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Rouse MA, Ramanan S, Halai AD, Volfart A, Garrard P, Patterson K, Rowe JB, Lambon Ralph MA. The impact of bilateral versus unilateral anterior temporal lobe damage on face recognition, person knowledge and semantic memory. Cereb Cortex 2024; 34:bhae336. [PMID: 39123309 PMCID: PMC11315654 DOI: 10.1093/cercor/bhae336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 07/24/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
The functional importance of the anterior temporal lobes (ATLs) has come to prominence in two active, albeit unconnected literatures-(i) face recognition and (ii) semantic memory. To generate a unified account of the ATLs, we tested the predictions from each literature and examined the effects of bilateral versus unilateral ATL damage on face recognition, person knowledge, and semantic memory. Sixteen people with bilateral ATL atrophy from semantic dementia (SD), 17 people with unilateral ATL resection for temporal lobe epilepsy (TLE; left = 10, right = 7), and 14 controls completed tasks assessing perceptual face matching, person knowledge and general semantic memory. People with SD were impaired across all semantic tasks, including person knowledge. Despite commensurate total ATL damage, unilateral resection generated mild impairments, with minimal differences between left- and right-ATL resection. Face matching performance was largely preserved but slightly reduced in SD and right TLE. All groups displayed the familiarity effect in face matching; however, it was reduced in SD and right TLE and was aligned with the level of item-specific semantic knowledge in all participants. We propose a neurocognitive framework whereby the ATLs underpin a resilient bilateral representation system that supports semantic memory, person knowledge and face recognition.
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Affiliation(s)
- Matthew A Rouse
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, UK
| | - Siddharth Ramanan
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, UK
| | - Ajay D Halai
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, UK
| | - Angélique Volfart
- Université de Lorraine, CNRS, 2 avenue de la Forêt de Haye, Nancy F-54000, France
- Psychological Sciences Research Institute, University of Louvain, Place du Cardinal Mercier, 10, Louvain-la-Neuve B-1348, Belgium
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Victoria Park Road, Brisbane 4059, Australia
| | - Peter Garrard
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Karalyn Patterson
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, UK
- Department of Clinical Neurosciences, University of Cambridge, Hills Road, Cambridge CB2 0SZ, United Kingdom
| | - James B Rowe
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, UK
- Department of Clinical Neurosciences, University of Cambridge, Hills Road, Cambridge CB2 0SZ, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0SZ, United Kingdom
| | - Matthew A Lambon Ralph
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, UK
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Reecher HM, Bearden DJ, Koop JI, Berl MM, Patrick KE, Ailion AS. The changing landscape of electrical stimulation language mapping with subdural electrodes and stereoelectroencephalography for pediatric epilepsy: A literature review and commentary. Epilepsia 2024; 65:1879-1898. [PMID: 38787551 DOI: 10.1111/epi.18009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024]
Abstract
Electrical stimulation mapping (ESM) is used to locate the brain areas supporting language directly within the human cortex to minimize the risk of functional decline following epilepsy surgery. ESM is completed by utilizing subdural grid or depth electrodes (stereo-electroencephalography [sEEG]) in combination with behavioral evaluation of language. Despite technological advances, there is no standardized method of assessing language during pediatric ESM. To identify current clinical practices for pediatric ESM of language, we surveyed neuropsychologists in the Pediatric Epilepsy Research Consortium. Results indicated that sEEG is used for functional mapping at >80% of participating epilepsy surgery centers (n = 13/16) in the United States. However, >65% of sites did not report a standardized protocol to map language. Survey results indicated a clear need for practice recommendations regarding ESM of language. We then utilized PubMed/Medline and PsychInfo to identify 42 articles that reported on ESM of language, of which 18 met inclusion criteria, which included use of ESM/signal recording to localize language regions in children (<21 years) and a detailed account of the procedure and language measures used, and region-specific language localization outcomes. Articles were grouped based on the language domain assessed, language measures used, and the brain regions involved. Our review revealed the need for evidence-based clinical guidelines for pediatric language paradigms during ESM and a standardized language mapping protocol as well as standardized reporting of brain regions in research. Relevant limitations and future directions are discussed with a focus on considerations for pediatric language mapping.
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Affiliation(s)
- Hope M Reecher
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Donald J Bearden
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Jennifer I Koop
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Neurology, Department of Neuropsychology, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Madison M Berl
- Department of Neuropsychology, Children's National Hospital, Washington, DC, USA
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Kristina E Patrick
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Neuroscience, Seattle Children's Hospital, Seattle, Washington, USA
| | - Alyssa S Ailion
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Kheder A. Escaping the Procrustean Bed: A Perspective on Pediatric Stereoelectroencephalography. J Clin Neurophysiol 2024; 41:410-414. [PMID: 38935654 DOI: 10.1097/wnp.0000000000001047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
SUMMARY Stereoelectroencephalography is an established, hypothesis-driven method for investigating refractory epilepsy. There are special considerations and some limitations that apply to children who undergo stereoelectroencephalography. A key principle in stereoelectroencephalography is taking an individualized approach to investigating refractory epilepsy. A crucial factor for success in a personalized pediatric epilepsy surgery is understanding some of the fundamental and unique aspects of it, including, but not limited to, diverse etiology, epilepsy syndromes, maturation, and age-related characteristics as well as neural plasticity. Such features are reflected in the ontogeny of semiology and electrophysiology. In addition, special considerations are taken into account during cortical stimulation in children. Stereoelectroencephalography can guide a tailored surgical intervention where it is sufficient to render the patient seizure-free but it also lessens collateral damage with a minimum or no functional deficit. Epilepsy surgery outcomes remain stagnant despite advances in noninvasive testing modalities. A stereoelectroencephalography "way of thinking" and guided mentorship may influence outcomes positively.
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Affiliation(s)
- Ammar Kheder
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, U.S.A
- Children's Healthcare of Atlanta, Atlanta, Georgia, U.S.A.; and
- Emory and Children's Pediatric Institute, 2015 Uppergate Drive, Atlanta, Georgia, U.S.A
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4
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Leisman G. On the Application of Developmental Cognitive Neuroscience in Educational Environments. Brain Sci 2022; 12:1501. [PMID: 36358427 PMCID: PMC9688360 DOI: 10.3390/brainsci12111501] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/25/2022] [Accepted: 11/01/2022] [Indexed: 09/29/2023] Open
Abstract
The paper overviews components of neurologic processing efficiencies to develop innovative methodologies and thinking to school-based applications and changes in educational leadership based on sound findings in the cognitive neurosciences applied to schools and learners. Systems science can allow us to better manage classroom-based learning and instruction on the basis of relatively easily evaluated efficiencies or inefficiencies and optimization instead of simply examining achievement. "Medicalizing" the learning process with concepts such as "learning disability" or employing grading methods such as pass-fail does little to aid in understanding the processes that learners employ to acquire, integrate, remember, and apply information learned. The paper endeavors to overview and provided reference to tools that can be employed that allow a better focus on nervous system-based strategic approaches to classroom learning.
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Affiliation(s)
- Gerry Leisman
- Movement and Cognition Laboratory, Department of Physical Therapy, University of Haifa, Haifa 3498838, Israel; or
- Department of Neurology, Universidad de Ciencias Médicas de la Habana, Havana 11300, Cuba
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Binding LP, Dasgupta D, Giampiccolo D, Duncan JS, Vos SB. Structure and function of language networks in temporal lobe epilepsy. Epilepsia 2022; 63:1025-1040. [PMID: 35184291 PMCID: PMC9773900 DOI: 10.1111/epi.17204] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 12/30/2022]
Abstract
Individuals with temporal lobe epilepsy (TLE) may have significant language deficits. Language capabilities may further decline following temporal lobe resections. The language network, comprising dispersed gray matter regions interconnected with white matter fibers, may be atypical in individuals with TLE. This review explores the structural changes to the language network and the functional reorganization of language abilities in TLE. We discuss the importance of detailed reporting of patient's characteristics, such as, left- and right-sided focal epilepsies as well as lesional and nonlesional pathological subtypes. These factors can affect the healthy functioning of gray and/or white matter. Dysfunction of white matter and displacement of gray matter function could concurrently impact their ability, in turn, producing an interactive effect on typical language organization and function. Surgical intervention can result in impairment of function if the resection includes parts of this structure-function network that are critical to language. In addition, impairment may occur if language function has been reorganized and is included in a resection. Conversely, resection of an epileptogenic zone may be associated with recovery of cortical function and thus improvement in language function. We explore the abnormality of functional regions in a clinically applicable framework and highlight the differences in the underlying language network. Avoidance of language decline following surgical intervention may depend on tailored resections to avoid critical areas of gray matter and their white matter connections. Further work is required to elucidate the plasticity of the language network in TLE and to identify sub-types of language representation, both of which will be useful in planning surgery to spare language function.
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Affiliation(s)
- Lawrence P. Binding
- Department of Computer ScienceCentre for Medical Image ComputingUniversity College LondonLondonUK
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Debayan Dasgupta
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
- Victor Horsley Department of NeurosurgeryNational Hospital for Neurology and NeurosurgeryLondonUK
| | - Davide Giampiccolo
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
- Victor Horsley Department of NeurosurgeryNational Hospital for Neurology and NeurosurgeryLondonUK
- Institute of NeuroscienceCleveland Clinic LondonLondonUK
- Department of NeurosurgeryVerona University HospitalUniversity of VeronaVeronaItaly
| | - John S. Duncan
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Sjoerd B. Vos
- Department of Computer ScienceCentre for Medical Image ComputingUniversity College LondonLondonUK
- Neuroradiological Academic UnitUCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
- Centre for Microscopy, Characterisation, and AnalysisThe University of Western AustraliaNedlandsWestern AustraliaAustralia
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6
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Alotaibi F, Mir A, Al-Faraidy M, Jallul T, Al-Baradie R. Pediatric awake epilepsy surgery: Intraoperative language mapping utilizing digital video gaming and electrocorticography. Epilepsy Behav Rep 2022; 17:100521. [PMID: 35118367 PMCID: PMC8792417 DOI: 10.1016/j.ebr.2021.100521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 11/20/2022] Open
Abstract
Awake craniotomy for language mapping in children requires a specific perioperative strategy. Extraoperative language cortical mapping using a grid electrode provides more optimal setting that reduces anxiety and improves compliance. The utilization of video game familiar to the pediatric patient reduce anxiety and enhance cooperation during awake language cortical mapping.
Intraoperative functional language mapping is vital to minimize the risks associated with surgical removal of the seizure onset zone in selected patients with epilepsy. In children, this method has been reported extraoperatively by the placement of invasive electrodes to map the language area and monitor epileptic activity. It is difficult from a technical standpoint to perform an awake craniotomy and language mapping in young children under 10 years of age. Here we report a 9-year-old boy suffering from drug-resistant non-lesional epilepsy who underwent extraoperative and intraoperative electrical stimulation with successful identification of Broca’s language area. Electrocorticography (ECOG) was applied intraoperatively in a continuous manner utilizing grid electrodes before the skin opening. We found that the use of visual digital video games facilitated extraoperative and intraoperative cortical mapping. Cortical language inhibition by electrical stimulation was elicited at an amplitude of 7 mA (100 μs single-phase duration and 50 Hz pulse width). Resection of the seizure onset zone was completed safely. The post-resection ECOG revealed the disappearance of epileptogenic electrographic discharges at the seizure onset contacts and at other involved contacts in the epileptogenic zone. After surgery, the child recovered well with no language deficits and remained seizure-free. The child remembered only the video game test that was performed intraoperatively. This report highlights safety strategies for awake language mapping in pediatrics and the importance of the perioperative use of a visual digital video game and continuous ECOG, in addition to the use of targeted language cortex stimulation to facilitate faster and safer intraoperative language mapping under awake conditions in this age group.
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Affiliation(s)
- Faisal Alotaibi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Neuroscience Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Corresponding author at: Division of Neurological Surgery, Neuroscience Department, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia.
| | - Ali Mir
- Neuroscience Centre, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mona Al-Faraidy
- Anesthesia Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Tareq Jallul
- Neuroscience Centre, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Raidah Al-Baradie
- Neuroscience Centre, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Koop JI, Credille K, Wang Y, Loman M, Marashly A, Kim I, Lew SM, Maheshwari M. Determination of language dominance in pediatric patients with epilepsy for clinical decision-making: Correspondence of intracarotid amobarbitol procedure and fMRI modalities. Epilepsy Behav 2021; 121:108041. [PMID: 34082317 DOI: 10.1016/j.yebeh.2021.108041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 11/29/2022]
Abstract
Identification of the language dominant hemisphere is an essential part of the evaluation of potential pediatric epilepsy surgery patients. Historically, language dominance has been determined using the intracarotid amobarbitol procedure (IAP), but use of functional Magnetic Resonance Imaging (fMRI) scanning is becoming more common. Few studies examine the correspondence between fMRI and IAP in pediatric samples. The current study examined the agreement of hemispheric lateralization as determined by fMRI and IAP in a consecutive sample of 10 pediatric patients with epilepsy evaluated for epilepsy surgery. Data showed a strong correlation between IAP and fMRI lateralilty indices (r=.91) and 70% agreement in determination of hemispheric dominance, despite increased demonstration of bilateral or atypical language representation in this pediatric sample. Clinical implications and interpretation challenges are discussed.
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Affiliation(s)
- Jennifer I Koop
- Department of Neurology (Neuropsychology), Medical College of Wisconsin, Milwaukee, WI, United States.
| | - Kevin Credille
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Yang Wang
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Michelle Loman
- Department of Neurology (Neuropsychology), Medical College of Wisconsin, Milwaukee, WI, United States
| | - Ahmad Marashly
- Division of Pediatric Neurology, University of Washington/Seattle Children's Hospital, Seattle, WA, United States
| | - Irene Kim
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Sean M Lew
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Mohit Maheshwari
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, United States
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8
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Aron O, Jonas J, Colnat-Coulbois S, Maillard L. Language Mapping Using Stereo Electroencephalography: A Review and Expert Opinion. Front Hum Neurosci 2021; 15:619521. [PMID: 33776668 PMCID: PMC7987679 DOI: 10.3389/fnhum.2021.619521] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/11/2021] [Indexed: 11/25/2022] Open
Abstract
Stereo-electroencephalography (sEEG) is a method that uses stereotactically implanted depth electrodes for extra-operative mapping of epileptogenic and functional networks. sEEG derived functional mapping is achieved using electrical cortical stimulations (ECS) that are currently the gold standard for delineating eloquent cortex. As this stands true especially for primary cortices (e.g., visual, sensitive, motor, etc.), ECS applied to higher order brain areas determine more subtle behavioral responses. While anterior and posterior language areas in the dorsal language stream seem to share characteristics with primary cortices, basal temporal language area (BTLA) in the ventral temporal cortex (VTC) behaves as a highly associative cortex. After a short introduction and considerations about methodological aspects of ECS using sEEG, we review the sEEG language mapping literature in this perspective. We first establish the validity of this technique to map indispensable language cortices in the dorsal language stream. Second, we highlight the contrast between the growing empirical ECS experience and the lack of understanding regarding the fundamental mechanisms underlying ECS behavioral effects, especially concerning the dispensable language cortex in the VTC. Evidences for considering network architecture as determinant for ECS behavioral response complexities are discussed. Further, we address the importance of designing new research in network organization of language as this could enhance ECS ability to map interindividual variability, pathology driven reorganization, and ultimately identify network resilience markers in order to better predict post-operative language deficit. Finally, based on a whole body of available studies, we believe there is strong evidence to consider sEEG as a valid, safe and reliable method for defining eloquent language cortices although there have been no proper comparisons between surgical resections with or without extra-operative or intra-operative language mapping.
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Affiliation(s)
- Olivier Aron
- Department of Neurology, Nancy University Hospital Center, Nancy, France
- CRAN, Université́ de Lorraine, CNRS, Nancy, France
| | - Jacques Jonas
- Department of Neurology, Nancy University Hospital Center, Nancy, France
- CRAN, Université́ de Lorraine, CNRS, Nancy, France
| | | | - Louis Maillard
- Department of Neurology, Nancy University Hospital Center, Nancy, France
- CRAN, Université́ de Lorraine, CNRS, Nancy, France
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9
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Grande KM, Ihnen SKZ, Arya R. Electrical Stimulation Mapping of Brain Function: A Comparison of Subdural Electrodes and Stereo-EEG. Front Hum Neurosci 2020; 14:611291. [PMID: 33364930 PMCID: PMC7750438 DOI: 10.3389/fnhum.2020.611291] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
Despite technological and interpretative advances, the non-invasive modalities used for pre-surgical evaluation of patients with drug-resistant epilepsy (DRE), fail to generate a concordant anatomo-electroclinical hypothesis for the location of the seizure onset zone in many patients. This requires chronic monitoring with intracranial electroencephalography (EEG), which facilitates better localization of the seizure onset zone, and allows evaluation of the functional significance of cortical regions-of-interest by electrical stimulation mapping (ESM). There are two principal modalities for intracranial EEG, namely subdural electrodes and stereotactic depth electrodes (stereo-EEG). Although ESM is considered the gold standard for functional mapping with subdural electrodes, there have been concerns about its utility with stereo-EEG. This is mainly because subdural electrodes allow contiguous sampling of the dorsolateral convexity of cerebral hemispheres, and permit delineation of the extent of eloquent functional areas on the cortical surface. Stereo-EEG, while having relatively sparse sampling on the cortical surface, offers the ability to access the depth of sulci, mesial and basal surfaces of cerebral hemispheres, and deep structures such as the insula, which are largely inaccessible to subdural electrodes. As stereo-EEG is increasingly the preferred modality for intracranial monitoring, we find it opportune to summarize the literature for ESM with stereo-EEG in this narrative review. Emerging evidence shows that ESM for defining functional neuroanatomy is feasible with stereo-EEG, but probably requires a different approach for interpretation and clinical decision making compared to ESM with subdural electrodes. We have also compared ESM with stereo-EEG and subdural electrodes, for current thresholds required to evoke desired functional responses vs. unwanted after-discharges. In this regard, there is preliminary evidence that ESM with stereo-EEG may be safer than ESM with subdural grids. Finally, we have highlighted important unanswered clinical and scientific questions for ESM with stereo-EEG in the hope to encourage future research and collaborative efforts.
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Affiliation(s)
- Krista M. Grande
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Sarah K. Z. Ihnen
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Ravindra Arya
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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10
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Roubicek G, Gonzalez L, Lah S, Jackman A, Harvey AS, Saling MM. Verbal memory in children with temporal lobe epilepsy: Exploring task-specificity. Epilepsy Behav 2020; 111:107341. [PMID: 32795885 DOI: 10.1016/j.yebeh.2020.107341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/30/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022]
Abstract
RATIONALE This study explored the applicability of the adult model of task-specificity of memory to children with temporal lobe epilepsy (TLE). METHOD Retrospective clinical audit; 38 children and adolescents (6-16 years) with lesional TLE (n = 22 mesial; n = 16 lateral) treated at tertiary pediatric hospitals completed two types of verbal memory paradigms: arbitrary associative (Verbal Paired Associates - Hard Pairs) and semantically related (Verbal Paired Associates - Easy Pairs; Stories). RESULTS Children with mesial TLE performed more poorly than their lateral TLE counterparts on both types of memory paradigms: arbitrary associative and semantically related (Stories only). Groups with left and right TLE performed comparably on all verbal memory measures. CONCLUSIONS Our findings suggest that the adult model of task-specificity may not be completely applicable to children with TLE. Consideration of the developmental context is critical in research and clinical work with pediatric populations.
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Affiliation(s)
- Gabriella Roubicek
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia.
| | - Linda Gonzalez
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, Australia.
| | - Suncica Lah
- School of Psychology, The University of Sydney, 94 - 100 Mallett Street, Camperdown, Sydney, New South Wales, Australia.
| | - Angie Jackman
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia.
| | - A Simon Harvey
- Department of Neurology, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.
| | - Michael Martin Saling
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia; The Florey Institute of Neuroscience and Mental Health, 245 Burgundy Street, Heidelberg, Victoria, Australia.
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11
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Hyslop A, Duchowny M. Electrical stimulation mapping in children. Seizure 2020; 77:59-63. [DOI: 10.1016/j.seizure.2019.07.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 12/01/2022] Open
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12
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Gonzalez LM, Wrennall JA. A neuropsychological model for the pre-surgical evaluation of children with focal-onset epilepsy: An integrated approach. Seizure 2020; 77:29-39. [DOI: 10.1016/j.seizure.2018.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/28/2018] [Accepted: 12/17/2018] [Indexed: 12/20/2022] Open
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13
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Balter S, Lin G, Leyden KM, Paul BM, McDonald CR. Neuroimaging correlates of language network impairment and reorganization in temporal lobe epilepsy. BRAIN AND LANGUAGE 2019; 193:31-44. [PMID: 27393391 PMCID: PMC5215985 DOI: 10.1016/j.bandl.2016.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/27/2016] [Accepted: 06/15/2016] [Indexed: 06/02/2023]
Abstract
Advanced, noninvasive imaging has revolutionized our understanding of language networks in the brain and is reshaping our approach to the presurgical evaluation of patients with epilepsy. Functional magnetic resonance imaging (fMRI) has had the greatest impact, unveiling the complexity of language organization and reorganization in patients with epilepsy both pre- and postoperatively, while volumetric MRI and diffusion tensor imaging have led to a greater appreciation of structural and microstructural correlates of language dysfunction in different epilepsy syndromes. In this article, we review recent literature describing how unimodal and multimodal imaging has advanced our knowledge of language networks and their plasticity in epilepsy, with a focus on the most frequently studied epilepsy syndrome in adults, temporal lobe epilepsy (TLE). We also describe how new analytic techniques (i.e., graph theory) are leading to a refined characterization of abnormal brain connectivity, and how subject-specific imaging profiles combined with clinical data may enhance the prediction of both seizure and language outcomes following surgical interventions.
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Affiliation(s)
- S Balter
- Department of Neurology, University of California, San Francisco, CA, United States; UCSF Comprehensive Epilepsy Center, United States
| | - G Lin
- Palo Alto University, Palo Alto, CA, United States
| | - K M Leyden
- Multimodal Imaging Laboratory, University of California, San Diego, CA, United States
| | - B M Paul
- Department of Neurology, University of California, San Francisco, CA, United States; UCSF Comprehensive Epilepsy Center, United States
| | - C R McDonald
- Multimodal Imaging Laboratory, University of California, San Diego, CA, United States; Department of Psychiatry, University of California, San Diego, CA, United States.
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14
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MEG Assessment of Expressive Language in Children Evaluated for Epilepsy Surgery. Brain Topogr 2019; 32:492-503. [PMID: 30895423 PMCID: PMC6476853 DOI: 10.1007/s10548-019-00703-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 03/07/2019] [Indexed: 11/21/2022]
Abstract
Establishing language dominance is an important step in the presurgical evaluation of patients with refractory epilepsy. In the absence of a universally accepted gold-standard non-invasive method to determine language dominance in the preoperative assessment, a range of tools and methodologies have recently received attention. When applied to pediatric age, many of the proposed methods, such as functional magnetic resonance imaging (fMRI), may present some challenges due to the time-varying effects of epileptogenic lesions and of on-going seizures on maturational phenomena. Magnetoencephalography (MEG) has the advantage of being insensitive to the distortive effects of anatomical lesions on brain microvasculature and to differences in the metabolism or vascularization of the developing brain and also provides a less intimidating recording environment for younger children. In this study we investigated the reliability of lateralized synchronous cortical activation during a verb generation task in a group of 28 children (10 males and 18 females, mean age 12 years) with refractory epilepsy who were evaluated for epilepsy surgery. The verb generation task was associated with significant decreases in beta oscillatory power (13–30 Hz) in frontal and temporal lobes. The MEG data were compared with other available presurgical non-invasive data including cortical stimulation, neuropsychological and fMRI data on language lateralization where available. We found that the lateralization of MEG beta power reduction was concordant with language dominance determined by one or more different assessment methods (i.e. cortical stimulation mapping, neuropsychological, fMRI or post-operative data) in 89% of patients. Our data suggest that qualitative hemispheric differences in task-related changes of spectral power could offer a promising insight into the contribution of dominant and non-dominant hemispheres in language processing and may help to characterize the specialization and lateralization of language processes in children.
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Drane DL, Pedersen NP. Knowledge of language function and underlying neural networks gained from focal seizures and epilepsy surgery. BRAIN AND LANGUAGE 2019; 189:20-33. [PMID: 30615986 PMCID: PMC7183240 DOI: 10.1016/j.bandl.2018.12.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 09/05/2018] [Accepted: 12/19/2018] [Indexed: 05/09/2023]
Abstract
The effects of epilepsy and its treatments have contributed significantly to language models. The setting of epilepsy surgery, which allows for careful pre- and postsurgical evaluation of patients with cognitive testing and neuroimaging, has produced a wealth of language findings. Moreover, a new wave of surgical interventions, including stereotactic laser ablation and radio frequency ablation, have contributed new insights and corrections to language models as they can make extremely precise, focal lesions. This review covers the common language deficits observed in focal dyscognitive seizure syndromes. It also addresses the effects of surgical interventions on language, and highlights insights gained from unique epilepsy assessment methods (e.g., cortical stimulation mapping, Wada evaluation). Emergent findings are covered including a lack of involvement of the hippocampus in confrontation word retrieval, possible roles for key white matter tracts in language, and the often-overlooked basal temporal language area. The relationship between language and semantic memory networks is also explored, with brief consideration given to the prevailing models of semantic processing, including the amodal Hub and distributed, multi-modal processing models.
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Affiliation(s)
- Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA.
| | - Nigel P Pedersen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
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16
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Electrical Stimulation Mapping of the Brain: Basic Principles and Emerging Alternatives. J Clin Neurophysiol 2018; 35:86-97. [PMID: 29499015 DOI: 10.1097/wnp.0000000000000440] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The application of electrical stimulation mapping (ESM) of the brain for clinical use is approximating a century. Despite this long-standing history, the value of ESM for guiding surgical resections and sparing eloquent cortex is documented largely by small retrospective studies, and ESM protocols are largely inherited and lack standardization. Although models are imperfect and mechanisms are complex, the probabilistic causality of ESM has guaranteed its perpetuation into the 21st century. At present, electrical stimulation of cortical tissue is being revisited for network connectivity. In addition, noninvasive and passive mapping techniques are rapidly evolving to complement and potentially replace ESM in specific clinical situations. Lesional and epilepsy neurosurgery cases now offer different opportunities for multimodal functional assessments.
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Chou N, Serafini S, Muh CR. Cortical Language Areas and Plasticity in Pediatric Patients With Epilepsy: A Review. Pediatr Neurol 2018; 78:3-12. [PMID: 29191650 DOI: 10.1016/j.pediatrneurol.2017.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 08/28/2017] [Accepted: 10/02/2017] [Indexed: 12/12/2022]
Abstract
Chronic injury to the brain from seizure activity is associated with decreased language skills in pediatric patients, as measured on neuropsychological tests for language function and academic achievement. This makes the study of language in patients with epilepsy clinically necessary. Functional magnetic resonance imaging and direct electrical cortical stimulation have been used to evaluate aspects of cortical language processing in healthy adults and in adults with epilepsy or other neurological insults. Results of these studies help to locate cortical language areas that are involved with modality-specific language processing (visual naming, auditory naming, sentence-completion, and repetition) and the neuroplasticity of language areas in the setting of neurological injury and reorganization. A better understanding of language processing contributes to a more efficient and efficacious electrical cortical stimulation mapping of language areas for patients with intractable epilepsy who are undergoing preresection evaluation. Most of the current literature on localization and reorganization of cortical language areas in the setting of epilepsy concerns the adult patient population, whereas the literature on pediatric patients is substantially lacking in comparison. This article reviews the conclusions drawn thus far from Wada, magnetoencephalography, functional magnetic resonance imaging, and electrical cortical stimulation language studies on types of language reorganization seen in pediatric patients with intractable temporal lobe epilepsy and the clinical factors associated with reorganization, and proposes future directions of research to further the academic and clinical understanding of language processing in pediatric patients.
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Affiliation(s)
- Naomi Chou
- Duke University School of Medicine, Durham, North Carolina
| | - Sandra Serafini
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Carrie R Muh
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina.
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Language Representation Following Left MCA Stroke in Children and Adults: An fMRI Study. Can J Neurol Sci 2017; 44:483-497. [PMID: 28468691 DOI: 10.1017/cjn.2017.44] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In this case series, functional magnetic resonance imaging was used to examine brain networks that mediate different aspects of language function in 4 young adults (17-22 years) with a history of left middle cerebral artery (MCA) stroke in childhood (40 years of age). Although it is widely believed that altered lateralization patterns are more likely to occur following early brain injuries compared with later brain injuries, the presumed plasticity of the young brain has been challenged in recent years, particularly in the domain of language. METHODS We explored this issue by contrasting the brain activation patterns of individuals with childhood left MCA stroke and adult left MCA stroke while performing two language tasks: verb generation and picture-word matching. Importantly, both groups showed significant recovery of language function, based on standard clinical indicators. RESULTS Controls showed left lateralized activation for both tasks, although much more pronounced for verb generation. Adult stroke patients also showed left lateralization for both tasks, though somewhat weaker than controls. Childhood stroke patients exhibited significantly weaker lateralization than the adult group for verb generation, but there was no significant group difference for picture-word matching. CONCLUSIONS These preliminary findings suggest that successful reorganization of language function is more likely to involve bilateral recruitment following left MCA stroke in childhood than in adulthood. Of importance, although childhood stroke patients had primarily subcortical lesions, there were substantial alterations in cortical activation patterns.
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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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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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Duchowny M. Targeting tubers in paediatric epilepsy surgery candidates. Brain 2016; 139:2583-2586. [PMID: 27671027 DOI: 10.1093/brain/aww216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael Duchowny
- Department of Neurology, Miami Children's Health System, Clinical Professor of Neurology, Herbert Wortheim College of Medicine, Florida International University, Miami, Florida, USA
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Maulisova A, Korman B, Rey G, Bernal B, Duchowny M, Niederlova M, Krsek P, Novak V. Atypical language representation in children with intractable temporal lobe epilepsy. Epilepsy Behav 2016; 58:91-6. [PMID: 27064828 DOI: 10.1016/j.yebeh.2016.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 03/04/2016] [Accepted: 03/05/2016] [Indexed: 11/29/2022]
Abstract
This study evaluated language organization in children with intractable epilepsy caused by temporal lobe focal cortical dysplasia (FCD) alone or dual pathology (temporal lobe FCD and hippocampal sclerosis, HS). We analyzed clinical, neurological, fMRI, neuropsychological, and histopathologic data in 46 pediatric patients with temporal lobe lesions who underwent excisional epilepsy surgery. The frequency of atypical language representation was similar in both groups, but children with dual pathology were more likely to be left-handed. Atypical receptive language cortex correlated with lower intellectual capacity, verbal abstract conceptualization, receptive language abilities, verbal working memory, and a history of status epilepticus but did not correlate with higher seizure frequency or early seizure onset. Histopathologic substrate had only a minor influence on neuropsychological status. Greater verbal comprehension deficits were noted in children with atypical receptive language representation, a risk factor for cognitive morbidity.
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Affiliation(s)
- Alice Maulisova
- Charles University, Faculty of Arts, Department of Psychology, Prague, Czech Republic; Motol University Hospital, Prague, Czech Republic
| | - Brandon Korman
- Brain Institute, Nicklaus Children's Hospital, Miami, FL, United States.
| | - Gustavo Rey
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Byron Bernal
- Department of Radiology, Nicklaus Children's Hospital, Miami, FL, United States
| | - Michael Duchowny
- Brain Institute, Nicklaus Children's Hospital, Miami, FL, United States; Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Marketa Niederlova
- Charles University, Faculty of Arts, Department of Psychology, Prague, Czech Republic
| | - Pavel Krsek
- Charles University, 2nd Faculty of Medicine, Prague, Czech Republic; Motol University Hospital, Prague, Czech Republic
| | - Vilem Novak
- University of Ostrava, Faculty of Medicine, Ostrava, Czech Republic; Faculty Hospital Ostrava, Ostrava, Czech Republic
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Delion M, Terminassian A, Lehousse T, Aubin G, Malka J, N'Guyen S, Mercier P, Menei P. Specificities of Awake Craniotomy and Brain Mapping in Children for Resection of Supratentorial Tumors in the Language Area. World Neurosurg 2015; 84:1645-52. [PMID: 26164190 DOI: 10.1016/j.wneu.2015.06.073] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 06/29/2015] [Accepted: 06/30/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND In the pediatric population, awake craniotomy began to be used for the resection of brain tumor located close to eloquent areas. Some specificities must be taken into account to adapt this method to children. OBJECTIVE The aim of this clinical study is to not only confirm the feasibility of awake craniotomy and language brain mapping in the pediatric population but also identify the specificities and necessary adaptations of the procedure. METHODS Six children aged 11 to 16 were operated on while awake under local anesthesia with language brain mapping for supratentorial brain lesions (tumor and cavernoma). The preoperative planning comprised functional magnetic resonance imaging (MRI) and neuropsychologic and psychologic assessment. The specific preoperative preparation is clearly explained including hypnosis conditioning and psychiatric evaluation. The success of the procedure was based on the ability to perform the language brain mapping and the tumor removal without putting the patient to sleep. We investigated the pediatric specificities, psychological experience, and neuropsychologic follow-up. RESULTS The children experienced little anxiety, probably in large part due to the use of hypnosis. We succeeded in doing the cortical-subcortical mapping and removing the tumor without putting the patient to sleep in all cases. The psychological experience was good, and the neuropsychologic follow-up showed a favorable evolution. CONCLUSIONS Preoperative preparation and hypnosis in children seemed important for performing awake craniotomy and contributing language brain mapping with the best possible psychological experience. The pediatrics specificities are discussed.
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Affiliation(s)
- Matthieu Delion
- Department of Neurosurgery, Angers Teaching Hospital, Angers, France; Anatomy Laboratory, Medical Faculty, University of Angers, LUNAM, Angers, France.
| | - Aram Terminassian
- Department of Anesthesiology, Angers Teaching Hospital, Angers, France
| | - Thierry Lehousse
- Department of Anesthesiology, Angers Teaching Hospital, Angers, France
| | - Ghislaine Aubin
- Department of Neuropsychology, Angers Teaching Hospital, Angers, France
| | - Jean Malka
- Department of Child Psychiatry, Angers Teaching Hospital, Angers, France
| | - Sylvie N'Guyen
- Department of Pediatric Neurology, Angers Teaching Hospital, Angers, France
| | - Philippe Mercier
- Department of Neurosurgery, Angers Teaching Hospital, Angers, France; Anatomy Laboratory, Medical Faculty, University of Angers, LUNAM, Angers, France
| | - Philippe Menei
- Department of Neurosurgery, Angers Teaching Hospital, Angers, France
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24
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Brna P, Duchowny M, Resnick T, Dunoyer C, Bhatia S, Jayakar P. The diagnostic utility of intracranial EEG monitoring for epilepsy surgery in children. Epilepsia 2015; 56:1065-70. [DOI: 10.1111/epi.12983] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2015] [Indexed: 01/22/2023]
Affiliation(s)
- Paula Brna
- IWK Health Centre; Dalhousie University; Halifax Nova Scotia Canada
| | - Michael Duchowny
- Brain Institute; Miami Children's Hospital; Miami Florida U.S.A
- Department of Neurology; Miami Children's Hospital; Miami Florida U.S.A
| | - Trevor Resnick
- Brain Institute; Miami Children's Hospital; Miami Florida U.S.A
- Department of Neurology; Miami Children's Hospital; Miami Florida U.S.A
| | | | - Sanjiv Bhatia
- Brain Institute; Miami Children's Hospital; Miami Florida U.S.A
- Division of Neurosurgery; Miami Children's Hospital; Miami Florida U.S.A
| | - Prasanna Jayakar
- Brain Institute; Miami Children's Hospital; Miami Florida U.S.A
- Department of Neurology; Miami Children's Hospital; Miami Florida U.S.A
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25
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Object naming in epilepsy and epilepsy surgery. Epilepsy Behav 2015; 46:27-33. [PMID: 25599985 DOI: 10.1016/j.yebeh.2014.12.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 12/15/2014] [Accepted: 12/16/2014] [Indexed: 11/22/2022]
Abstract
The ability to express oneself verbally is critical for success in academic, occupational, and social domains. Unfortunately, word-finding or "naming" difficulty is the most common cognitive complaint among individuals with temporal lobe epilepsy (TLE), and a substantial body of work over the past several decades has documented naming impairment in left (language-dominant) TLE, with further risk to naming ability following left temporal lobe resection for seizure control. With these findings well established, this paper reviews more recent work that has aimed to identify the neuroanatomical substrates of naming, understand how adverse structural and functional effects of TLE might impinge upon these brain regions, predict and potentially reduce the risk of postoperative naming decline, and begin to understand naming difficulty in TLE from a developmental perspective. Factors that have confounded interpretation and hindrances to progress are discussed, and suggestions are provided for improved empirical investigation and directions for future research.
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Abstract
Intraoperative neurophysiologic monitoring endeavors to preserve the integrity of the nervous system at a time of potential risk. The examination of language function in the operative setting is a unique task that requires a detailed and systematic approach to be carried out efficiently and reliably in this dynamic environment. In this review, we detail the technique used to identify eloquent language cortex during awake craniotomy. This technique requires a coordinated effort to testing, which is reliant on preoperative assessment and structured approach to functional cortical mapping by the surgical, anesthetic, and neurophysiology teams. Despite the intricate nature of this modality of testing, the accurate identification of language areas facilitates neurosurgeries for tumor and focal epilepsy syndromes in the dominant cerebral hemisphere, which depend on maximal margins of resection for best outcomes.
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Najm IM, Tassi L, Sarnat HB, Holthausen H, Russo GL. Epilepsies associated with focal cortical dysplasias (FCDs). Acta Neuropathol 2014; 128:5-19. [PMID: 24916270 DOI: 10.1007/s00401-014-1304-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 05/26/2014] [Accepted: 05/26/2014] [Indexed: 11/24/2022]
Abstract
Focal cortical dysplasias (FCDs) are increasingly recognized as one of the most common causes of pharmaco-resistant epilepsies. FCDs were recently divided into various clinico-pathological subtypes due to distinct imaging, electrophysiological, and outcome characteristics. In this review, we will overview the international consensus classification of FCDs in light of more recently reported clinical, electrical, imaging and functional observations, and will also address areas of ongoing debate. In addition, we will summarize our current knowledge on pathobiology and epileptogenicity of FCDs as well as its underlying molecular and cellular mechanisms. The clinical (electroencephalographic, imaging, and functional) characteristics of major FCD subtypes and their implications on the presurgical evaluation and surgical management will be discussed in light of studies describing these characteristics and postoperative seizure outcomes in patients with medically intractable focal epilepsy due to histopathologically confirmed FCDs.
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Affiliation(s)
- Imad M Najm
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA,
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28
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Schmitt FC, Kaufmann J, Hoffmann MB, Tempelmann C, Kluge C, Rampp S, Voges J, Heinze HJ, Buentjen L, Grueschow M. Case report: practicability of functionally based tractography of the optic radiation during presurgical epilepsy work up. Neurosci Lett 2014; 568:56-61. [PMID: 24690576 DOI: 10.1016/j.neulet.2014.03.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 03/05/2014] [Accepted: 03/17/2014] [Indexed: 10/25/2022]
Abstract
Pre-operative tractography of the optic radiation (OR) has been advised to assess the risk for postoperative visual field deficit (VFD) in certain candidates for resective epilepsy surgery. Diffusion tensor imaging (DTI) tractography relies on a precise anatomical determination of start and target regions of interest (ROIs), such as the lateral geniculate nucleus (LGN) and the primary visual cortex (V1). The post-chiasmal visual pathway and V1 show considerable inter-individual variability, and in epilepsy patients parenchymatous lesions might further complicate this matter. A functionally based tractography (FBT) seems beneficial for precise OR identification. We assessed practicability of FBT for OR identification in a patient with occipital lobe epilepsy due to a temporo-occipital maldevelopmental tumor. The MRI protocol at 3T included a T1-weighted sagittal 3D scan, a T2-weighted axial 2D scan and a DTI scan using an echo planar spin echo sequence. ROIs for fiber tracking of OR (LGN & V1) were determined with T2*-weighted fMRI-based retinotopic assessment. After DTI pre-processing and fiber tracking, paths with similar properties were combined in clusters for visual presentation and OR localization. Retinotopic phase maps allowed for the identification of V1 and LGN for a precise DTI-based reconstruction of OR, which was distant to the patient's tumor. Location and structure of ORs were comparable in each hemisphere. FBT could thus influence the human research of the extrastriate visual pathway and the risk management of post-operative VFD in epilepsy surgery.
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Affiliation(s)
- F C Schmitt
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, D-39120 Magdeburg, Germany.
| | - J Kaufmann
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, D-39120 Magdeburg, Germany
| | - M B Hoffmann
- Department of Ophthalmology, Otto-von-Guericke University, Leipziger Str. 44, D-39120 Magdeburg, Germany; Center for Behavioural Brain Science (CBBS), Otto-von-Guericke-University, Universitätsplatz 2, D-39106 Magdeburg, Germany
| | - C Tempelmann
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, D-39120 Magdeburg, Germany
| | - C Kluge
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, D-39120 Magdeburg, Germany; Center for Behavioural Brain Science (CBBS), Otto-von-Guericke-University, Universitätsplatz 2, D-39106 Magdeburg, Germany
| | - S Rampp
- Epilepsy Center Erlangen, University of Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - J Voges
- Department of Stereotactic Neurosurgery, Otto-von-Guericke University, Leipziger Str. 44, D-39120 Magdeburg, Germany; Leibnitz Institute of Neurobiology, Leipziger Str. 44, D-39120 Magdeburg, Germany
| | - H J Heinze
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, D-39120 Magdeburg, Germany; Leibnitz Institute of Neurobiology, Leipziger Str. 44, D-39120 Magdeburg, Germany
| | - L Buentjen
- Department of Stereotactic Neurosurgery, Otto-von-Guericke University, Leipziger Str. 44, D-39120 Magdeburg, Germany
| | - M Grueschow
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, D-39120 Magdeburg, Germany; Department of Economics, University Zurich, Blümlisalpstrasse 10, CH-8006 Zurich, Switzerland
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Serafini S, Komisarow JM, Gallentine W, Mikati MA, Bonner MJ, Kranz PG, Haglund MM, Grant G. Reorganization and stability for motor and language areas using cortical stimulation: case example and review of the literature. Brain Sci 2013; 3:1597-614. [PMID: 24961623 PMCID: PMC4061887 DOI: 10.3390/brainsci3041597] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 11/14/2013] [Indexed: 11/25/2022] Open
Abstract
The cerebral organization of language in epilepsy patients has been studied with invasive procedures such as Wada testing and electrical cortical stimulation mapping and more recently with noninvasive neuroimaging techniques, such as functional MRI. In the setting of a chronic seizure disorder, clinical variables have been shown to contribute to cerebral language reorganization underscoring the need for language lateralization and localization procedures. We present a 14-year-old pediatric patient with a refractory epilepsy disorder who underwent two neurosurgical resections of a left frontal epileptic focus separated by a year. He was mapped extraoperatively through a subdural grid using cortical stimulation to preserve motor and language functions. The clinical history and extensive workup prior to surgery is discussed as well as the opportunity to compare the cortical maps for language, motor, and sensory function before each resection. Reorganization in cortical tongue sensory areas was seen concomitant with a new zone of ictal and interictal activity in the previous tongue sensory area. Detailed neuropsychological data is presented before and after any surgical intervention to hypothesize about the extent of reorganization between epochs. We conclude that intrahemispheric cortical plasticity does occur following frontal lobe resective surgery in a teenager with medically refractory seizures.
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Affiliation(s)
- Sandra Serafini
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Box 3807, Durham, NC 27710, USA.
| | - Jordan M Komisarow
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Box 3807, Durham, NC 27710, USA.
| | - William Gallentine
- Division of Pediatric Neurology, Department of Neurology, Duke University Medical Center, Box 3936, Durham, NC 27710, USA.
| | - Mohamad A Mikati
- Division of Pediatric Neurology, Department of Neurology, Duke University Medical Center, Box 3936, Durham, NC 27710, USA.
| | - Melanie J Bonner
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3527, Durham, NC 27705, USA.
| | - Peter G Kranz
- Division of Neuroradiology, Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA.
| | - Michael M Haglund
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Box 3807, Durham, NC 27710, USA.
| | - Gerald Grant
- Department of Neurosurgery, Stanford University, Lucile Packard Children's Hospital, R211 MC 5327, 300 Pasteur Drive, Stanford, CA 94305, USA.
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Interhemispheric functional connectivity following prenatal or perinatal brain injury predicts receptive language outcome. J Neurosci 2013; 33:5612-25. [PMID: 23536076 DOI: 10.1523/jneurosci.2851-12.2013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Early brain injury alters both structural and functional connectivity between the cerebral hemispheres. Despite increasing knowledge on the individual hemispheric contributions to recovery from such injury, we know very little about how their interactions affect this process. In the present study, we related interhemispheric structural and functional connectivity to receptive language outcome following early left hemisphere stroke. We used functional magnetic resonance imaging to study 14 people with neonatal brain injury, and 25 age-matched controls during passive story comprehension. With respect to structural connectivity, we found that increased volume of the corpus callosum predicted good receptive language outcome, but that this is not specific to people with injury. In contrast, we found that increased posterior superior temporal gyrus interhemispheric functional connectivity during story comprehension predicted better receptive language performance in people with early brain injury, but worse performance in typical controls. This suggests that interhemispheric functional connectivity is one potential compensatory mechanism following early injury. Further, this pattern of results suggests refinement of the prevailing notion that better language outcome following early left hemisphere injury relies on the contribution of the contralesional hemisphere (i.e., the "right-hemisphere-take-over" theory). This pattern of results was also regionally specific; connectivity of the angular gyrus predicted poorer performance in both groups, independent of brain injury. These results present a complex picture of recovery, and in some cases, such recovery relies on increased cooperation between the injured hemisphere and homologous regions in the contralesional hemisphere, but in other cases, the opposite appears to hold.
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Enatsu R, Kubota Y, Kakisaka Y, Bulacio J, Piao Z, O’Connor T, Horning K, Mosher J, Burgess RC, Bingaman W, Nair DR. Reorganization of posterior language area in temporal lobe epilepsy: A cortico-cortical evoked potential study. Epilepsy Res 2013; 103:73-82. [DOI: 10.1016/j.eplepsyres.2012.07.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 06/15/2012] [Accepted: 07/03/2012] [Indexed: 11/25/2022]
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Brown EC, Muzik O, Rothermel R, Matsuzaki N, Juhász C, Shah AK, Atkinson MD, Fuerst D, Mittal S, Sood S, Diwadkar VA, Asano E. Evaluating reverse speech as a control task with language-related gamma activity on electrocorticography. Neuroimage 2012; 60:2335-45. [PMID: 22387167 DOI: 10.1016/j.neuroimage.2012.02.040] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 02/13/2012] [Accepted: 02/15/2012] [Indexed: 10/28/2022] Open
Abstract
Reverse speech has often been used as a control task in brain-mapping studies of language utilizing various non-invasive modalities. The rationale is that reverse speech is comparable to forward speech in terms of auditory characteristics, while omitting the linguistic components. Thus, it may control for non-language auditory functions. This finds some support in fMRI studies indicating that reverse speech resulted in less blood-oxygen-level-dependent (BOLD) signal intensity in perisylvian regions than forward speech. We attempted to externally validate a reverse speech control task using intracranial electrocorticography (ECoG) in eight patients with intractable focal epilepsy. We studied adolescent and adult patients who underwent extraoperative ECoG prior to resective epilepsy surgery. All patients received an auditory language task during ECoG recording. Patients were presented 115 audible question stimuli, including 30 reverse speech trials. Reverse speech trials more strongly engaged bilateral superior temporal sites than did the corresponding forward speech trials. Forward speech trials elicited larger gamma-augmentation at frontal lobe sites not attributable to sensorimotor function. Other temporal and frontal sites of significant augmentation showed no significant difference between reverse and forward speech. Thus, we failed to validate reported evidence of weaker activation of temporal neocortices during reverse compared to forward speech. Superior temporal lobe engagement may indicate increased attention to reverse speech. Reverse speech does not appear to be a suitable task for the control of non-language auditory functions on ECoG.
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Affiliation(s)
- Erik C Brown
- MD-PhD Program, School of Medicine, Wayne State University, Detroit, MI 48201, USA
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Abstract
AbstractFunctional magnetic resonance imaging (fMRI) has been recognised as a neuroimaging technique suitable for examination of higher cognitive function in children. It has been used to elucidate cognitive neural networks associated with various aspects of language function in several group and case studies of school-aged children. Language function has been lateralised and localised with fMRI in clinical samples, neurologically normal children and children with developmental language disorders. Issues of plasticity of language function during development and following injury have also been considered. Several paediatric case studies have also raised questions with respect to the interpretation of fMRI language activation. In spite of methodological challenges, fMRI has proved a useful technique for examination of the brain-behaviour relationship in developmental language functions. This paper reviews fMRI studies of language, including reading, in children.
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Abstract
With a major role in revealing epileptogenic lesions, magnetic resonance imaging (MRI) has also been very helpful in surgical planning and postoperative follow-up of drug-resistant focal epilepsies. In this article, in addition to discussing the most common epileptogenic lesions, advanced quantitative and functional MRI techniques in detecting abnormalities and revealing hemodynamic and microstructural changes are emphasized.
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35
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de Ribaupierre S, Fohlen M, Bulteau C, Dorfmüller G, Delalande O, Dulac O, Chiron C, Hertz-Pannier L. Presurgical language mapping in children with epilepsy: clinical usefulness of functional magnetic resonance imaging for the planning of cortical stimulation. Epilepsia 2011; 53:67-78. [PMID: 22126260 DOI: 10.1111/j.1528-1167.2011.03329.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Presurgical language mapping in dominant hemisphere epilepsy to evaluate the risk of postoperative deficit is particularly difficult in children. Extraoperative invasive cortical stimulation can show some areas critical to language, but not all of them, due to scarce sampling, poor cooperation, cortical immaturity, or network reorganization, whereas functional magnetic resonance imaging (fMRI) displays entire networks involved in, but not necessarily critical to, language. In a homogeneous series of children with epilepsy, we compared the contributions of language fMRI and depth electrode stimulations to optimize language mapping. METHODS Eight children (7.5-15.5 years) with left frontal or temporal epilepsy underwent language fMRI and language stimulation with depth electrodes as part of their comprehensive presurgical workup. fMRI data collected during sentence generation were analyzed using statistical parametric mapping (SPM2) (false discovery rate [FDR] p < 0.05). Bipolar stimulations were performed during language production tasks. By coregistering fMRI and postimplantation computed tomography (CT) images, we were able to directly compare the cortical areas identified by both investigations. KEY FINDINGS fMRI during sentence generation robustly showed activation in the whole perisylvian regions with little reorganization (left hemisphere dominant in 7). Of the 184 electrode contacts tested for language, only 8 were positive (language disruption) in three of the seven patients with periictal language impairment and left language dominance. All of the positive contacts colocalized with an fMRI activated cluster, that is, fMRI did not miss any region critical to language (sensitivity = 100%). However, 54 of the 176 negative contacts were within activated clusters (low specificity). SIGNIFICANCE In children with epilepsy, the sensitivity of fMRI during sentence generation allows for the detection of all critical regions displayed by cortical stimulation within the large perisylvian language network, but with a low specificity. It is, therefore, useful to optimize the placement of intracranial electrodes when language mapping is necessary. Systematic planning of the electrode placement according to language fMRI maps should increase the yield of extraoperative cortical stimulation, which appears rather low in children when compared to adults.
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36
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Hamberger MJ, Cole J. Language organization and reorganization in epilepsy. Neuropsychol Rev 2011; 21:240-51. [PMID: 21842185 PMCID: PMC3193181 DOI: 10.1007/s11065-011-9180-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 07/31/2011] [Indexed: 10/17/2022]
Abstract
The vast majority of healthy individuals are left hemisphere dominant for language; however, individuals with left hemisphere epilepsy have a higher likelihood of atypical language organization. The cerebral organization of language in epilepsy has been studied with invasive procedures such as Wada testing and electrical cortical stimulation mapping (ESM), and more recently, with noninvasive neuroimaging techniques such as functional magnetic resonance imaging (fMRI). Investigators have used these techniques to explore the influence of unique clinical features inherent in epilepsy that might contribute to the reorganization of language, such as location of seizure onset, age of seizure onset, and extent of interictal epileptiform activity. In this paper, we review the contribution of these and other clinical variables to the lateralization and localization of language in epilepsy, and how these patient-related variables affect the results from these three different, yet complementary methodologies. Unlike the abrupt language changes that occur following acute brain injury with disruption of established language circuits, converging evidence suggests that the chronic nature of epileptic activity can result in a developmental shift of language from the left to the right hemisphere or re-routing of language pathways from traditional to non-traditional areas within the dominant left hemisphere. Clinical variables have been shown to contribute to cerebral language reorganization in the setting of chronic seizure disorders, yet such factors have not been reliable predictors of altered language networks in individual patients, underscoring the need for language lateralization and localization procedures when definitive identification of language cortex is necessary for clinical care.
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Affiliation(s)
- Marla J Hamberger
- The Neurological Institute, Columbia University Medical Center, 710 West 168th Street, 7th floor, New York, NY 10032, USA.
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37
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Cui Z, Luan G. A venous malformation accompanying focal cortical dysplasia resulting in a reorganization of language-eloquent areas. J Clin Neurosci 2011; 18:404-6. [DOI: 10.1016/j.jocn.2010.05.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 05/27/2010] [Accepted: 05/31/2010] [Indexed: 10/18/2022]
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38
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Malformations of Cortical Development and Aberrant Cortical Networks: Epileptogenesis and Functional Organization. J Clin Neurophysiol 2010; 27:372-9. [DOI: 10.1097/wnp.0b013e3181fe0585] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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39
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Korman B, Bernal B, Duchowny M, Jayakar P, Altman N, Garaycoa G, Resnick T, Rey G. Atypical propositional language organization in prenatal and early-acquired temporal lobe lesions. J Child Neurol 2010; 25:985-93. [PMID: 20139401 DOI: 10.1177/0883073809357242] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigated differences in propositional language organization in children with developmental and acquired brain lesions. We evaluated 30 right-handed subjects with intractable epilepsy due to either focal cortical dysplasia or hippocampal sclerosis with neuropsychological testing and functional MRI prior to epilepsy surgery. Atypical activations were seen in both prenatal and early postnatal lesions, but the contribution of specific histopathological substrate was minimal. Atypical organization of both temporal and frontal language areas also correlated inversely with receptive vocabulary scores. The data demonstrated a greater propensity toward atypical activation patterns for receptive than expressive networks, particularly when lesions were located in the dominant temporal lobe. Atypical language organization was not correlated with seizure-related factors such as age at onset or duration of epilepsy. The patterns of atypical language activation support prior studies implicating proximity of pathology to eloquent cortex in the dominant hemisphere as the primary determinant of functional reorganization.
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Affiliation(s)
- Brandon Korman
- Brain Institute, Miami Children's Hospital, Miami, Florida 33155, USA
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40
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Anderson V, Spencer-Smith M, Coleman L, Anderson P, Williams J, Greenham M, Leventer RJ, Jacobs R. Children's executive functions: are they poorer after very early brain insult. Neuropsychologia 2010; 48:2041-50. [PMID: 20362597 DOI: 10.1016/j.neuropsychologia.2010.03.025] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 03/17/2010] [Accepted: 03/25/2010] [Indexed: 11/29/2022]
Abstract
Traditionally early brain insult (EBI) has been considered to have better outcome than later injury, consistent with the notion that the young brain is flexible and able to reorganize. Recent research findings question this view, suggesting that EBI might lead to poorer outcome than brain insult at any other age. Exploring this early vulnerability perspective, we investigated whether skills developing later in childhood, for example, executive functions (EF), would be at greater risk of disruption from EBI. The aim of this study was to investigate EF in children sustaining EBI at different developmental stages. We expected that brain insult during gestation and infancy, before the emergence of EF, would lead to global EF deficits. In contrast, we predicted that brain injury in late childhood would have fewer consequences. Using a cross-sectional, retrospective, group design we compared six groups of children (Total N=164), with a history of brain insult and documented focal brain pathology, aged 10-16 years on a range of measures of EF. Groups were based on age of EBI: (1) Congenital; (2) Peri-natal; (3) Infancy; (4) Preschool; (5) Middle Childhood; and (6) Late Childhood. Children with EBI were at increased risk for impairment across all aspects of EF. Presence of seizures and/or frontal pathology were not predictive of outcome, but age at insult was. Children sustaining EBI before age 3 recorded more global and severe EF deficits, while children with later EBI performed closer to normal expectations. With the exception of attentional control, skills emerging at time of insult were found to be more vulnerable to disruption than those previously established, supporting the 'early vulnerability' model for EBI.
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Affiliation(s)
- Vicki Anderson
- Murdoch Childrens Research Institute, Melbourne, Australia.
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41
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Ross ED. Cerebral localization of functions and the neurology of language: fact versus fiction or is it something else? Neuroscientist 2010; 16:222-43. [PMID: 20139334 DOI: 10.1177/1073858409349899] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Over the last 15 years there has been a burgeoning number of publications using functional brain imaging (>40,000 articles based on an ISI/Web of Science search) to localize behavioral and cognitive processes to specific areas in the human brain that are often not confirmed by traditional, lesion-based studies. Thus, there is a need to reassess what cerebral localization of functions is and is not. Otherwise, there is no rational way to interpret the escalating claims of localization in the functional imaging literature that is taking on the appearance of neurophysiologic "phrenology". This article will present arguments to suggest that functional localization in the brain is a robust but very dynamic, four-dimensional process. It is a learned phenomenon driven over time by large-scale, spatially distributed, neural networks seeking to efficiently maximize the processing, storage, and manipulation of information for cognitive and behavioral operations. Because of historical considerations and space limitations, the main focus will be on localization of language-related functions whose theoretical neurological basis can be generalized for any complex cognitive-behavioral function.
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Affiliation(s)
- Elliott D Ross
- Department of Neurology, University of Oklahoma Health Sciences Center and the VA Medical Center, Oklahoma City, Oklahoma, USA.
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42
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Roulet-Perez E, Davidoff V, Mayor-Dubois C, Maeder-Ingvar M, Seeck M, Ruffieux C, Villemure JG, Deonna T. Impact of severe epilepsy on development: Recovery potential after successful early epilepsy surgery. Epilepsia 2010; 51:1266-76. [DOI: 10.1111/j.1528-1167.2009.02487.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Anderson V, Jacobs R, Spencer-Smith M, Coleman L, Anderson P, Williams J, Greenham M, Leventer R. Does Early Age at Brain Insult Predict Worse Outcome? Neuropsychological Implications. J Pediatr Psychol 2009; 35:716-27. [DOI: 10.1093/jpepsy/jsp100] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Everts R, Harvey AS, Lillywhite L, Wrennall J, Abbott DF, Gonzalez L, Kean M, Jackson GD, Anderson V. Language lateralization correlates with verbal memory performance in children with focal epilepsy. Epilepsia 2009; 51:627-38. [PMID: 19958383 DOI: 10.1111/j.1528-1167.2009.02406.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Assessment of language dominance with functional magnetic resonance imaging (fMRI) and neuropsychological evaluation is often used prior to epilepsy surgery. This study explores whether language lateralization and cognitive performance are systematically related in young patients with focal epilepsy. METHODS Language fMRI and neuropsychological data (language, visuospatial functions, and memory) of 40 patients (7-18 years of age) with unilateral, refractory focal epilepsy in temporal and/or frontal areas of the left (n = 23) or right hemisphere (n = 17) were analyzed. fMRI data of 18 healthy controls (7-18 years) served as a normative sample. A laterality index was computed to determine the lateralization of activation in three regions of interest (frontal, parietal, and temporal). RESULTS Atypical language lateralization was demonstrated in 12 (30%) of 40 patients. A correlation between language lateralization and verbal memory performance occurred in patients with left-sided epilepsy over all three regions of interest, with bilateral or right-sided language lateralization being correlated with better verbal memory performance (Word Pairs Recall: frontal r = -0.4, p = 0.016; parietal r = -0.4, p = 0.043; temporal r = -0.4, p = 0.041). Verbal memory performance made the largest contribution to language lateralization, whereas handedness and side of seizures did not contribute to the variance in language lateralization. DISCUSSION This finding reflects the association between neocortical language and hippocampal memory regions in patients with left-sided epilepsy. Atypical language lateralization is advantageous for verbal memory performance, presumably a result of transfer of verbal memory function. In children with focal epilepsy, verbal memory performance provides a better idea of language lateralization than handedness and side of epilepsy and lesion.
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Affiliation(s)
- Regula Everts
- Critical Care and Neuroscience, Murdoch Children's Research Institute, Melbourne, Australia.
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Moshel YA, Elliott R, Teutonico F, Sellin J, Carlson C, Devinsky O, Weiner HL. Do tubers contain function? Resection of epileptogenic foci in perirolandic cortex in children with tuberous sclerosis complex. Epilepsia 2009; 51:1242-51. [DOI: 10.1111/j.1528-1167.2009.02493.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Duchowny M. Clinical, functional, and neurophysiologic assessment of dysplastic cortical networks: Implications for cortical functioning and surgical management. Epilepsia 2009; 50 Suppl 9:19-27. [DOI: 10.1111/j.1528-1167.2009.02291.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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47
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Rathore C, George A, Kesavadas C, Sankara Sarma P, Radhakrishnan K. Extent of initial injury determines language lateralization in mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). Epilepsia 2009; 50:2249-55. [DOI: 10.1111/j.1528-1167.2009.02300.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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48
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Kadis DS, Kerr EN, Rutka JT, Snead III OC, Weiss SK, Smith ML. Pathology type does not predict language lateralization in children with medically intractable epilepsy. Epilepsia 2009; 50:1498-504. [DOI: 10.1111/j.1528-1167.2008.02014.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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49
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Deutsch D, Dooley K, Henthorn T, Head B. Absolute pitch among students in an American music conservatory: association with tone language fluency. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2009; 125:2398-2403. [PMID: 19354413 DOI: 10.1121/1.3081389] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Absolute pitch (AP), the ability to name a musical note in the absence of a reference note, is extremely rare in the U.S. and Europe, and its genesis is unclear. The prevalence of AP was examined among students in an American music conservatory as a function of age of onset of musical training, ethnicity, and fluency in speaking a tone language. Taking those of East Asian ethnicity, the performance level on a test of AP was significantly higher among those who spoke a tone language very fluently compared with those who spoke a tone language fairly fluently and also compared with those who were not fluent in speaking a tone language. The performance level of this last group did not differ significantly from that of Caucasian students who spoke only nontone language. Early onset of musical training was associated with enhanced performance, but this did not interact with the effect of language. Further analyses showed that the results could not be explained by country of early music education. The findings support the hypothesis that the acquisition of AP by tone language speakers involves the same process as occurs in the acquisition of a second tone language.
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Affiliation(s)
- Diana Deutsch
- Department of Psychology, University of California, San Diego, La Jolla, California 92093, USA.
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50
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Anderson V, Spencer-Smith M, Leventer R, Coleman L, Anderson P, Williams J, Greenham M, Jacobs R. Childhood brain insult: can age at insult help us predict outcome? ACTA ACUST UNITED AC 2009; 132:45-56. [PMID: 19168454 DOI: 10.1093/brain/awn293] [Citation(s) in RCA: 188] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Until recently, the impact of early brain insult (EBI) has been considered to be less significant than for later brain injuries, consistent with the notion that the young brain is more flexible and able to reorganize in the context of brain insult. This study aimed to evaluate this notion by comparing cognitive and behavioural outcomes for children sustaining EBI at different times from gestation to late childhood. Children with focal brain insults were categorized according to timing of brain insult, represented by six developmental periods: (i) Congenital (n = 38): EBI: first-second trimester; (ii) Perinatal (n = 33); EBI: third trimester to 1 month post-natal; (iii) Infancy (n = 23): EBI: 2 months-2 years post-birth; (iv) Preschool (n = 19): EBI: 3-6 years; (v) Middle Childhood (n = 31): EBI: 7-9 years; and (vi) Late Childhood (n = 19): EBI: after age 10. Groups were similar with respect to injury and demographic factors. Children were assessed for intelligence, academic ability, everyday executive function and behaviour. Results showed that children with EBI were at increased risk for impairment in all domains assessed. Furthermore, children sustaining EBI before age 2 years recorded global and significant cognitive deficits, while children with later EBI performed closer to normal expectations, suggesting a linear association between age at insult and outcome. In contrast, for behaviour, children with EBI from 7 to 9 years performed worse than those with EBI from 3 to 6 years, and more like those with younger insults, suggesting that not all functions share the same pattern of vulnerability with respect to age at insult.
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Affiliation(s)
- Vicki Anderson
- Department of Psychology, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia.
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