosurgery Division, State University of Campinas, Unicamp, Sírio-Libranês, Brazil; Neurosurgery Division, Sírio-Libranês Hospital, Sírio-Libranês, Brazil; Neurosurgery Division, Santa Paula Hospital, Santa Paula, USA
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221
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Kadri PAS, de Oliveira JG, Krayenbühl N, Türe U, de Oliveira EPL, Al-Mefty O, Ribas GC. Surgical Approaches to the Temporal Horn: An Anatomic Analysis of White Matter Tract Interruption. Oper Neurosurg (Hagerstown) 2016; 13:258-270. [DOI: 10.1093/ons/opw011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 10/20/2016] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND: Surgical access to the temporal horn is necessary to treat tumors and vascular lesions, but is used mainly in patients with mediobasal temporal epilepsy. The surgical approaches to this cavity fall into 3 primary categories: lateral, inferior, and transsylvian. The current neurosurgical literature has underestimated the interruption of involved fiber bundles and the correlated clinical manifestations.
OBJECTIVE: To delineate the interruption of fiber bundles during the different approaches to the temporal horn.
METHODS: We simulated the lateral (trans-middle temporal gyrus), inferior (transparahippocampal gyrus), and transsylvian approaches in 20 previously frozen, formalin-fixed human brains (40 hemispheres). Fiber dissection was then done along the lateral and inferior aspects under the operating microscope. Each stage of dissection and its respective fiber tract interruption were defined.
RESULTS: The lateral (trans-middle temporal gyrus) approach interrupted “U” fibers, the superior longitudinal fasciculus (inferior arm), occipitofrontal fasciculus (ventral segment), uncinate fasciculus (dorsolateral segment), anterior commissure (posterior segment), temporopontine, inferior thalamic peduncle (posterior fibers), posterior thalamic peduncle (anterior portion), and tapetum fibers. The inferior (transparahippocampal gyrus) approach interrupted “U” fibers, the cingulum (inferior arm), and fimbria, and transected the hippocampal formation. The transsylvian approach interrupted “U” fibers (anterobasal region of the extreme capsule), the uncinate fasciculus (ventromedial segment), and anterior commissure (anterior segment), and transected the anterosuperior aspect of the amygdala.
CONCLUSION: White matter dissection improves our knowledge of the complex anatomy surrounding the temporal horn. Identifying the fiber bundles at risk during each surgical approach adds important information for choosing the appropriate surgical strategy.
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Affiliation(s)
- Paulo A. S. Kadri
- Division of Neurosurgery, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande-MS, Brazil
- Clinical Anatomy Discipline, Department of Surgery, University of São Paulo Medical School (FMUSP), São Paulo, Brazil
| | - Jean G. de Oliveira
- Division of Cerebrovas-cular and Skull Base Surgery, Center of Neurology and Neurosurgery Associates (CENNA), Hospital Beneficência Por-tuguesa de São Paulo-SP, Brazil
| | | | - Uğur Türe
- Department of Neurosurgery, Yeditepe University, Istanbul, Turkey
| | - Evandro P. L. de Oliveira
- Institute of Neuro-logical Sciences (ICNE), São Paulo-SP, Brazil
- Adjunct Professor of Neurosurgery, Mayo Clinic College of Medicine, Jacksonville, USA
| | - Ossama Al-Mefty
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Guilherme C. Ribas
- Clinical Anatomy Discipline, Department of Surgery, University of São Paulo Medical School (FMUSP), São Paulo, Brazil
- Neurosurgeon Albert Einstein Hospital, São Paulo - SP, Brazil
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222
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Electrical Stimulation for Seizure Induction and Functional Mapping in Stereoelectroencephalography. J Clin Neurophysiol 2016; 33:511-521. [DOI: 10.1097/wnp.0000000000000313] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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223
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Ille S, Sollmann N, Butenschoen VM, Meyer B, Ringel F, Krieg SM. Resection of highly language-eloquent brain lesions based purely on rTMS language mapping without awake surgery. Acta Neurochir (Wien) 2016; 158:2265-2275. [PMID: 27688208 DOI: 10.1007/s00701-016-2968-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 09/12/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND The resection of left-sided perisylvian brain lesions harbours the risk of postoperative language impairment. Therefore the individual patient's language distribution is investigated by intraoperative direct cortical stimulation (DCS) during awake surgery. Yet, not all patients qualify for awake surgery. Non-invasive language mapping by repetitive navigated transcranial magnetic stimulation (rTMS) has frequently shown a high correlation in comparison with the results of DCS language mapping in terms of language-negative brain regions. The present study analyses the extent of resection (EOR) and functional outcome of patients who underwent left-sided perisylvian resection of brain lesions based purely on rTMS language mapping. METHODS Four patients with left-sided perisylvian brain lesions (two gliomas WHO III, one glioblastoma, one cavernous angioma) underwent rTMS language mapping prior to surgery. Data from rTMS language mapping and rTMS-based diffusion tensor imaging fibre tracking (DTI-FT) were transferred to the intraoperative neuronavigation system. Preoperatively, 5 days after surgery (POD5), and 3 months after surgery (POM3) clinical follow-up examinations were performed. RESULTS No patient suffered from a new surgery-related aphasia at POM3. Three patients underwent complete resection immediately, while one patient required a second rTMS-based resection some days later to achieve the final, complete resection. CONCLUSIONS The present study shows for the first time the feasibility of successfully resecting language-eloquent brain lesions based purely on the results of negative language maps provided by rTMS language mapping and rTMS-based DTI-FT. In very select cases, this technique can provide a rescue strategy with an optimal functional outcome and EOR when awake surgery is not feasible.
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Affiliation(s)
- Sebastian Ille
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
- TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Nico Sollmann
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
- TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Vicki M Butenschoen
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
- TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Florian Ringel
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
- TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
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224
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Tani N, Kishima H, Khoo HM, Yanagisawa T, Oshino S, Maruo T, Hosomi K, Hirata M, Kazui H, Nomura KT, Aly MM, Kato A, Yoshimine T. Electrical stimulation of the parahippocampal gyrus for prediction of posthippocampectomy verbal memory decline. J Neurosurg 2016; 125:1053-1060. [PMID: 26771851 DOI: 10.3171/2015.7.jns15408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Epilepsy surgery is of known benefit for drug-resistant temporal lobe epilepsy (TLE); however, a certain number of patients suffer significant decline in verbal memory after hippocampectomy. To prevent this disabling complication, a reliable test for predicting postoperative memory decline is greatly desired. Therefore, the authors assessed the value of electrical stimulation of the parahippocampal gyrus (PHG) as a provocation test of verbal memory decline after hippocampectomy on the dominant side. METHODS Eleven right-handed, Japanese-speaking patients with medically intractable left TLE participated in the study. Before surgery, they underwent provocative testing via electrical stimulation of the left PHG during a verbal encoding task. Their pre- and posthippocampectomy memory function was evaluated according to the Wechsler Memory Scale-Revised (WMS-R) and/or Mini-Mental State Examination (MMSE) before and 6 months after surgery. The relationship between postsurgical memory decline and results of the provocative test was evaluated. RESULTS Left hippocampectomy was performed in 7 of the 11 patients. In 3 patients with a positive provocative recognition test, verbal memory function, as assessed by the WMS-R, decreased after hippocampectomy, whereas in 4 patients with a negative provocative recognition test, verbal memory function, as assessed by the WMS-R or MMSE, was preserved. CONCLUSIONS Results of the present study suggest that electrical stimulation of the PHG is a reliable provocative test to predict posthippocampectomy verbal memory decline.
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Affiliation(s)
- Naoki Tani
- Departments of 1 Neurosurgery and.,Department of Neurosurgery, Osaka General Medical Center, Osaka
| | - Haruhiko Kishima
- Departments of 1 Neurosurgery and.,Epilepsy Center, Osaka University Hospital, Suita
| | - Hui Ming Khoo
- Departments of 1 Neurosurgery and.,Department of Neurosurgery, Yao Municipal Hospital, Yao
| | - Takufumi Yanagisawa
- Departments of 1 Neurosurgery and.,Epilepsy Center, Osaka University Hospital, Suita
| | - Satoru Oshino
- Departments of 1 Neurosurgery and.,Epilepsy Center, Osaka University Hospital, Suita
| | - Tomoyuki Maruo
- Departments of 1 Neurosurgery and.,Department of Neurosurgery, Otemae Hospital, Osaka
| | - Koichi Hosomi
- Departments of 1 Neurosurgery and.,Epilepsy Center, Osaka University Hospital, Suita
| | - Masayuki Hirata
- Departments of 1 Neurosurgery and.,Epilepsy Center, Osaka University Hospital, Suita
| | - Hiroaki Kazui
- Psychiatry, Osaka University Graduate School of Medicine, Suita
| | | | - Mohamed M Aly
- Department of Neurosurgery, Mansoura University Hospital, Mansoura, Egypt
| | - Amami Kato
- Department of Neurosurgery, Kinki University School of Medicine, Osaka-Sayama, Japan; and
| | - Toshiki Yoshimine
- Departments of 1 Neurosurgery and.,Epilepsy Center, Osaka University Hospital, Suita
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225
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Awake surgery for hemispheric low-grade gliomas: oncological, functional and methodological differences between pediatric and adult populations. Childs Nerv Syst 2016; 32:1861-74. [PMID: 27659829 DOI: 10.1007/s00381-016-3069-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 03/14/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Brain mapping through a direct cortical and subcortical electrical stimulation during an awake craniotomy has gained an increasing popularity as a powerful tool to prevent neurological deficit while increasing extent of resection of hemispheric diffuse low-grade gliomas in adults. However, few case reports or very limited series of awake surgery in children are currently available in the literature. METHODS In this paper, we review the oncological and functional differences between pediatric and adult populations, and the methodological specificities that may limit the use of awake mapping in pediatric low-grade glioma surgery. RESULTS This could be explained by the fact that pediatric low-grade gliomas have a different epidemiology and biologic behavior in comparison to adults, with pilocytic astrocytomas (WHO grade I glioma) as the most frequent histotype, and with WHO grade II gliomas less prone to anaplastic transformation than their adult counterparts. In addition, aside from the issue of poor collaboration of younger children under 10 years of age, some anatomical and functional peculiarities of children developing brain (cortical and subcortical myelination, maturation of neural networks and of specialized cortical areas) can influence direct electrical stimulation methodology and sensitivity, limiting its use in children. CONCLUSIONS Therefore, even though awake procedure with cortical and axonal stimulation mapping can be adapted in a specific subgroup of children with a diffuse glioma from the age of 10 years, only few pediatric patients are nonetheless candidates for awake brain surgery.
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226
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Miozzo M, Williams AC, McKhann GM, Hamberger MJ. Topographical gradients of semantics and phonology revealed by temporal lobe stimulation. Hum Brain Mapp 2016; 38:688-703. [PMID: 27654942 DOI: 10.1002/hbm.23409] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/12/2016] [Accepted: 09/13/2016] [Indexed: 01/18/2023] Open
Abstract
Word retrieval is a fundamental component of oral communication, and it is well established that this function is supported by left temporal cortex. Nevertheless, the specific temporal areas mediating word retrieval and the particular linguistic processes these regions support have not been well delineated. Toward this end, we analyzed over 1000 naming errors induced by left temporal cortical stimulation in epilepsy surgery patients. Errors were primarily semantic (lemon → "pear"), phonological (horn → "corn"), non-responses, and delayed responses (correct responses after a delay), and each error type appeared predominantly in a specific region: semantic errors in mid-middle temporal gyrus (TG), phonological errors and delayed responses in middle and posterior superior TG, and non-responses in anterior inferior TG. To the extent that semantic errors, phonological errors and delayed responses reflect disruptions in different processes, our results imply topographical specialization of semantic and phonological processing. Specifically, results revealed an inferior-to-superior gradient, with more superior regions associated with phonological processing. Further, errors were increasingly semantically related to targets toward posterior temporal cortex. We speculate that detailed semantic input is needed to support phonological retrieval, and thus, the specificity of semantic input increases progressively toward posterior temporal regions implicated in phonological processing. Hum Brain Mapp 38:688-703, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Alicia C Williams
- Department of Neurology, Columbia University Medical Center, New York
| | - Guy M McKhann
- Department of Neurology, Columbia University Medical Center, New York
| | - Marla J Hamberger
- Department of Neurology, Columbia University Medical Center, New York
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227
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Jiang T, Ince NF, Jiang T, Wang T, Mei S, Li Y, Wang X, Sha Z. Local spatial correlation analysis of hand flexion/extension using intraoperative high-density ECoG. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:6190-3. [PMID: 26737706 DOI: 10.1109/embc.2015.7319806] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We recorded motor cortical activity using highdensity electrocorticogram (ECoG) from three patients during awake craniotomy. Subjects repeatedly executed hand flexion/extension tasks according to auditory instructions. Clear event-related desynchronization (ERD) in beta band (8-32) Hz and event-related synchronization (ERS) in gamma band (60-200) Hz were observed. High frequency band (HFB: 60-200 Hz) activation was found to be more localized compared to low frequency band (LFB: 8-32 Hz) activation in all subjects. Local spatial correlation maps in LFB and HFB were constructed by computing the correlation between channels. Local spatial correlation dropped more in the ERD/ERS areas consistently in two subjects. The results indicate that ERD/ERS patterns are more spatially uncorrelated and denser ECoG electrode is necessary within these areas to map uncorrelated `sources'. High resolution electrodes might improve both clinical functional mapping and brain machine interface outcomes in the near future.
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228
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Fernández-Coello A, Havas V, Juncadella M, Sierpowska J, Rodríguez-Fornells A, Gabarrós A. Age of language acquisition and cortical language organization in multilingual patients undergoing awake brain mapping. J Neurosurg 2016; 126:1912-1923. [PMID: 27540905 DOI: 10.3171/2016.5.jns152791] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Most knowledge regarding the anatomical organization of multilingualism is based on aphasiology and functional imaging studies. However, the results have still to be validated by the gold standard approach, namely electrical stimulation mapping (ESM) during awake neurosurgical procedures. In this ESM study the authors describe language representation in a highly specific group of 13 multilingual individuals, focusing on how age of acquisition may influence the cortical organization of language. METHODS Thirteen patients who had a high degree of proficiency in multiple languages and were harboring lesions within the dominant, left hemisphere underwent ESM while being operated on under awake conditions. Demographic and language data were recorded in relation to age of language acquisition (for native languages and early- and late-acquired languages), neuropsychological pre- and postoperative language testing, the number and location of language sites, and overlapping distribution in terms of language acquisition time. Lesion growth patterns and histopathological characteristics, location, and size were also recorded. The distribution of language sites was analyzed with respect to age of acquisition and overlap. RESULTS The functional language-related sites were distributed in the frontal (55%), temporal (29%), and parietal lobes (16%). The total number of native language sites was 47. Early-acquired languages (including native languages) were represented in 97 sites (55 overlapped) and late-acquired languages in 70 sites (45 overlapped). The overlapping distribution was 20% for early-early, 71% for early-late, and 9% for late-late. The average lesion size (maximum diameter) was 3.3 cm. There were 5 fast-growing and 7 slow-growing lesions. CONCLUSIONS Cortical language distribution in multilingual patients is not homogeneous, and it is influenced by age of acquisition. Early-acquired languages have a greater cortical representation than languages acquired later. The prevalent native and early-acquired languages are largely represented within the perisylvian left hemisphere frontoparietotemporal areas, and the less prevalent late-acquired languages are mostly overlapped with them.
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Affiliation(s)
- Alejandro Fernández-Coello
- Sections of 1 Neurosurgery and.,Department of Pathology and Experimental Therapeutics, Anatomy and Human Embryology Unit, and.,CIBER de Bioingeniería, Biomateriales y Nanomedicina
| | - Viktória Havas
- Cognition and Brain Plasticity Group, IDIBELL, L'Hospitalet de Llobregat.,Department of Language and Literature, Norwegian University of Science and Technology, Trondheim, Norway
| | - Montserrat Juncadella
- Neurology, Hospital Universitari de Bellvitge, Campus Bellvitge, University of Barcelona-IDIBELL
| | - Joanna Sierpowska
- Department of Basic Psychology, Campus Bellvitge, University of Barcelona.,Cognition and Brain Plasticity Group, IDIBELL, L'Hospitalet de Llobregat
| | - Antoni Rodríguez-Fornells
- Department of Basic Psychology, Campus Bellvitge, University of Barcelona.,Cognition and Brain Plasticity Group, IDIBELL, L'Hospitalet de Llobregat.,Catalan Institution for Research and Advanced Studies, Barcelona, Spain; and
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229
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Son EI, Kim JE. Spectrum of neurosurgeon's role in epilepsy surgery. Biomed J 2016; 39:177-82. [PMID: 27621118 PMCID: PMC6140298 DOI: 10.1016/j.bj.2016.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/21/2016] [Indexed: 11/28/2022] Open
Abstract
It is well known that there is high quality evidence of epilepsy surgery as an effective and safe option for patients with drug refractory epilepsy by advanced imaging technology and computerized electrophysiological facilities during recent three decades. However, it still remains debate regarding necessities of epilepsy surgery in terms of less satisfactory surgical outcome, especially in non-lesional neocortical epilepsies. This review is for the role of epileptic neurosurgeon rather than the role of epilepsy surgery, namely, the necessity of neurosurgeon's positive participation starting from the first visit of epilepsy patients followed by pertaining process by stages and its degree of contribution. All experienced epilepsy centers also need innovative or challenging trial absolutely through this kind of standpoint, because all of the present protocols and techniques are coming from the past. In any event, the interdepartmental and interpersonal cooperation is inevitable especially for improving patient's quality of life. Serious neurosurgical considerations are needed for patients with intractable epilepsies, especially in referred cases from other center for the purpose of double check, and incongruent cases with contrary opinions by epileptologist.
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Affiliation(s)
- Eun-Ik Son
- Department of Neurosurgery and Epilepsy Center, Keimyung University Dongsan Medical Center, South Korea.
| | - Ji-Eun Kim
- Department of Neurology, School of Medicine, Catholic University of Daegu, South Korea
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230
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Roux FE, Durand JB, Djidjeli I, Moyse E, Giussani C. Variability of intraoperative electrostimulation parameters in conscious individuals: language cortex. J Neurosurg 2016; 126:1641-1652. [PMID: 27419823 DOI: 10.3171/2016.4.jns152434] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Electrostimulation in awake brain mapping is widely used to guide tumor removal, but methodologies can differ substantially across institutions. The authors studied electrostimulation brain mapping data to characterize the variability of the current intensity threshold across patients and the effect of its variations on the number, type, and surface area of the essential language areas detected. METHODS Over 7 years, the authors prospectively studied 100 adult patients who were undergoing intraoperative brain mapping during resection of left hemisphere tumors. In all 100 cases, the same protocol of electrostimulation brain mapping (a controlled naming task-bipolar stimulation with biphasic square wave pulses of 1-msec duration and 60-Hz trains, maximum train duration 6 sec) and electrocorticography was used to detect essential language areas. RESULTS The minimum positive thresholds of stimulation varied from patient to patient; the mean minimum intensity required to detect interference was 4.46 mA (range 1.5-9 mA), and in a substantial proportion of sites (13.5%) interference was detected only at intensities above 6 mA. The threshold varied within a given patient for different naming areas in 22% of cases. Stimulation of the same naming area with greater intensities led to slight changes in the type of response in 19% of cases and different types of responses in 4.5%. Naming sites detected were located in subcentimeter cortical areas (50% were less than 20 mm2), but their extent varied with the intensity of stimulation. During a brain mapping session, the same intensity of stimulation reproduced the same type of interference in 94% of the cases. There was no statistically significant difference between the mean stimulation intensities required to produce interfereince in the left inferior frontal lobe (Broca's area), the supramarginal gyri, and the posterior temporal region. CONCLUSIONS Intrasubject and intersubject variations of the minimum thresholds of positive naming areas and changes in the type of response and in the size of these areas according to the intensity used may limit the interpretation of data from electrostimulation in awake brain mapping. To optimize the identification of language areas during electrostimulation brain mapping, it is important to use different intensities of stimulation at the maximum possible currents, avoiding afterdischarges. This could refine the clinical results and scientific data derived from these mapping sessions.
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Affiliation(s)
- Franck-Emmanuel Roux
- Pôle Neuroscience (Neurochirurgie), Centre Hospitalo-Universitaire de Toulouse.,Centre de Recherche Cerveau et Cognition (CNRS; CerCo), Toulouse, France; and
| | | | - Imène Djidjeli
- Pôle Neuroscience (Neurochirurgie), Centre Hospitalo-Universitaire de Toulouse.,Centre de Recherche Cerveau et Cognition (CNRS; CerCo), Toulouse, France; and
| | - Emmanuel Moyse
- Pôle Neuroscience (Neurochirurgie), Centre Hospitalo-Universitaire de Toulouse.,Université de Toulouse, UPS
| | - Carlo Giussani
- Neurosurgery, Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Ospedale San, Gerardo, Monza, Italy
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231
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Mikdashi JA, Esdaile JM, Alarcón GS, Crofford L, Fessler BJ, Shanberg L, Brunner H, Gall V, Kalden JR, Lockshin MD, Liang MH, Roberts N, Schneider M. Proposed response criteria for neurocognitive impairment in systemic lupus erythematosus clinical trials. Lupus 2016; 16:418-25. [PMID: 17664232 DOI: 10.1177/0961203307079044] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to identify reliable and valid instruments to measure cognitive impairment in systemic lupus erythematosus (SLE), and to define minimally important change of cognitive impairment in SLE for clinical trials. Neurocognitive measures used in randomized clinical trials in SLE were reviewed, and response criteria were developed using consensus expert opinion. The definition of cognitive impairment in the ACR nomenclature for neuropsychiatric lupus syndrome was adopted. Cognitive impairment is a deficit of 2.0 or more standard deviations (SD) below the mean, compared to normative data, in the key domains of attention, memory and psychomotor speed. Cognitive decline is defined as a deficit of 1.5—1.9 SD below the mean. Focal decline is defined if impairment exists in one or more measures within one domain, and multifocal decline if impairment exists on measures spanning two or more domains. The combination of ACR neuropsychological battery and the Cognitive Symptoms Inventory (CSI) is recommended to quantitate cognitive function. A clinically important response is defined as an improvement of ≥ 1.0 SD with an effect size of 1.0 in the key domains of the ACR neuropsychological testing, and an improvement of ≥ 1.0 SD with an effect size of 1.0 in functional performance of the CSI. Lupus (2007) 16, 418—425
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232
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Hamberger MJ, Miozzo M, Schevon CA, Morrison C, Carlson C, Mehta AD, Klein GE, McKhann GM, Williams AC. Functional differences among stimulation-identified cortical naming sites in the temporal region. Epilepsy Behav 2016; 60:124-129. [PMID: 27206230 PMCID: PMC4912888 DOI: 10.1016/j.yebeh.2016.04.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 11/16/2022]
Abstract
To preserve postoperative language, electrical stimulation mapping is often conducted prior to surgery involving the language-dominant hemisphere. Object naming is the task most widely used to identify language cortex, and sites where stimulation elicits naming difficulty are typically spared from resection. In clinical practice, sites classified as positive undergo no further testing regarding the underlying cause of naming failure. Word production is a complex function involving multiple mechanisms that culminate in the identification of the target word. Two main mechanisms, i.e., semantic and phonological, underlie the retrieval of stored information regarding word meaning and word sounds, and naming can be hampered by disrupting either of these. These two mechanisms are likely mediated by different brain areas, and therefore, stimulation-identified naming sites might not be functionally equivalent. We investigated whether further testing at stimulation-identified naming sites would reveal an anatomical dissociation between these two mechanisms. In 16 patients with refractory temporal lobe epilepsy (TLE) with implanted subdural electrodes, we tested whether, despite inability to produce an item name, patients could reliably access semantic or phonological information regarding objects during cortical stimulation. We found that stimulation at naming sites in superior temporal cortex tended to impair phonological processing yet spared access to semantic information. By contrast, stimulation of inferior temporal naming sites revealed a greater proportion of sites where semantic access was impaired and a dissociation between sites where stimulation spared or disrupted semantic or phonological processing. These functional-anatomical dissociations reveal the more specific contribution to naming provided by these cortical areas and shed light on the often profound, interictal word-finding deficit observed in temporal lobe epilepsy. Additionally, these techniques potentially lay the groundwork for future studies to determine whether particular naming sites that fall within the margins of the desired clinical resection might be resected without significant risk of decline.
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Affiliation(s)
- Marla J Hamberger
- Department of Neurology, Columbia University Medical Center, New York, NY, United States.
| | - Michele Miozzo
- Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Catherine A Schevon
- Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Chris Morrison
- Department of Neurology, New York University Medical Center, New York, NY, United States
| | - Chad Carlson
- Department of Neurology, New York University Medical Center, New York, NY, United States
| | - Ashesh D Mehta
- Department of Neurological Surgery, North Shore LIJ Medical Center, New Hyde Park, NY, United States
| | - Gad E Klein
- Department of Neurological Surgery, North Shore LIJ Medical Center, New Hyde Park, NY, United States
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, United States
| | - Alicia C Williams
- Department of Neurology, Columbia University Medical Center, New York, NY, United States
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233
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Mapping of cortical language function by functional magnetic resonance imaging and repetitive navigated transcranial magnetic stimulation in 40 healthy subjects. Acta Neurochir (Wien) 2016; 158:1303-16. [PMID: 27138329 DOI: 10.1007/s00701-016-2819-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 04/20/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Functional magnetic resonance imaging (fMRI) is considered to be the standard method regarding non-invasive language mapping. However, repetitive navigated transcranial magnetic stimulation (rTMS) gains increasing importance with respect to that purpose. However, comparisons between both methods are sparse. METHODS We performed fMRI and rTMS language mapping of the left hemisphere in 40 healthy, right-handed subjects in combination with the tasks that are most commonly used in the neurosurgical context (fMRI: word-generation = WGEN task; rTMS: object-naming = ON task). Different rTMS error rate thresholds (ERTs) were calculated, and Cohen's kappa coefficient and the cortical parcellation system (CPS) were used for systematic comparison of the two techniques. RESULTS Overall, mean kappa coefficients were low, revealing no distinct agreement. We found the highest agreement for both techniques when using the 2-out-of-3 rule (CPS region defined as language positive in terms of rTMS if at least 2 out of 3 stimulations led to a naming error). However, kappa for this threshold was only 0.24 (kappa of <0, 0.01-0.20, 0.21-0.40, 0.41-0.60, 0.61-0.80 and 0.81-0.99 indicate less than chance, slight, fair, moderate, substantial and almost perfect agreement, respectively). CONCLUSIONS Because of the inherent differences in the underlying physiology of fMRI and rTMS, the different tasks used and the impossibility of verifying the results via direct cortical stimulation (DCS) in the population of healthy volunteers, one must exercise caution in drawing conclusions about the relative usefulness of each technique for language mapping. Nevertheless, this study yields valuable insights into these two mapping techniques for the most common language tasks currently used in neurosurgical practice.
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234
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Abstract
Cerebrovascular disease plays a paramount role in mortality and morbidity, and the clinical and basic sci entific study of acute stroke has blossomed, leading both to increased survival and to increasing numbers of people with disabilities from stroke. Neurobiological study of the chronic form of this prevalent neurological disease has lagged behind investigation of the acute illness. This article reviews how and why this situation will change. Four major points are addressed: 1) The anatomical organizations of functional brain systems are less topographically precise than commonly believed. 2) Cortical plasticity exists in adults and takes a number of forms, including unmasking of existing circuits, growth of new synapses via axonal sprouting or dendritic proliferation, and development of compensatory processes. 3) It is possible to manipulate this plasticity with behavioral and pharmacological interventions, and such manipulations can have a beneficial effect on recovery. 4) Functional neuroimaging, particularly the noninvasive method of fMRI, can be used to study in vivo both cerebral plasticity after stroke and the interventions that might influence recovery by affecting this plasticity. Although there is much to be accomplished, the prognosis is extremely good for a neuroscience of stroke rehabilitation. NEUROSCIENTIST 4:426-434, 1998
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Affiliation(s)
- Steven L. Small
- Department of Neurology, University of Maryland School
of Medicine Baltimore, Maryland, Kernan Rehabilitation Hospital, University of Maryland
School of Medicine Baltimore, Maryland
| | - Ana Solodkin
- Kernan Rehabilitation Hospital, University of Maryland
School of Medicine Baltimore, Maryland, Department of Anatomy and Neurobiology (AS) University
of Maryland School of Medicine Baltimore, Maryland
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235
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Abstract
Surgery is an important therapeutic alternative for patients with uncontrolled epilepsy. Preoperative identification of brain regions important for language is important to reduce the risk of functional impairment after surgery. The Wada test suffers from several technical and clinical disadvantages and provides hemispheric data at best. More invasive methods such as intraoperative or chronic subdural cortical mapping have more limited application. New approaches using neuroimaging methods offer the opportunity to localize, as well as lateralize, language. In addition, normal volunteers can be studied with the same techniques, providing comparative and control data. Although most normal studies have been reported as group data, it is important for individual scans to be available for comparison with patient studies to understand the normal range of interindividual variability. Two techniques, PET with 15O-water-PET and fMRI, have been used. Both detect signal changes associated with increased regional blood flow during neuronal activity. Usually, scans performed during a language task are compared with those obtained during control conditions. It is important to choose activation tasks carefully, to make sure one is imaging activation associated with the particular process of interest. PET has advantages, including a fully diffusible tracer, standardized analytic methods, a more comfortable environment, and less sensitivity to movement artifact. On the other hand, it involves a cyclotron-produced tracer, radiation exposure, and is more difficult to repeat. FMRI over represents the effects of large vascular structures and is very sensitive to movement but uses widely available equipment and has no limitation on the number of studies. For both studies, it is important to understand the potential effects of such factors as attention, fatigue, and familiarity with the material. Several studies comparing 15O-water-PET and fMRI to the Wada test found that the former are at least as accurate for language lateralization. In addition, we compared 15O-water-PET to direct subdural electrode cortical stimulation and found that regions showing increased cerebral blood flow during naming tasks co-registered with subdural electrodes that disrupted language during electrical stimulation. In this and other studies, PET detected more regions than electrical stimulation techniques. The whole brain cannot be covered with electrodes, but some areas participating in a task may not be crucial for it. FMRI is particularly useful for children. We compared cortical activation patterns in normal children, adolescents, and adults. The activation patterns, and laterality of language dominance, in children 8 years and above, were similar to adults, although some differences could reflect maturation and evolving focality of cognitive processes. In children with epilepsy, fMRI successfully identified language laterality and provided data on intrahemispheric localization. Studies also showed the effects of the epileptic focus on normal activation patterns for several tasks. Neuroimaging functional mapping is an important tool, still in the process of development and evolution. Although potentially of great clinical and scientific value, it should be used and interpreted cautiously.
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Affiliation(s)
- William D. Gaillard
- Clinical Epilepsy Section, National Institutes of Health, Bethesda Maryland, Children’s National Medical Center, Washington, D.C
| | - William H. Theodore
- Clinical Epilepsy Section, National Institutes of Health, Bethesda Maryland,
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236
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Abstract
Neurosurgical procedures for tumors or intractable epilepsy are often accompanied by risk to postoperative cognitive function; surgery in the left temporal or frontal lobes, for example, can place language functions at risk. Hence, prior to tissue extraction, one common surgical goal is to attempt to identify frontal and temporal regions that should be spared in order to preserve language function. We describe how basic research on false memory for word lists has led to a novel approach for identifying such language-related regions in healthy controls. That is, rapid presentation of semantically related words (e.g., bed, rest, awake) and phonologically related words (e.g., peep, weep, heap) with instructions to attend to relations among the words elicits activity in underlying language networks. Furthermore, it is often possible to identify the neural underpinnings of these networks in an individual person in about an hour of functional magnetic resonance imaging (fMRI) scanning. We conclude by suggesting directions for future research with this lexical-processing protocol, the overarching goal being to link basic cognitive science and clinical practice.
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237
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Kobyakov GL, Lubnin AY, Kulikov AS, Gavrilov AG, Goryaynov SA, Poddubskiy AA, Lodygina KS. [Awake craniotomy]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2016; 80:107-116. [PMID: 27186613 DOI: 10.17116/neiro2016801107-116] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Awake craniotomy is a neurosurgical intervention aimed at identifying and preserving the eloquent functional brain areas during resection of tumors located near the cortical and subcortical language centers. This article provides a review of the modern literature devoted to the issue. The anatomical rationale and data of preoperative functional neuroimaging, intraoperative electrophysiological monitoring, and neuropsychological tests as well as the strategy of active surgical intervention are presented. Awake craniotomy is a rapidly developing technique aimed at both preserving speech and motor functions and improving our knowledge in the field of speech psychophysiology.
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Affiliation(s)
- G L Kobyakov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A Yu Lubnin
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A S Kulikov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A G Gavrilov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | | | - K S Lodygina
- Burdenko Neurosurgical Institute, Moscow, Russia
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238
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Hervey-Jumper SL, Berger MS. Maximizing safe resection of low- and high-grade glioma. J Neurooncol 2016; 130:269-282. [PMID: 27174197 DOI: 10.1007/s11060-016-2110-4] [Citation(s) in RCA: 305] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 03/23/2016] [Indexed: 10/21/2022]
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239
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Southwell DG, Hervey-Jumper SL, Perry DW, Berger MS. Intraoperative mapping during repeat awake craniotomy reveals the functional plasticity of adult cortex. J Neurosurg 2016; 124:1460-9. [PMID: 26544767 DOI: 10.3171/2015.5.jns142833] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
To avoid iatrogenic injury during the removal of intrinsic cerebral neoplasms such as gliomas, direct electrical stimulation (DES) is used to identify cortical and subcortical white matter pathways critical for language, motor, and sensory function. When a patient undergoes more than 1 brain tumor resection as in the case of tumor recurrence, the use of DES provides an unusual opportunity to examine brain plasticity in the setting of neurological disease.
METHODS
The authors examined 561 consecutive cases in which patients underwent DES mapping during surgery forglioma resection. “Positive” and “negative” sites—discrete cortical regions where electrical stimulation did (positive) or did not (negative) produce transient sensory, motor, or language disturbance—were identified prior to tumor resection and documented by intraoperative photography for categorization into functional maps. In this group of 561 patients, 18 were identified who underwent repeat surgery in which 1 or more stimulation sites overlapped with those tested during the initial surgery. The authors compared intraoperative sensory, motor, or language mapping results between initial and repeat surgeries, and evaluated the clinical outcomes for these patients.
RESULTS
A total of 117 sites were tested for sensory (7 sites, 6.0%), motor (9 sites, 7.7%), or language (101 sites, 86.3%) function during both initial and repeat surgeries. The mean interval between surgical procedures was 4.1 years. During initial surgeries, 95 (81.2%) of 117 sites were found to be negative and 22 (18.8%) of 117 sites were found to be positive. During repeat surgeries, 103 (88.0%) of 117 sites were negative and 14 (12.0%) of 117 were positive. Of the 95 sites that were negative at the initial surgery, 94 (98.9%) were also negative at the repeat surgery, while 1 (1.1%) site was found to be positive. Of the 22 sites that were initially positive, 13 (59.1%) remained positive at repeat surgery, while 9 (40.9%) had become negative for function. Overall, 6 (33.3%) of 18 patients exhibited loss of function at 1 or more motor or language sites between surgeries. Loss of function at these sites was not associated with neurological impairment at the time of repeat surgery, suggesting that neurological function was preserved through neural circuit reorganization or activation of latent functional pathways.
CONCLUSIONS
The adult central nervous system reorganizes motor and language areas in patients with glioma. Ultimately, adult neural plasticity may help to preserve motor and language function in the presence of evolving structural lesions. The insight gained from this subset of patients has implications for our understanding of brain plasticity in clinical settings.
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240
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Riva M, Fava E, Gallucci M, Comi A, Casarotti A, Alfiero T, Raneri FA, Pessina F, Bello L. Monopolar high-frequency language mapping: can it help in the surgical management of gliomas? A comparative clinical study. J Neurosurg 2016; 124:1479-89. [DOI: 10.3171/2015.4.jns14333] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECT
Intraoperative language mapping is traditionally performed with low-frequency bipolar stimulation (LFBS). High-frequency train-of-five stimulation delivered by a monopolar probe (HFMS) is an alternative technique for motor mapping, with a lower reported seizure incidence. The application of HFMS in language mapping is still limited. Authors of this study assessed the efficacy and safety of HFMS for language mapping during awake surgery, exploring its clinical impact compared with that of LFBS.
METHODS
Fifty-nine patients underwent awake surgery with neuropsychological testing, and LFBS and HFMS were compared. Frequency, type, and site of evoked interference were recorded. Language was scored preoperatively and 1 week and 3 months after surgery. Extent of resection was calculated as well.
RESULTS
High-frequency monopolar stimulation induced a language disturbance when the repetition rate was set at 3 Hz. Interference with counting (p = 0.17) and naming (p = 0.228) did not vary between HFMS and LFBS. These results held true when preoperative tumor volume, lesion site, histology, and recurrent surgery were considered.
Intraoperative responses (1603) in all patients were compared. The error rate for both modalities differed from baseline values (p < 0.001) but not with one another (p = 0.06). Low-frequency bipolar stimulation sensitivity (0.458) and precision (0.665) were slightly higher than the HFMS counterparts (0.367 and 0.582, respectively). The error rate across the 3 types of language errors (articulatory, anomia, paraphasia) did not differ between the 2 stimulation methods (p = 0.279).
CONCLUSIONS
With proper setting adjustments, HFMS is a safe and effective technique for language mapping.
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Affiliation(s)
- Marco Riva
- 1Neurosurgery, Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Rozzano (MI),
| | - Enrica Fava
- 1Neurosurgery, Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Rozzano (MI),
- 2Unit of Neurosurgical Oncology, Humanitas Research Hospital, Rozzano (MI), and
| | | | - Alessandro Comi
- 2Unit of Neurosurgical Oncology, Humanitas Research Hospital, Rozzano (MI), and
| | | | - Tommaso Alfiero
- 1Neurosurgery, Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Rozzano (MI),
| | - Fabio A. Raneri
- 1Neurosurgery, Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Rozzano (MI),
| | - Federico Pessina
- 2Unit of Neurosurgical Oncology, Humanitas Research Hospital, Rozzano (MI), and
| | - Lorenzo Bello
- 1Neurosurgery, Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Rozzano (MI),
- 2Unit of Neurosurgical Oncology, Humanitas Research Hospital, Rozzano (MI), and
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241
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Collard MJ, Fifer MS, Benz HL, McMullen DP, Wang Y, Milsap GW, Korzeniewska A, Crone NE. Cortical subnetwork dynamics during human language tasks. Neuroimage 2016; 135:261-72. [PMID: 27046113 DOI: 10.1016/j.neuroimage.2016.03.072] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 03/12/2016] [Accepted: 03/26/2016] [Indexed: 02/07/2023] Open
Abstract
Language tasks require the coordinated activation of multiple subnetworks-groups of related cortical interactions involved in specific components of task processing. Although electrocorticography (ECoG) has sufficient temporal and spatial resolution to capture the dynamics of event-related interactions between cortical sites, it is difficult to decompose these complex spatiotemporal patterns into functionally discrete subnetworks without explicit knowledge of each subnetwork's timing. We hypothesized that subnetworks corresponding to distinct components of task-related processing could be identified as groups of interactions with co-varying strengths. In this study, five subjects implanted with ECoG grids over language areas performed word repetition and picture naming. We estimated the interaction strength between each pair of electrodes during each task using a time-varying dynamic Bayesian network (tvDBN) model constructed from the power of high gamma (70-110Hz) activity, a surrogate for population firing rates. We then reduced the dimensionality of this model using principal component analysis (PCA) to identify groups of interactions with co-varying strengths, which we term functional network components (FNCs). This data-driven technique estimates both the weight of each interaction's contribution to a particular subnetwork, and the temporal profile of each subnetwork's activation during the task. We found FNCs with temporal and anatomical features consistent with articulatory preparation in both tasks, and with auditory and visual processing in the word repetition and picture naming tasks, respectively. These FNCs were highly consistent between subjects with similar electrode placement, and were robust enough to be characterized in single trials. Furthermore, the interaction patterns uncovered by FNC analysis correlated well with recent literature suggesting important functional-anatomical distinctions between processing external and self-produced speech. Our results demonstrate that subnetwork decomposition of event-related cortical interactions is a powerful paradigm for interpreting the rich dynamics of large-scale, distributed cortical networks during human cognitive tasks.
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Affiliation(s)
- Maxwell J Collard
- Department of Neurology, Johns Hopkins University, 600 N. Wolfe St., Meyer 2-161, Baltimore, MD 21287, USA; Department of Biomedical Engineering, Johns Hopkins University, 720 Rutland Ave., Baltimore, MD 21205, USA.
| | - Matthew S Fifer
- Department of Biomedical Engineering, Johns Hopkins University, 720 Rutland Ave., Baltimore, MD 21205, USA
| | - Heather L Benz
- Department of Biomedical Engineering, Johns Hopkins University, 720 Rutland Ave., Baltimore, MD 21205, USA; Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD 20993, USA
| | - David P McMullen
- Department of Neurosurgery, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Yujing Wang
- Department of Biomedical Engineering, Johns Hopkins University, 720 Rutland Ave., Baltimore, MD 21205, USA; Fischell Department of Bioengineering, University of Maryland, Room 2330 Jeong H. Kim Engineering Building (Bldg. # 225), College Park, MD 20742, USA
| | - Griffin W Milsap
- Department of Biomedical Engineering, Johns Hopkins University, 720 Rutland Ave., Baltimore, MD 21205, USA
| | - Anna Korzeniewska
- Department of Neurology, Johns Hopkins University, 600 N. Wolfe St., Meyer 2-161, Baltimore, MD 21287, USA
| | - Nathan E Crone
- Department of Neurology, Johns Hopkins University, 600 N. Wolfe St., Meyer 2-161, Baltimore, MD 21287, USA
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242
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Vincent M, Rossel O, Hayashibe M, Herbet G, Duffau H, Guiraud D, Bonnetblanc F. The difference between electrical microstimulation and direct electrical stimulation – towards new opportunities for innovative functional brain mapping? Rev Neurosci 2016; 27:231-58. [DOI: 10.1515/revneuro-2015-0029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/17/2015] [Indexed: 11/15/2022]
Abstract
AbstractBoth electrical microstimulation (EMS) and direct electrical stimulation (DES) of the brain are used to perform functional brain mapping. EMS is applied to animal fundamental neuroscience experiments, whereas DES is performed in the operating theatre on neurosurgery patients. The objective of the present review was to shed new light on electrical stimulation techniques in brain mapping by comparing EMS and DES. There is much controversy as to whether the use of DES during wide-awake surgery is the ‘gold standard’ for studying the brain function. As part of this debate, it is sometimes wrongly assumed that EMS and DES induce similar effects in the nervous tissues and have comparable behavioural consequences. In fact, the respective stimulation parameters in EMS and DES are clearly different. More surprisingly, there is no solid biophysical rationale for setting the stimulation parameters in EMS and DES; this may be due to historical, methodological and technical constraints that have limited the experimental protocols and prompted the use of empirical methods. In contrast, the gap between EMS and DES highlights the potential for new experimental paradigms in electrical stimulation for functional brain mapping. In view of this gap and recent technical developments in stimulator design, it may now be time to move towards alternative, innovative protocols based on the functional stimulation of peripheral nerves (for which a more solid theoretical grounding exists).
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Affiliation(s)
- Marion Vincent
- 1INRIA, Université de Montpellier, LIRMM, équipe DEMAR, F-34095 Montpellier, France
| | - Olivier Rossel
- 1INRIA, Université de Montpellier, LIRMM, équipe DEMAR, F-34095 Montpellier, France
| | - Mitsuhiro Hayashibe
- 1INRIA, Université de Montpellier, LIRMM, équipe DEMAR, F-34095 Montpellier, France
| | | | | | - David Guiraud
- 1INRIA, Université de Montpellier, LIRMM, équipe DEMAR, F-34095 Montpellier, France
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243
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Combined DTI Tractography and Functional MRI Study of the Language Connectome in Healthy Volunteers: Extensive Mapping of White Matter Fascicles and Cortical Activations. PLoS One 2016; 11:e0152614. [PMID: 27029050 PMCID: PMC4814138 DOI: 10.1371/journal.pone.0152614] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 03/16/2016] [Indexed: 11/23/2022] Open
Abstract
Despite a better understanding of brain language organization into large-scale cortical networks, the underlying white matter (WM) connectivity is still not mastered. Here we combined diffusion tensor imaging (DTI) fiber tracking (FT) and language functional magnetic resonance imaging (fMRI) in twenty healthy subjects to gain new insights into the macroscopic structural connectivity of language. Eight putative WM fascicles for language were probed using a deterministic DTI-FT technique: the arcuate fascicle (AF), superior longitudinal fascicle (SLF), uncinate fascicle (UF), temporo-occipital fascicle, inferior fronto-occipital fascicle (IFOF), middle longitudinal fascicle (MdLF), frontal aslant fascicle and operculopremotor fascicle. Specific measurements (i.e. volume, length, fractional anisotropy) and precise cortical terminations were derived for each WM fascicle within both hemispheres. Connections between these WM fascicles and fMRI activations were studied to determine which WM fascicles are related to language. WM fascicle volumes showed asymmetries: leftward for the AF, temporoparietal segment of SLF and UF, and rightward for the frontoparietal segment of the SLF. The lateralization of the AF, IFOF and MdLF extended to differences in patterns of anatomical connections, which may relate to specific hemispheric abilities. The leftward asymmetry of the AF was correlated to the leftward asymmetry of fMRI activations, suggesting that the lateralization of the AF is a structural substrate of hemispheric language dominance. We found consistent connections between fMRI activations and terminations of the eight WM fascicles, providing a detailed description of the language connectome. WM fascicle terminations were also observed beyond fMRI-confirmed language areas and reached numerous cortical areas involved in different functional brain networks. These findings suggest that the reported WM fascicles are not exclusively involved in language and might be related to other cognitive functions such as visual recognition, spatial attention, executive functions, memory, and processing of emotional and behavioral aspects.
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244
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Alagapan S, Schmidt SL, Lefebvre J, Hadar E, Shin HW, Frӧhlich F. Modulation of Cortical Oscillations by Low-Frequency Direct Cortical Stimulation Is State-Dependent. PLoS Biol 2016; 14:e1002424. [PMID: 27023427 PMCID: PMC4811434 DOI: 10.1371/journal.pbio.1002424] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 03/02/2016] [Indexed: 01/05/2023] Open
Abstract
Cortical oscillations play a fundamental role in organizing large-scale functional brain networks. Noninvasive brain stimulation with temporally patterned waveforms such as repetitive transcranial magnetic stimulation (rTMS) and transcranial alternating current stimulation (tACS) have been proposed to modulate these oscillations. Thus, these stimulation modalities represent promising new approaches for the treatment of psychiatric illnesses in which these oscillations are impaired. However, the mechanism by which periodic brain stimulation alters endogenous oscillation dynamics is debated and appears to depend on brain state. Here, we demonstrate with a static model and a neural oscillator model that recurrent excitation in the thalamo-cortical circuit, together with recruitment of cortico-cortical connections, can explain the enhancement of oscillations by brain stimulation as a function of brain state. We then performed concurrent invasive recording and stimulation of the human cortical surface to elucidate the response of cortical oscillations to periodic stimulation and support the findings from the computational models. We found that (1) stimulation enhanced the targeted oscillation power, (2) this enhancement outlasted stimulation, and (3) the effect of stimulation depended on behavioral state. Together, our results show successful target engagement of oscillations by periodic brain stimulation and highlight the role of nonlinear interaction between endogenous network oscillations and stimulation. These mechanistic insights will contribute to the design of adaptive, more targeted stimulation paradigms. This study presents mathematical models that explain the effect of temporally patterned electrical stimulation on cortical oscillations and provides supporting evidence using data recorded directly from human cortex during transcranial electrical stimulation. Rhythms in the brain are believed to play an important role in cognition. Disruptions in these oscillations are associated with a number of neurological and psychiatric disorders. Therefore, noninvasive brain stimulation techniques that target these oscillations offer promise as therapeutic tools. In particular, transcranial alternating current stimulation (tACS) applies a periodic stimulation waveform to engage specific oscillations in the cortex. Although recent studies provide evidence for the modulation of cortical oscillations by tACS, the exact mechanism by which the effects are produced is poorly understood. We propose two mathematical models of interaction between periodic electrical stimulation and ongoing brain activity that may explain the effects of tACS. In addition, we present a unique dataset in which we stimulated the patients’ cortical surface with subdural electrodes and observed the responses to stimulation in neighboring electrodes. We found that stimulation enhanced ongoing oscillations both during and immediately after stimulation. This enhancement depended on the brain state, thereby supporting our proposed models. Our results demonstrate the effect of electrical stimulation on cortical oscillations and highlight the importance of considering the state of the brain when designing electrical stimulation therapies for disorders of the central nervous system.
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Affiliation(s)
- Sankaraleengam Alagapan
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Stephen L Schmidt
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.,UNC/NCSU Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jérémie Lefebvre
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Department of Mathematics, University of Toronto, Toronto, Ontario, Canada
| | - Eldad Hadar
- Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Hae Won Shin
- Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.,Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Flavio Frӧhlich
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.,UNC/NCSU Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.,Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.,Neurobiology Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.,Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.,Neuroscience Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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245
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Ojemann JG. Editorial: Passive language mapping. J Neurosurg 2016; 125:1577-1579. [PMID: 26991385 DOI: 10.3171/2015.6.jns15927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jeffrey G Ojemann
- Department of Neurological Surgery, University of Washington, Seattle Children's Hospital, Seattle, Washington
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246
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Electrocorticography Is Not Necessary During Awake Brain Surgery for Gliomas. World Neurosurg 2016; 91:656-7. [PMID: 27001242 DOI: 10.1016/j.wneu.2016.03.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 03/10/2016] [Indexed: 01/01/2023]
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247
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Long MA, Katlowitz KA, Svirsky MA, Clary RC, Byun TM, Majaj N, Oya H, Howard MA, Greenlee JDW. Functional Segregation of Cortical Regions Underlying Speech Timing and Articulation. Neuron 2016; 89:1187-1193. [PMID: 26924439 PMCID: PMC4833207 DOI: 10.1016/j.neuron.2016.01.032] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/20/2015] [Accepted: 01/08/2016] [Indexed: 02/03/2023]
Abstract
Spoken language is a central part of our everyday lives, but the precise roles that individual cortical regions play in the production of speech are often poorly understood. To address this issue, we focally lowered the temperature of distinct cortical regions in awake neurosurgical patients, and we relate this perturbation to changes in produced speech sequences. Using this method, we confirm that speech is highly lateralized, with the vast majority of behavioral effects seen on the left hemisphere. We then use this approach to demonstrate a clear functional dissociation between nearby cortical speech sites. Focal cooling of pars triangularis/pars opercularis (Broca's region) and the ventral portion of the precentral gyrus (speech motor cortex) resulted in the manipulation of speech timing and articulation, respectively. Our results support a class of models that have proposed distinct processing centers underlying motor sequencing and execution for speech.
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Affiliation(s)
- Michael A Long
- NYU Neuroscience Institute, Department of Otolaryngology, NYU Neuroscience Institute, New York University Langone Medical Center, New York, NY 10016 USA; Center for Neural Science, New York University, New York, NY 10003 USA.
| | - Kalman A Katlowitz
- NYU Neuroscience Institute, Department of Otolaryngology, NYU Neuroscience Institute, New York University Langone Medical Center, New York, NY 10016 USA; Center for Neural Science, New York University, New York, NY 10003 USA
| | - Mario A Svirsky
- NYU Neuroscience Institute, Department of Otolaryngology, NYU Neuroscience Institute, New York University Langone Medical Center, New York, NY 10016 USA; Center for Neural Science, New York University, New York, NY 10003 USA
| | - Rachel C Clary
- NYU Neuroscience Institute, Department of Otolaryngology, NYU Neuroscience Institute, New York University Langone Medical Center, New York, NY 10016 USA; Center for Neural Science, New York University, New York, NY 10003 USA
| | - Tara McAllister Byun
- Department of Communicative Sciences and Disorders, New York University, New York, NY 10012 USA
| | - Najib Majaj
- Center for Neural Science, New York University, New York, NY 10003 USA
| | - Hiroyuki Oya
- Department of Neurosurgery, Human Brain Research Lab, University of Iowa, Iowa City, IA 52242 USA
| | - Matthew A Howard
- Department of Neurosurgery, Human Brain Research Lab, University of Iowa, Iowa City, IA 52242 USA
| | - Jeremy D W Greenlee
- Department of Neurosurgery, Human Brain Research Lab, University of Iowa, Iowa City, IA 52242 USA
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248
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de Pesters A, Taplin AM, Adamo MA, Ritaccio AL, Schalk G. Electrocorticographic mapping of expressive language function without requiring the patient to speak: A report of three cases. EPILEPSY & BEHAVIOR CASE REPORTS 2016; 6:13-8. [PMID: 27408803 PMCID: PMC4925928 DOI: 10.1016/j.ebcr.2016.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 02/25/2016] [Accepted: 02/26/2016] [Indexed: 01/24/2023]
Abstract
Objective Patients requiring resective brain surgery often undergo functional brain mapping during perioperative planning to localize expressive language areas. Currently, all established protocols to perform such mapping require substantial time and patient participation during verb generation or similar tasks. These issues can make language mapping impractical in certain clinical circumstances (e.g., during awake craniotomies) or with certain populations (e.g., pediatric patients). Thus, it is important to develop new techniques that reduce mapping time and the requirement for active patient participation. Several neuroscientific studies reported that the mere auditory presentation of speech stimuli can engage not only receptive but also expressive language areas. Here, we tested the hypothesis that submission of electrocorticographic (ECoG) recordings during a short speech listening task to an appropriate analysis procedure can identify eloquent expressive language cortex without requiring the patient to speak. Methods Three patients undergoing temporary placement of subdural electrode grids passively listened to stories while we recorded their ECoG activity. We identified those sites whose activity in the broadband gamma range (70–170 Hz) changed immediately after presentation of the speech stimuli with respect to a prestimulus baseline. Results Our analyses revealed increased broadband gamma activity at distinct locations in the inferior frontal cortex, superior temporal gyrus, and/or perisylvian areas in all three patients and premotor and/or supplementary motor areas in two patients. The sites in the inferior frontal cortex that we identified with our procedure were either on or immediately adjacent to locations identified using electrical cortical stimulation (ECS) mapping. Conclusions The results of this study provide encouraging preliminary evidence that it may be possible that a brief and practical protocol can identify expressive language areas without requiring the patient to speak. This protocol could provide the clinician with a map of expressive language cortex within a few minutes. This may be useful as an adjunct to ECS interrogation or as an alternative to mapping using functional magnetic resonance imaging (fMRI). In conclusion, with further development and validation in more subjects, the approach presented here could help in identifying expressive language areas in situations where patients cannot speak in response to task instructions.
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Affiliation(s)
- Adriana de Pesters
- National Center for Adaptive Neurotechnologies, Wadsworth Center, New York State Department of Health, Albany, NY, USA; Department of Biomedical Sciences, State University of New York at Albany, Albany, NY, USA
| | - AmiLyn M Taplin
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Matthew A Adamo
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | | | - Gerwin Schalk
- National Center for Adaptive Neurotechnologies, Wadsworth Center, New York State Department of Health, Albany, NY, USA; Department of Biomedical Sciences, State University of New York at Albany, Albany, NY, USA; Department of Neurology, Albany Medical College, Albany, NY, USA
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249
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Cheung C, Hamiton LS, Johnson K, Chang EF. The auditory representation of speech sounds in human motor cortex. eLife 2016; 5. [PMID: 26943778 PMCID: PMC4786411 DOI: 10.7554/elife.12577] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 02/12/2016] [Indexed: 11/13/2022] Open
Abstract
In humans, listening to speech evokes neural responses in the motor cortex. This has been controversially interpreted as evidence that speech sounds are processed as articulatory gestures. However, it is unclear what information is actually encoded by such neural activity. We used high-density direct human cortical recordings while participants spoke and listened to speech sounds. Motor cortex neural patterns during listening were substantially different than during articulation of the same sounds. During listening, we observed neural activity in the superior and inferior regions of ventral motor cortex. During speaking, responses were distributed throughout somatotopic representations of speech articulators in motor cortex. The structure of responses in motor cortex during listening was organized along acoustic features similar to auditory cortex, rather than along articulatory features as during speaking. Motor cortex does not contain articulatory representations of perceived actions in speech, but rather, represents auditory vocal information.
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Affiliation(s)
- Connie Cheung
- Graduate Program in Bioengineering, University of California, Berkeley-University of California, San Francisco, San Francisco, United States.,Department of Neurological Surgery, University of California, San Francisco, San Francisco, United States.,Center for Integrative Neuroscience, University of California, San Francisco, San Francisco, United States.,Department of Physiology, University of California, San Francisco, San Francisco, United States
| | - Liberty S Hamiton
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, United States.,Center for Integrative Neuroscience, University of California, San Francisco, San Francisco, United States.,Department of Physiology, University of California, San Francisco, San Francisco, United States
| | - Keith Johnson
- Department of Linguistics, University of California, Berkeley, Berkeley, United States
| | - Edward F Chang
- Graduate Program in Bioengineering, University of California, Berkeley-University of California, San Francisco, San Francisco, United States.,Department of Neurological Surgery, University of California, San Francisco, San Francisco, United States.,Center for Integrative Neuroscience, University of California, San Francisco, San Francisco, United States.,Department of Physiology, University of California, San Francisco, San Francisco, United States
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250
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Blank I, Balewski Z, Mahowald K, Fedorenko E. Syntactic processing is distributed across the language system. Neuroimage 2016; 127:307-323. [PMID: 26666896 PMCID: PMC4755877 DOI: 10.1016/j.neuroimage.2015.11.069] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 10/23/2015] [Accepted: 11/28/2015] [Indexed: 11/30/2022] Open
Abstract
Language comprehension recruits an extended set of regions in the human brain. Is syntactic processing localized to a particular region or regions within this system, or is it distributed across the entire ensemble of brain regions that support high-level linguistic processing? Evidence from aphasic patients is more consistent with the latter possibility: damage to many different language regions and to white-matter tracts connecting them has been shown to lead to similar syntactic comprehension deficits. However, brain imaging investigations of syntactic processing continue to focus on particular regions within the language system, often parts of Broca's area and regions in the posterior temporal cortex. We hypothesized that, whereas the entire language system is in fact sensitive to syntactic complexity, the effects in some regions may be difficult to detect because of the overall lower response to language stimuli. Using an individual-subjects approach to localizing the language system, shown in prior work to be more sensitive than traditional group analyses, we indeed find responses to syntactic complexity throughout this system, consistent with the findings from the neuropsychological patient literature. We speculate that such distributed nature of syntactic processing could perhaps imply that syntax is inseparable from other aspects of language comprehension (e.g., lexico-semantic processing), in line with current linguistic and psycholinguistic theories and evidence. Neuroimaging investigations of syntactic processing thus need to expand their scope to include the entire system of high-level language processing regions in order to fully understand how syntax is instantiated in the human brain.
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Affiliation(s)
- Idan Blank
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, 77 Massachusetts Ave., Cambridge, MA 02139, USA; McGovern Institute for Brain Research, Massachusetts Institute of Technology, 77 Massachusetts Ave., Cambridge, MA 02139, USA.
| | - Zuzanna Balewski
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, 77 Massachusetts Ave., Cambridge, MA 02139, USA
| | - Kyle Mahowald
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, 77 Massachusetts Ave., Cambridge, MA 02139, USA
| | - Evelina Fedorenko
- Department of Psychiatry, Massachusetts General Hospital, East 13th Street, Charlestown, MA 02129, USA.
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