Reproducibility of measures of neurophysiological activity in Wernicke's area: a magnetic source imaging study

The Clinical Utility of Transcranial Magnetic Stimulation in Determining Hemispheric Dominance for Language: A Magnetoencephalography Comparison Study

PURPOSE

Transcranial magnetic stimulation (TMS) has recently emerged as a noninvasive alternative to the intracarotid sodium amytal (Wada) procedure for establishing hemispheric dominance (HD) for language. The accuracy of HD determined by TMS was examined by comparing against the HD derived by magnetoencephalography (MEG), a prominent clinical technique with excellent concordance with the Wada procedure.

METHODS

Sixty-seven patients (54 patients ≤18 years) underwent language mapping with TMS and MEG as part of clinical epilepsy and tumor presurgical assessment. Language was mapped in MEG during an auditory word recognition paradigm, and a laterality index was calculated using the number of dipoles and their spatial extent in the two hemispheres. Transcranial magnetic stimulation language mapping was performed as patients performed a naming task, and TMS-induced speech disruptions were recorded during 5-Hz TMS applied to anterior and posterior language cortices. Transcranial magnetic stimulation laterality index was estimated using the number and type of speech disruption in the language regions of each hemisphere.

RESULTS

Transcranial magnetic stimulation and MEG estimates of HD were concordant in 42 (63%) patients, resulting in a sensitivity of 74% and a specificity of 72%. The overall accuracy of TMS was 73%, equivalent to an odds ratio of 7.35.

CONCLUSIONS

In this first large-scale comparative study in a clinical population, we demonstrate that TMS is a safe and reliable noninvasive tool in determining HD for language. Improving the accuracy of TMS by optimizing TMS parameters and improving task choice will further facilitate the use of TMS to characterize language function, especially in pediatrics.

Assessment of hemispheric dominance for receptive language in pediatric patients under sedation using magnetoencephalography

Non-invasive assessment of hemispheric dominance for receptive language using magnetoencephalography (MEG) is now a well-established procedure used across several epilepsy centers in the context of pre-surgical evaluation of children and adults while awake, alert and attentive. However, the utility of MEG for the same purpose, in cases of sedated patients, is contested. Establishment of the efficiency of MEG is especially important in the case of children who, for a number of reasons, must be assessed under sedation. Here we explored the efficacy of MEG language mapping under sedation through retrospective review of 95 consecutive pediatric patients, who underwent our receptive language test as part of routine clinical evaluation. Localization of receptive language cortex and subsequent determination of laterality was successfully completed in 78% (n = 36) and 55% (n = 27) of non-sedated and sedated patients, respectively. Moreover, the proportion of patients deemed left hemisphere dominant for receptive language did not differ between non-sedated and sedated patients, exceeding 90% in both groups. Considering the challenges associated with assessing brain function in pediatric patients, the success of passive MEG in the context of the cases reviewed in this study support the utility of this method in pre-surgical receptive language mapping.

Evaluating signal-correlated noise as a control task with language-related gamma activity on electrocorticography

OBJECTIVE

Our recent electrocorticography (ECoG) study suggested reverse speech, a widely used control task, to be a poor control for non-language-related auditory activity. We hypothesized that this may be due to retained perception as a human voice. We report a follow-up ECoG study in which we contrast forward and reverse speech with a signal-correlated noise (SCN) control task that cannot be perceived as a human voice.

METHODS

Ten patients were presented 90 audible stimuli, including 30 each of corresponding forward speech, reverse speech, and SCN trials, during ECoG recording with evaluation of gamma activity between 50 and 150 Hz.

RESULTS

Sites of the lateral temporal gyri activated throughout speech stimuli were generally less activated by SCN, while some temporal sites seemed to process both human and non-human sounds. Reverse speech trials were associated with activities across the temporal lobe similar to those associated with forward speech.

CONCLUSIONS

Findings herein externally validate functional neuroimaging studies utilizing SCN as a control for non-language-specific auditory function. Our findings are consistent with the notion that stimuli perceived as originating from a human voice are poor controls for non-language auditory function.

SIGNIFICANCE

Our findings have implications in functional neuroimaging research as well as improved clinical mapping of auditory functions.

Spatiotemporal and frequency signatures of word recognition in the developing brain: a magnetoencephalographic study

High-frequency oscillations in the brain open a new window for studies of language development in humans. The objective of this study is to determine the spatiotemporal and frequency signatures of word processing in healthy children. Sixty healthy children aged 6-17 years were studied with a whole-cortex magnetoencephalography (MEG) system using a word recognition paradigm optimized for children. The temporal signature of neuromagnetic activation was measured using averaged waveforms. The spatial and frequency signatures of neuromagnetic activation were assessed with wavelet-based beamformer analyses. The results of waveform analyses showed that the latencies of the first and third neuromagnetic responses changed with age (p<0.01). The source imaging data revealed a clear lateralization of source activation in the 70-120 Hz range in children within the age range of 6 to 13 years of age (p<0.01). Males and females demonstrated different developmental trajectories over the age range of 9 to 13 years of age (p<0.01). These findings suggest that left-hemisphere language processing emerges from early bilateral brain areas with gender optimal neural networks. The neuromagnetic signatures of language development in healthy children may be used as references for future identification of aberrant language function in children with various disorders.

Language lateralization represented by spatiotemporal mapping of magnetoencephalography

BACKGROUND AND PURPOSE

Determination of hemispheric language dominance is critical for planning epilepsy surgery. We assess the usefulness of spatiotemporal source analysis of magnetoencephalography for determining language laterality.

MATERIALS AND METHODS

Thirty-five patients with epilepsy were studied. The patients performed a semantic word-processing task during MEG recording. Epochs containing language-related neuromagnetic activity were averaged after preprocessing. The averaged data between 250 and 550 ms after stimulus were analyzed by using dynamic statistical parametric mapping. ROIs were obtained in the opercular and triangular parts of the inferior frontal gyrus, superior temporal gyrus, and supramarginal gyrus in both hemispheres. We calculated laterality indices according to 1) dSPM-amplitude method, based on the amplitude of activation in the ROIs, and 2) dSPM-counting method, based on the number of unit dipoles with activation over a threshold in the ROIs. The threshold was determined as half of the maximum value in all ROIs for each patient. A LI ≥0.10 or ≤-0.10 was considered left- or right-hemisphere dominance, respectively; a LI between -0.10 and 0.10 was considered bilateral. All patients underwent an intracarotid amobarbital procedure as part of presurgical evaluation.

RESULTS

The dSPM-counting method demonstrated laterality consistent with the IAP in 32 of 35 patients (91.4%), the remaining 3 (8.6%) demonstrated bilateral language representation, whereas the dSPM-amplitude method showed 18 (51.4%) concordant and 17 (48.6%) bilateral. No laterality opposite to the IAP was found.

CONCLUSIONS

Spatiotemporal mapping of language lateralization with the dSPM-counting method may reduce the necessity for an IAP in as many as 90% of patients.

Lateralizing language with magnetic source imaging: validation based on the Wada test

PURPOSE

Magnetoencephalography (MEG)/magnetic source imaging (MSI) is a noninvasive functional neuroimaging procedure used to localize language-specific regions in the brain. The Wada test, or intracarotid amobarbital procedure (IAP), is the gold standard in determining speech/language lateralization for presurgical planning, although it is invasive and associated with morbidity. The purpose of this study is to provide further validation on the use of MSI for presurgical language lateralization by comparing results against the IAP.

METHODS

The sample consisted of 35 patients with epilepsy and/or brain tumor undergoing presurgical evaluation at the Minnesota Epilepsy Group. All patients received both an IAP and MSI to determine hemispheric language dominance. For MSI, a 148-channel MEG system was used to record activation of language-specific cortex by an auditory word-recognition task.

RESULTS

The MSI and IAP were concordant in determining language in the hemisphere to be treated in 86% of the cases with sensitivity and specificity values of 80% and 100%, respectively.

CONCLUSIONS

The results from this study are consistent with prior research findings comparing functional neuroimaging procedures to the IAP in determining language lateralization in presurgical patients. The current study provides an important replication and support for Papanicolaou et al.'s findings in 2004 using a consecutive clinical sample from a different institution. An unusually high rate of atypical IAP language cases in this sample and differences between the two procedures are believed to explain the noted discrepancies. MSI is a viable noninvasive alternative to the IAP in the presurgical determination of language lateralization.

Functional Neuroimaging of Language Using Magnetoencephalography

Magnetoencephalography (MEG) is a novel functional brain mapping technique capable of non-invasively measuring neurophysiological activity based on direct measures of the magnetic flux at the head surface associated with the synchronized electrical activity of neuronal populations. Among the most actively sought applications of MEG has been localization of language-specific cortex. This is in part due to its practical application for pre-surgical evaluation of patients with epilepsy or brain tumors. Until recently, comprehensive language mapping during surgical planning has relied on the application of invasive diagnostic methods, namely the Wada procedure and direct electrocortical stimulation mapping, often considered as the "gold standard" techniques for identifying language-specific cortex. In this review, we evaluate the utility of MEG as a tool for functional mapping of language in both clinical and normal populations. In particular, we provide a general description of MEG, with emphasis on facets of the technique related to language mapping. Additionally, we discuss the application of appropriate MEG language-mapping protocols developed to reliably generate spatiotemporal profiles of language activity, and address the validity of the technique against the "gold standards" of the Wada and electrocortical mapping procedures.

Hemispheric language dominance in magnetoencephalography: sensitivity, specificity, and data reduction techniques

Understanding the areas involved in language functions not only enables investigators to understand neuroanatomical structures, but may be a promising technique in the presurgical evaluation of epilepsy. The predictive power of various data reduction techniques was tested on language data obtained by magnetoencephalography (MEG) of 16 patients and 12 control subjects. Words were presented aurally in two phases: the study phase and the recognition phase. Subjects were asked to remember words from the study phase and indicate if they remembered those words during the recognition phase. Single equivalent-current dipoles were calculated to determine laterality indices and the neuroanatomical correlates of language function. For all patients, results indicated a concordance, sensitivity, and specificity of 0.75. After consideration of IQ scores and exclusion from the analysis of those patients with scores below the average range, the results indicated a concordance of 0.90, sensitivity of 0.86, and specificity of 1.00. These findings are consistent with previous MEG investigations of language function in comparison with the Wada technique and support the use of MEG language mapping in most patients with an IQ within or above the average range.

Reliability of language mapping with magnetic source imaging in epilepsy surgery candidates

The external validity of a noninvasive language mapping protocol with magnetoencephalography (MEG) has been established through direct comparisons with invasive functional mapping techniques. This study examines the test-retest and interrater reliability of this protocol under realistic testing conditions in 21 epilepsy surgery candidates. Brain activation maps were obtained in the context of an auditory word recognition task and represented by temporally contiguous dipolar activity sources. Both the duration and strength of the associated magnetic flux were used as measures of the magnitude of regional brain activity. Hemispheric asymmetry indices based on these measures showed good interrater reliability and intraparticipant reproducibility. Similar findings were obtained with respect to the location of the geometric center of receptive language-specific cortex (Wernicke's) area in the dominant hemisphere. The results further support the adequacy of this MEG-based brain mapping protocol as a noninvasive tool for receptive language localization in epilepsy surgery candidates.