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Yu L, Dugan P, Doyle W, Devinsky O, Friedman D, Flinker A. A left-lateralized dorsolateral prefrontal network for naming. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.15.594403. [PMID: 38798614 PMCID: PMC11118423 DOI: 10.1101/2024.05.15.594403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
The ability to connect the form and meaning of a concept, known as word retrieval, is fundamental to human communication. While various input modalities could lead to identical word retrieval, the exact neural dynamics supporting this convergence relevant to daily auditory discourse remain poorly understood. Here, we leveraged neurosurgical electrocorticographic (ECoG) recordings from 48 patients and dissociated two key language networks that highly overlap in time and space integral to word retrieval. Using unsupervised temporal clustering techniques, we found a semantic processing network located in the middle and inferior frontal gyri. This network was distinct from an articulatory planning network in the inferior frontal and precentral gyri, which was agnostic to input modalities. Functionally, we confirmed that the semantic processing network encodes word surprisal during sentence perception. Our findings characterize how humans integrate ongoing auditory semantic information over time, a critical linguistic function from passive comprehension to daily discourse.
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Affiliation(s)
- Leyao Yu
- Department of Biomedical Engineering, New York University, New York, 10016, New York, the United States
- Department of Neurology, School of Medicine, New York University, New York, 10016, New York, the United States
| | - Patricia Dugan
- Department of Neurology, School of Medicine, New York University, New York, 10016, New York, the United States
| | - Werner Doyle
- Department of Neurosurgery, School of Medicine, New York University, New York, 10016, New York, the United States
| | - Orrin Devinsky
- Department of Neurology, School of Medicine, New York University, New York, 10016, New York, the United States
| | - Daniel Friedman
- Department of Neurology, School of Medicine, New York University, New York, 10016, New York, the United States
| | - Adeen Flinker
- Department of Biomedical Engineering, New York University, New York, 10016, New York, the United States
- Department of Neurology, School of Medicine, New York University, New York, 10016, New York, the United States
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Trimmel K, Vos SB, Binding L, Caciagli L, Xiao F, van Graan LA, Koepp MJ, Thompson PJ, Duncan JS. Naming fMRI-guided white matter language tract volumes influence naming decline after temporal lobe resection. J Neurol 2024:10.1007/s00415-024-12315-2. [PMID: 38583105 DOI: 10.1007/s00415-024-12315-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 03/08/2024] [Accepted: 03/08/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE The aim of this study was to explore the relation of language functional MRI (fMRI)-guided tractography with postsurgical naming decline in people with temporal lobe epilepsy (TLE). METHODS Twenty patients with unilateral TLE (9 left) were studied with auditory and picture naming functional MRI tasks. Activation maxima in the left posterobasal temporal lobe were used as seed regions for whole-brain fibre tractography. Clinical naming performance was assessed preoperatively, 4 months, and 12 months following temporal lobe resection. Volumes of white matter language tracts in both hemispheres as well as tract volume laterality indices were explored as moderators of postoperative naming decline using Pearson correlations and multiple linear regression with other clinical variables. RESULTS Larger volumes of white matter language tracts derived from auditory and picture naming maxima in the hemisphere of subsequent surgery as well as stronger lateralization of picture naming tract volumes to the side of surgery correlated with greater language decline, which was independent of fMRI lateralization status. Multiple regression for picture naming tract volumes was associated with a significant decline of naming function with 100% sensitivity and 93% specificity at both short-term and long-term follow-up. INTERPRETATION Naming fMRI-guided white matter language tract volumes relate to postoperative naming decline after temporal lobe resection in people with TLE. This can assist stratification of surgical outcome and minimize risk of postoperative language deficits in TLE.
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Affiliation(s)
- Karin Trimmel
- Department of Neurology, Medical University of Vienna, Vienna, Austria.
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, UK.
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK.
| | - Sjoerd B Vos
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, UK
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, London, UK
- Centre for Microscopy Characterisation and Analysis, University of Western Australia, Nedlands, Australia
| | - Lawrence Binding
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, UK
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Lorenzo Caciagli
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, UK
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
- Department of Neurology, Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fenglai Xiao
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, UK
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
| | - Louis A van Graan
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, UK
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
| | - Matthias J Koepp
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, UK
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
| | - Pamela J Thompson
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, UK
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
| | - John S Duncan
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, UK
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
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Noll KR, Asman P, Tasnim I, Hall M, Connelly K, Swamy C, Ene C, Tummala S, Grasu RM, Liu HL, Kumar VA, Muir M, Prinsloo S, Michener H, Wefel JS, Ince NF, Prabhu SS. Intraoperative language mapping guided by real-time visualization of gamma band modulation electrocorticograms: Case report and proof of concept. Neurooncol Pract 2024; 11:92-100. [PMID: 38222047 PMCID: PMC10785572 DOI: 10.1093/nop/npad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Background Electrocorticography (ECoG) language mapping is often performed extraoperatively, frequently involves offline processing, and relationships with direct cortical stimulation (DCS) remain variable. We sought to determine the feasibility and preliminary utility of an intraoperative language mapping approach guided by real-time visualization of electrocorticograms. Methods A patient with astrocytoma underwent awake craniotomy with intraoperative language mapping, utilizing a dual iPad stimulus presentation system coupled to a real-time neural signal processing platform capable of both ECoG recording and delivery of DCS. Gamma band modulations in response to 4 language tasks at each electrode were visualized in real-time. Next, DCS was conducted for each neighboring electrode pair during language tasks. Results All language tasks resulted in strongest heat map activation at an electrode pair in the anterior to mid superior temporal gyrus. Consistent speech arrest during DCS was observed for Object and Action naming tasks at these same electrodes, indicating good correspondence with ECoG heat map recordings. This region corresponded well with posterior language representation via preoperative functional MRI. Conclusions Intraoperative real-time visualization of language task-based ECoG gamma band modulation is feasible and may help identify targets for DCS. If validated, this may improve the efficiency and accuracy of intraoperative language mapping.
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Affiliation(s)
- Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Priscella Asman
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Israt Tasnim
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Matthew Hall
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Katherine Connelly
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chandra Swamy
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Chibawanye Ene
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sudhakar Tummala
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Roxana M Grasu
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ho-Ling Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vinodh A Kumar
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Matthew Muir
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarah Prinsloo
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hayley Michener
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nuri F Ince
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Hamberger MJ, Heydari ND, Seidel WT. Complementary auditory and Visual Naming Tests: Revised and updated for ages 16-55 years. Clin Neuropsychol 2024; 38:164-181. [PMID: 37035940 PMCID: PMC10562516 DOI: 10.1080/13854046.2023.2192421] [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: 10/17/2022] [Accepted: 03/13/2023] [Indexed: 04/11/2023]
Abstract
Objective: Historically, naming has been assessed with visual object naming; however, we have found that auditory description naming significantly enhances lateralization and localization of dysfunction. We previously published auditory naming (ANT) and complementary Visual Naming Tests (VNT) for young adults, and recently developed these measures for children (ages 6-15 years) and older adults (ages 56-100 years). Here, we update the original stimuli and more rigorously norm the tests for ages 16-55, addressing prior limitations. Methods: Test stimuli were selected based on item characteristics and preliminary screening, eliminating those with less than 90% name agreement. A sample of 178 healthy individuals ages 16-55 years were administered the updated ANT and VNT, and other standardized measures, either in person (n = 114) or via telehealth (n = 64). Results: With no effect of age, yet a significant influence of education, education-based normative data are provided for accuracy, tips-of-the-tongue (i.e. delayed, accurate responses plus correct responses following phonemic cueing), and an aggregate Summary Score. Internal and test-retest reliability coefficients were reasonable (.67-.90). Conclusions: These measures provide updated and improved naming assessment for ages 16-55 years, contributing to a contiguous set of naming tests for school-aged children through elderly adults. Compared to the original ANT and VNT, these measures were designed to have stimuli longevity, and offer reduced item burden and evidence-based recommendations for performance measures with the greatest clinical sensitivity. The addition of these measures enables continuity in assessment across the age span, facilitating longitudinal assessment related to disease progression or therapeutic intervention.
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Affiliation(s)
- Marla J. Hamberger
- Department of Neurology, Columbia University Medical Center, New York, New York
| | - Nahal D. Heydari
- Department of Neurology, Columbia University Medical Center, New York, New York
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Papanicolaou AC. Non-Invasive Mapping of the Neuronal Networks of Language. Brain Sci 2023; 13:1457. [PMID: 37891824 PMCID: PMC10605023 DOI: 10.3390/brainsci13101457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/13/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
This review consists of three main sections. In the first, the Introduction, the main theories of the neuronal mediation of linguistic operations, derived mostly from studies of the effects of focal lesions on linguistic performance, are summarized. These models furnish the conceptual framework on which the design of subsequent functional neuroimaging investigations is based. In the second section, the methods of functional neuroimaging, especially those of functional Magnetic Resonance Imaging (fMRI) and of Magnetoencephalography (MEG), are detailed along with the specific activation tasks employed in presurgical functional mapping. The reliability of these non-invasive methods and their validity, judged against the results of the invasive methods, namely, the "Wada" procedure and Cortical Stimulation Mapping (CSM), is assessed and their use in presurgical mapping is justified. In the third and final section, the applications of fMRI and MEG in basic research are surveyed in the following six sub-sections, each dealing with the assessment of the neuronal networks for (1) the acoustic and phonological, (2) for semantic, (3) for syntactic, (4) for prosodic operations, (5) for sign language and (6) for the operations of reading and the mechanisms of dyslexia.
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Affiliation(s)
- Andrew C Papanicolaou
- Department of Pediatrics, Division of Pediatric Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38013, USA
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6
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Kitazawa Y, Sonoda M, Sakakura K, Mitsuhashi T, Firestone E, Ueda R, Kambara T, Iwaki H, Luat AF, Marupudi NI, Sood S, Asano E. Intra- and inter-hemispheric network dynamics supporting object recognition and speech production. Neuroimage 2023; 270:119954. [PMID: 36828156 PMCID: PMC10112006 DOI: 10.1016/j.neuroimage.2023.119954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023] Open
Abstract
We built normative brain atlases that animate millisecond-scale intra- and inter-hemispheric white matter-level connectivity dynamics supporting object recognition and speech production. We quantified electrocorticographic modulations during three naming tasks using event-related high-gamma activity from 1,114 nonepileptogenic intracranial electrodes (i.e., non-lesional areas unaffected by epileptiform discharges). Using this electrocorticography data, we visualized functional connectivity modulations defined as significant naming-related high-gamma modulations occurring simultaneously at two sites connected by direct white matter streamlines on diffusion-weighted imaging tractography. Immediately after stimulus onset, intra- and inter-hemispheric functional connectivity enhancements were confined mainly across modality-specific perceptual regions. During response preparation, left intra-hemispheric connectivity enhancements propagated in a posterior-to-anterior direction, involving the left precentral and prefrontal areas. After overt response onset, inter- and intra-hemispheric connectivity enhancements mainly encompassed precentral, postcentral, and superior-temporal (STG) gyri. We found task-specific connectivity enhancements during response preparation as follows. Picture naming enhanced activity along the left arcuate fasciculus between the inferior-temporal and precentral/posterior inferior-frontal (pIFG) gyri. Nonspeech environmental sound naming augmented functional connectivity via the left inferior longitudinal and fronto-occipital fasciculi between the medial-occipital and STG/pIFG. Auditory descriptive naming task enhanced usage of the left frontal U-fibers, involving the middle-frontal gyrus. Taken together, the commonly observed network enhancements include inter-hemispheric connectivity optimizing perceptual processing exerted in each hemisphere, left intra-hemispheric connectivity supporting semantic and lexical processing, and inter-hemispheric connectivity for symmetric oral movements during overt speech. Our atlases improve the currently available models of object recognition and speech production by adding neural dynamics via direct intra- and inter-hemispheric white matter tracts.
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Affiliation(s)
- Yu Kitazawa
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, 48201, USA; Department of Neurology and Stroke Medicine, Yokohama City University, Yokohama, 2360004, Japan
| | - Masaki Sonoda
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, 48201, USA; Department of Neurosurgery, Yokohama City University, Yokohama, 2360004, Japan
| | - Kazuki Sakakura
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, 48201, USA; Department of Neurosurgery, University of Tsukuba, Tsukuba, 3058575, Japan
| | - Takumi Mitsuhashi
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, 48201, USA; Department of Neurosurgery, Juntendo University, Tokyo, 1138421, Japan
| | - Ethan Firestone
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, 48201, USA; Department of Physiology, Wayne State University, Detroit, 48201, USA
| | - Riyo Ueda
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, 48201, USA
| | - Toshimune Kambara
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, 48201, USA; Department of Psychology, Hiroshima University, Hiroshima, 7398524, Japan
| | - Hirotaka Iwaki
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, 48201, USA; Department of Psychiatry, Hachinohe City Hospital, Hachinohe, 0318555, Japan
| | - Aimee F Luat
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, 48201, USA; Department of Neurology, Children's Hospital of Michigan, Wayne State University, Detroit, 48201, USA; Department of Pediatrics, Central Michigan University, Mount Pleasant, 48858, USA
| | - Neena I Marupudi
- Department of Neurosurgery, Children's Hospital of Michigan, Wayne State University, Detroit, 48201, USA
| | - Sandeep Sood
- Department of Neurosurgery, Children's Hospital of Michigan, Wayne State University, Detroit, 48201, USA
| | - Eishi Asano
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, 48201, USA; Department of Neurology, Children's Hospital of Michigan, Wayne State University, Detroit, 48201, USA.
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Hamberger MJ, Heydari N, Caccappolo E, Seidel WT. Naming in Older Adults: Complementary Auditory and Visual Assessment. J Int Neuropsychol Soc 2022; 28:574-587. [PMID: 34085630 PMCID: PMC8642458 DOI: 10.1017/s1355617721000552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Naming difficulty is a common symptom of multiple age-related neurodegenerative disorders. As naming difficulty increases with age, valid, up-to-date naming assessment tools are crucial for differentiating between neurotypical changes in healthy aging and pathological naming difficulty. We aimed to develop and provide normative data for complementary auditory description naming and visual naming tests for older adults. Furthermore, these measures would include not only untimed accuracy, typically the sole naming performance measure, but also additional scores that incorporate features characteristic of actual word finding difficulty. METHODS A normative sample of 407 healthy older adults, aged 56-100 years, were administered the Auditory Naming Test (ANT) and Visual Naming Test (VNT), and other standardized measures. RESULTS Item analyses resulted in 36 stimuli for both tests. Age-stratified, education-based normative data are provided for accuracy, response time, tip-of-the-tongue (i.e., delayed, yet accurate responses plus correct responses following phonemic cueing), and multiple Summary Scores. Internal and test-retest reliability coefficients were reasonable (.59-.84). Untimed accuracy scores were high across age groups, seemingly reflecting stability of naming into late adulthood; however, time- and cue-based scores revealed reduced efficiency in word retrieval with increasing age. CONCLUSIONS These complementary auditory and visual naming test for older adults improve upon the current standard by providing more sensitive performance measures and the addition of an auditory-verbal component for assessing naming. Detection of subtle naming changes in healthy aging holds promise for capturing symptomatic naming changes during the early stages of neurocognitive disorders involving expressive language, potentially assisting in earlier diagnoses and more timely treatment.
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Affiliation(s)
| | - Nahal Heydari
- Department of Neurology, Columbia University, New York, NY
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8
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Significance of event related causality (ERC) in eloquent neural networks. Neural Netw 2022; 149:204-216. [PMID: 35248810 PMCID: PMC9029701 DOI: 10.1016/j.neunet.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 11/20/2022]
Abstract
Neural activity emerges and propagates swiftly between brain areas. Investigation of these transient large-scale flows requires sophisticated statistical models. We present a method for assessing the statistical confidence of event-related neural propagation. Furthermore, we propose a criterion for statistical model selection, based on both goodness of fit and width of confidence intervals. We show that event-related causality (ERC) with two-dimensional (2D) moving average, is an efficient estimator of task-related neural propagation and that it can be used to determine how different cognitive task demands affect the strength and directionality of neural propagation across human cortical networks. Using electrodes surgically implanted on the surface of the brain for clinical testing prior to epilepsy surgery, we recorded electrocorticographic (ECoG) signals as subjects performed three naming tasks: naming of ambiguous and unambiguous visual objects, and as a contrast, naming to auditory description. ERC revealed robust and statistically significant patterns of high gamma activity propagation, consistent with models of visually and auditorily cued word production. Interestingly, ambiguous visual stimuli elicited more robust propagation from visual to auditory cortices relative to unambiguous stimuli, whereas naming to auditory description elicited propagation in the opposite direction, consistent with recruitment of modalities other than those of the stimulus during object recognition and naming. The new method introduced here is uniquely suitable to both research and clinical applications and can be used to estimate the statistical significance of neural propagation for both cognitive neuroscientific studies and functional brain mapping prior to resective surgery for epilepsy and brain tumors.
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Kiroy V, Bakhtin O, Krivko E, Lazurenko D, Aslanyan E, Shaposhnikov D, Shcherban I. Spoken and Inner Speech-related EEG Connectivity in Different Spatial Direction. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2021.103224] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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10
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Zhou T, Yu T, Li Z, Zhou X, Wen J, Li X. Functional mapping of language-related areas from natural, narrative speech during awake craniotomy surgery. Neuroimage 2021; 245:118720. [PMID: 34774771 DOI: 10.1016/j.neuroimage.2021.118720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/22/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022] Open
Abstract
Accurate localization of brain regions responsible for language and cognitive functions in epilepsy patients is important. Electrocorticography (ECoG)-based real-time functional mapping (RTFM) has been shown to be a safer alternative to electrical cortical stimulation mapping (ESM), which is currently the clinical/gold standard. Conventional methods for analyzing RTFM data mostly account for the ECoG signal in certain frequency bands, especially high gamma. Compared to ESM, they have limited accuracy when assessing channel responses. In the present study, we developed a novel RTFM method based on tensor component analysis (TCA) to address the limitations of current estimation methods. Our approach analyzes the whole frequency spectrum of the ECoG signal during natural continuous speech. We construct third-order tensors that contain multichannel time-frequency information and use TCA to extract low-dimensional temporal, spectral and spatial modes. Temporal modulation scores (correlation values) are then calculated between the time series of voice envelope features and TCA-estimated temporal courses, and significant temporal modulation determines which components' channel weightings are displayed to the neurosurgeon as a guide for follow-up ESM. In our experiments, data from thirteen patients with refractory epilepsy were recorded during preoperative evaluation for their epileptogenic zones (EZs), which were located adjacent to the eloquent cortex. Our results showed higher detection accuracy of our proposed method in a narrative speech task, suggesting that our method complements ESM and is an improvement over the prior RTFM method. To our knowledge, this is the first TCA-based method to pinpoint language-specific brain regions during continuous speech that uses whole-band ECoG.
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Affiliation(s)
- Tianyi Zhou
- Center for Cognition and Neuroergonomics, State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University at Zhuhai 519087, China.
| | - Tao Yu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
| | - Zheng Li
- Center for Cognition and Neuroergonomics, State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University at Zhuhai 519087, China.
| | - Xiaoxia Zhou
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
| | - Jianbin Wen
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China.
| | - Xiaoli Li
- Center for Cognition and Neuroergonomics, State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University at Zhuhai 519087, China; State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China.
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11
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Hirsch JA, Cuesta GM, Fonzetti P, Comaty J, Jordan BD, Cirio R, Levin L, Abrahams A, Fry KM. Expanded Exploration of the Auditory Naming Test in Patients with Dementia. J Alzheimers Dis 2021; 81:1763-1779. [PMID: 33998546 DOI: 10.3233/jad-210322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Auditory naming tests are superior to visual confrontation naming tests in revealing word-finding difficulties in many neuropathological conditions. OBJECTIVE To delineate characteristics of auditory naming most likely to reveal anomia in patients with dementia, and possibly improve diagnostic utility, we evaluated a large sample of patients referred with memory impairment complaints. METHODS Patients with dementia (N = 733) or other cognitive impairments and normal individuals (N = 69) were evaluated for frequency of impairment on variables of the Auditory Naming Test (ANT) of Hamberger & Seidel versus the Boston Naming Test (BNT). RESULTS Naming impairment occurred more frequently using the ANT total score (φ= 0.41) or ANT tip-of-the tongue score (TOT; φ= 0.19) but not ANT mean response time compared to the BNT in patients with dementia (p < 0.001). Significantly more patients were impaired on ANT variables than on the BNT in Alzheimer's disease (AD), vascular dementia (VaD), mixed AD/VaD, and multiple domain mild cognitive impairment (mMCI) but not in other dementias or amnestic MCI (aMCI). This differential performance of patients on auditory versus visual naming tasks was most pronounced in older, well-educated, male patients with the least cognitive impairment. Impaired verbal comprehension was not contributory. Inclusion of an ANT index score increased sensitivity in the dementia sample (92%). Poor specificity (41%) may be secondary to the inherent limitation of using the BNT as a control variable. CONCLUSION The ANT index score adds diagnostic utility to the assessment of naming difficulties in patients with suspected dementia.
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Affiliation(s)
- Joseph A Hirsch
- Department of Psychiatry, Lenox Hill Hospital, Northwell Health, New York, NY, USA.,Department of Psychology, Pace University, New York, NY, USA
| | - George M Cuesta
- New York Harbor Healthcare System, Veterans Health Administration, New York, NY, USA.,New York University Langone Medical Center, New York, NY, USA
| | | | | | - Barry D Jordan
- Rancho Los Amigos National Rehabilitation Hospital, Downey, CA, USA
| | | | - Leanne Levin
- New York Medical College, Department of Medicine, Valhalla, NY, USA
| | | | - Kathleen M Fry
- George E. Wahlen Department of Veterans Affairs Medical Center, Department of Psychology, Salt Lake City, UT, USA
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Aabedi AA, Kakaizada S, Young JS, Ahn E, Weissman DH, Berger MS, Brang D, Hervey-Jumper SL. Balancing task sensitivity with reliability for multimodal language assessments. J Neurosurg 2021; 135:1817-1824. [PMID: 34049284 PMCID: PMC10404475 DOI: 10.3171/2020.10.jns202947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intraoperative tasks for awake language mapping are typically selected based on the language tracts that will likely be encountered during tumor resection. However, diminished attention and arousal secondary to perioperative sedatives may reduce a task's usefulness for identifying eloquent cortex. For instance, accuracy in performing select language tasks may be high preoperatively but decline in the operating room. In the present study, the authors sought to identify language tasks that can be performed with high accuracy in both situational contexts so the neurosurgical team can be confident that speech errors committed during awake language mapping result from direct cortical stimulation to eloquent cortex, rather than from poor performance in general. METHODS We administered five language tasks to 44 patients: picture naming (PN), text reading (TR), auditory object naming (AN), repetition of 4-syllable words (4SYL), and production of syntactically intact sentences (SYNTAX). Performance was assessed using the 4-point scale of the quick aphasia battery 24 hours preoperatively and intraoperatively. We next determined whether or not accuracy on each task was higher preoperatively than intraoperatively. We also determined whether 1) intraoperative accuracy on a given task predicted intraoperative performance on the other tasks and 2) low preoperative accuracy on a task predicted a decrease in accuracy intraoperatively. RESULTS Relative to preoperative accuracy, intraoperative accuracy declined on PN (3.90 vs 3.82, p = 0.0001), 4SYL (3.96 vs 3.91, p = 0.0006), and SYNTAX (3.85 vs 3.67, p = 0.0001) but not on TR (3.96 vs 3.94, p = 0.13) or AN (3.70 vs 3.58, p = 0.058). Intraoperative accuracy on PN and AN independently predicted intraoperative accuracy on the remaining language tasks (p < 0.001 and p < 0.01, respectively). Finally, low preoperative accuracy on SYNTAX predicted a decrease in accuracy on this task intraoperatively (R2 = 0.36, p = 0.00002). CONCLUSIONS While TR lacks sensitivity in identifying language deficits at baseline, accuracy on TR is stable across testing settings. Baseline accuracy on the other four of our five language tasks was not predictive of intraoperative performance, signifying the need to repeat language tests prior to stimulation mapping to confirm reliability.
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Affiliation(s)
- Alexander A. Aabedi
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Sofia Kakaizada
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Jacob S. Young
- Department of Neurological Surgery, University of California, San Francisco, California
| | - EunSeon Ahn
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | | | - Mitchel S. Berger
- Department of Neurological Surgery, University of California, San Francisco, California
| | - David Brang
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
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13
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Ouyang H, Yu J, Duan J, Zheng L, Li L, Guo X. Empathy-based tolerance towards poor norm violators in third-party punishment. Exp Brain Res 2021; 239:2171-2180. [PMID: 33978785 DOI: 10.1007/s00221-021-06128-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/29/2021] [Indexed: 11/28/2022]
Abstract
Third-party punishment (TPP) plays an important role in fairness norm enforcement. This study investigated how the economic status of proposers could modulate third parties' behavioural and neural responses to unfairness. Participants played a TPP game as third parties deciding whether to punish proposers after observing the offers from proposers while behavioural and electroencephalogram (EEG) data were recorded. The proposers were of either high economic status or low economic status, and the recipients were middle class. The behavioural results indicated that participants reported decreased punishment for poor-proposed unfair offers compared to rich-proposed unfair offers, and this effect was stronger for highly unfair offers. Neurally, greater P200, a component involved in empathy processing, was observed in response to highly unfair offers (i.e. 90:10 and 80:20) proposed by the poor, suggesting that when the targets of severe punishments were poor proposers, participants showed greater empathy for poor norm violators in highly unfair trials. Taken together, these findings help to elucidate that the third-parties tend to tolerate the norm-violating behaviours conducted by the poor and provided further neuroscience evidence for the influence of economic status of proposers on TPP.
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Affiliation(s)
- Hui Ouyang
- School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | | | - Jipeng Duan
- School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Li Zheng
- School of Psychology and Cognitive Science, East China Normal University, Shanghai, China. .,Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China. .,Key Laboratory of Brain Functional Genomics, Ministry of Education, Shanghai Key Laboratory of Brain Functional Genomics, East China Normal University, Shanghai, China. .,National Demonstration Center for Experimental Psychology Education, East China Normal University, Shanghai, China.
| | - Lin Li
- School of Psychology and Cognitive Science, East China Normal University, Shanghai, China. .,National Demonstration Center for Experimental Psychology Education, East China Normal University, Shanghai, China.
| | - Xiuyan Guo
- School of Psychology and Cognitive Science, East China Normal University, Shanghai, China.,Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China.,Key Laboratory of Brain Functional Genomics, Ministry of Education, Shanghai Key Laboratory of Brain Functional Genomics, East China Normal University, Shanghai, China.,National Demonstration Center for Experimental Psychology Education, East China Normal University, Shanghai, China
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14
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Wang Y, Hays MA, Coogan C, Kang JY, Flinker A, Arya R, Korzeniewska A, Crone NE. Spatial-Temporal Functional Mapping Combined With Cortico-Cortical Evoked Potentials in Predicting Cortical Stimulation Results. Front Hum Neurosci 2021; 15:661976. [PMID: 33935673 PMCID: PMC8079642 DOI: 10.3389/fnhum.2021.661976] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
Functional human brain mapping is commonly performed during invasive monitoring with intracranial electroencephalographic (iEEG) electrodes prior to resective surgery for drug resistant epilepsy. The current gold standard, electrocortical stimulation mapping (ESM), is time consuming, sometimes elicits pain, and often induces after discharges or seizures. Moreover, there is a risk of overestimating eloquent areas due to propagation of the effects of stimulation to a broader network of language cortex. Passive iEEG spatial-temporal functional mapping (STFM) has recently emerged as a potential alternative to ESM. However, investigators have observed less correspondence between STFM and ESM maps of language than between their maps of motor function. We hypothesized that incongruities between ESM and STFM of language function may arise due to propagation of the effects of ESM to cortical areas having strong effective connectivity with the site of stimulation. We evaluated five patients who underwent invasive monitoring for seizure localization, whose language areas were identified using ESM. All patients performed a battery of language tasks during passive iEEG recordings. To estimate the effective connectivity of stimulation sites with a broader network of task-activated cortical sites, we measured cortico-cortical evoked potentials (CCEPs) elicited across all recording sites by single-pulse electrical stimulation at sites where ESM was performed at other times. With the combination of high gamma power as well as CCEPs results, we trained a logistic regression model to predict ESM results at individual electrode pairs. The average accuracy of the classifier using both STFM and CCEPs results combined was 87.7%, significantly higher than the one using STFM alone (71.8%), indicating that the correspondence between STFM and ESM results is greater when effective connectivity between ESM stimulation sites and task-activated sites is taken into consideration. These findings, though based on a small number of subjects to date, provide preliminary support for the hypothesis that incongruities between ESM and STFM may arise in part from propagation of stimulation effects to a broader network of cortical language sites activated by language tasks, and suggest that more studies, with larger numbers of patients, are needed to understand the utility of both mapping techniques in clinical practice.
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Affiliation(s)
- Yujing Wang
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mark A Hays
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Christopher Coogan
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Joon Y Kang
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Adeen Flinker
- Department of Neurology, New York University School of Medicine, New York, NY, United States
| | - Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Anna Korzeniewska
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nathan E Crone
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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15
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Drane DL, Pedersen NP, Sabsevitz DS, Block C, Dickey AS, Alwaki A, Kheder A. Cognitive and Emotional Mapping With SEEG. Front Neurol 2021; 12:627981. [PMID: 33912122 PMCID: PMC8072290 DOI: 10.3389/fneur.2021.627981] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/04/2021] [Indexed: 02/05/2023] Open
Abstract
Mapping of cortical functions is critical for the best clinical care of patients undergoing epilepsy and tumor surgery, but also to better understand human brain function and connectivity. The purpose of this review is to explore existing and potential means of mapping higher cortical functions, including stimulation mapping, passive mapping, and connectivity analyses. We examine the history of mapping, differences between subdural and stereoelectroencephalographic approaches, and some risks and safety aspects, before examining different types of functional mapping. Much of this review explores the prospects for new mapping approaches to better understand other components of language, memory, spatial skills, executive, and socio-emotional functions. We also touch on brain-machine interfaces, philosophical aspects of aligning tasks to brain circuits, and the study of consciousness. We end by discussing multi-modal testing and virtual reality approaches to mapping higher cortical functions.
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Affiliation(s)
- Daniel L. Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
- Emory Epilepsy Center, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, United States
| | - Nigel P. Pedersen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
- Emory Epilepsy Center, Atlanta, GA, United States
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - David S. Sabsevitz
- Department of Psychology and Psychiatry, Mayo Clinic, Jacksonville, FL, United States
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Cady Block
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Adam S. Dickey
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Abdulrahman Alwaki
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Ammar Kheder
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
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16
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Wang Y, Korzeniewska A, Usami K, Valenzuela A, Crone NE. The Dynamics of Language Network Interactions in Lexical Selection: An Intracranial EEG Study. Cereb Cortex 2021; 31:2058-2070. [PMID: 33283856 PMCID: PMC7945024 DOI: 10.1093/cercor/bhaa344] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/18/2020] [Accepted: 10/22/2020] [Indexed: 11/14/2022] Open
Abstract
Speaking in sentences requires selection from contextually determined lexical representations. Although posterior temporal cortex (PTC) and Broca's areas play important roles in storage and selection, respectively, of lexical representations, there has been no direct evidence for physiological interactions between these areas on time scales typical of lexical selection. Using intracranial recordings of cortical population activity indexed by high-gamma power (70-150 Hz) modulations, we studied the causal dynamics of cortical language networks while epilepsy surgery patients performed a sentence completion task in which the number of potential lexical responses was systematically varied. Prior to completion of sentences with more response possibilities, Broca's area was not only more active, but also exhibited more local network interactions with and greater top-down influences on PTC, consistent with activation of, and competition between, more lexical representations. These findings provide the most direct experimental support yet for network dynamics playing a role in lexical selection among competing alternatives during speech production.
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Affiliation(s)
- Yujing Wang
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Fischell Department of Bioengineering, University of Maryland College Park, College Park, MD 20742, USA
| | - Anna Korzeniewska
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Kiyohide Usami
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, Sakyoku, Kyoto 606-8507, Japan
| | - Alyssandra Valenzuela
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Nathan E Crone
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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17
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Clinical application of intraoperative trial-free online-based language mapping for patients with refractory epilepsy. Epilepsy Behav 2021; 116:107496. [PMID: 33582498 DOI: 10.1016/j.yebeh.2020.107496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of the study was to develop and clinically test a trial-free online-based language mapping method for localizing the eloquent cortex easily in epilepsy operation. METHODS Nine patients with refractory epilepsy were included in this study according to the results of preoperative evaluation for their epileptogenic zones (EZs) located adjacent to the eloquent cortex. When patients were awakened up from general anesthesia during operation, the trial-free online-based language-mapping paradigm was performed. All positive points marked on the cortex in each test were labeled and superimposed together as the result of functional mapping for each patient. The eloquent cortex was mapped according to the results obtained both from the intraoperative trial-free task localization method and the traditional electrical cortical stimulation (ECS). RESULTS All patients completed this paradigms twice within 10 min. Based on the results of mapping, the EZs were tried to fully resected on the premise of preserving the mapped eloquent cortex as much as possible. The postoperative follow-up showed the outcome of Engel I in six patients and Engel II in three patients, whereas only two patients had aphemia after surgery and recovered within one week and three months, respectively. SIGNIFICANCE The intraoperative trial-free online-based language mapping method was primarily identified to be safe and effective. This novel method seems to be promising and worthy of improvement.
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18
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Trébuchon A, Liégeois-Chauvel C, Gonzalez-Martinez JA, Alario FX. Contributions of electrophysiology for identifying cortical language systems in patients with epilepsy. Epilepsy Behav 2020; 112:107407. [PMID: 33181892 DOI: 10.1016/j.yebeh.2020.107407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 11/26/2022]
Abstract
A crucial element of the surgical treatment of medically refractory epilepsy is to delineate cortical areas that must be spared in order to avoid clinically relevant neurological and neuropsychological deficits postoperatively. For each patient, this typically necessitates determining the language lateralization between hemispheres and language localization within hemisphere. Understanding cortical language systems is complicated by two primary challenges: the extent of the neural tissue involved and the substantial variability across individuals, especially in pathological populations. We review the contributions made through the study of electrophysiological activity to address these challenges. These contributions are based on the techniques of magnetoencephalography (MEG), intracerebral recordings, electrical-cortical stimulation (ECS), and the electrovideo analyses of seizures and their semiology. We highlight why no single modality alone is adequate to identify cortical language systems and suggest avenues for improving current practice.
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Affiliation(s)
- Agnès Trébuchon
- Aix-Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Catherine Liégeois-Chauvel
- Aix-Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France; Department of Neurological Surgery, School of Medicine, University of Pittsburgh (PA), USA
| | | | - F-Xavier Alario
- Department of Neurological Surgery, School of Medicine, University of Pittsburgh (PA), USA; Aix-Marseille Univ, CNRS, LPC, Marseille, France.
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19
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Left hemispheric α band cerebral oscillatory changes correlate with verbal memory. Sci Rep 2020; 10:14993. [PMID: 32929146 PMCID: PMC7490359 DOI: 10.1038/s41598-020-72087-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/25/2020] [Indexed: 11/12/2022] Open
Abstract
Event-related synchronisation (ERS) and event-related desynchronisation (ERD) have been observed via magnetoencephalography (MEG) in the language-dominant hemisphere. However, the relationship between ERS/ERD and clinical language indices is unclear. Therefore, the present study evaluated brain activity utilising MEG during a verb generation task in 36 subjects and determined ERS/ERD power values in θ, α, β, low γ and high γ frequency bands. To measure clinical language indices, we adopted Wechsler Memory Scale-revised. We observed ERD in the α band from the bilateral occipital to the left central brain region, in the β band from the bilateral occipital to the left frontal region and in the low γ band a high-power signal in the left frontal region. We also observed ERS in the θ band in bilateral frontal region and in the high γ band in bilateral occipital region. Furthermore, we found a significant negative correlation between α-band ERD power at the left postcentral gyrus and medial superior frontal gyrus and verbal memory score (correlation coefficients = − 0.574 and − 0.597, respectively). These results suggest that individuals with lower linguistic memory have less desynchronised α-band ERD power and α-band ERD power in the left hemisphere may be a neurophysiological biomarker for verbal memory.
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20
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Sakpichaisakul K, Byars AW, Horn PS, Aungaroon G, Greiner HM, Mangano FT, Holland KD, Arya R. Neuropsychological outcomes after pediatric epilepsy surgery: Role of electrical stimulation language mapping. Seizure 2020; 80:183-191. [PMID: 32604001 DOI: 10.1016/j.seizure.2020.06.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 01/06/2023] Open
Abstract
PURPOSE We studied the association between electrical stimulation mapping (ESM) with a visual naming task and post-operative neuropsychological outcomes after pediatric epilepsy surgery. METHODS Children who underwent epilepsy surgery, having pre- and 1-year post-surgery neuropsychological evaluation (NPE) available, were included. NPE scores were transformed using principal components (PC) analysis. The relationship between post-surgical PC scores, adjusted for pre-surgery PC scores, and ESM was analyzed. Clinical variables influencing this relationship were also sought. RESULTS One hundred and four children (89 patients >5 years-old, and 15 patients 3-5 years-old) were included. Among children >5 years-of-age, a significant effect of language ESM was observed on all 3 post-surgery PC scores adjusted for respective pre-surgery PC scores. Specifically, only 30 % patients who underwent language ESM had a decrease in PC1 scores ≥1-year after epilepsy surgery, compared to 68 % those who did not undergo language ESM (p = 0.001). Seizure outcomes, age at the time of surgery, predominant seizure type, and family history of epilepsy were other significant determinants of post-surgical PC scores including a change in PC scores from pre-surgery baseline. Combinations of pre-surgical variables were able to predict post-surgical PC scores with high specificity. In children aged 3-5 years, no significant effect of language ESM was seen on post-surgery PC scores adjusted for respective pre-surgery PC scores. CONCLUSIONS Speech/language ESM should be performed more widely in patients >5 years-of-age undergoing epilepsy surgery. Also, more efficient brain mapping techniques and language paradigms are needed for younger children.
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Affiliation(s)
- Kullasate Sakpichaisakul
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Division of Neurology, Department of Pediatrics, Queen Sirikit National Institute of Child Health, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Anna W Byars
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Paul S Horn
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Gewalin Aungaroon
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Hansel M Greiner
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Francesco T Mangano
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Katherine D Holland
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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21
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Korzeniewska A, Wang Y, Benz HL, Fifer MS, Collard M, Milsap G, Cervenka MC, Martin A, Gotts SJ, Crone NE. Changes in human brain dynamics during behavioral priming and repetition suppression. Prog Neurobiol 2020; 189:101788. [PMID: 32198060 DOI: 10.1016/j.pneurobio.2020.101788] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 01/13/2020] [Accepted: 03/13/2020] [Indexed: 11/29/2022]
Abstract
Behavioral responses to a perceptual stimulus are typically faster with repeated exposure to the stimulus (behavioral priming). This implicit learning mechanism is critical for survival but impaired in a variety of neurological disorders, including Alzheimer's disease. Many studies of the neural bases for behavioral priming have encountered an interesting paradox: in spite of faster behavioral responses, repeated stimuli usually elicit weaker neural responses (repetition suppression). Several neurophysiological models have been proposed to resolve this paradox, but noninvasive techniques for human studies have had insufficient spatial-temporal precision for testing their predictions. Here, we used the unparalleled precision of electrocorticography (ECoG) to analyze the timing and magnitude of task-related changes in neural activation and propagation while patients named novel vs repeated visual objects. Stimulus repetition was associated with faster verbal responses and decreased neural activation (repetition suppression) in ventral occipito-temporal cortex (VOTC) and left prefrontal cortex (LPFC). Interestingly, we also observed increased neural activation (repetition enhancement) in LPFC and other recording sites. Moreover, with analysis of high gamma propagation we observed increased top-down propagation from LPFC into VOTC, preceding repetition suppression. The latter results indicate that repetition suppression and behavioral priming are associated with strengthening of top-down network influences on perceptual processing, consistent with predictive coding models of repetition suppression, and they support a central role for changes in large-scale cortical dynamics in achieving more efficient and rapid behavioral responses.
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Affiliation(s)
- Anna Korzeniewska
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, 21287, USA.
| | - Yujing Wang
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, 21287, USA
| | - Heather L Benz
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, 21287, USA
| | - Matthew S Fifer
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, 21287, USA
| | - Max Collard
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, 21287, USA
| | - Griffin Milsap
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, 21287, USA
| | - Mackenzie C Cervenka
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, 21287, USA
| | - Alex Martin
- Laboratory of Brain and Cognition, National Institute of Mental Health, Bethesda, Maryland, 20852, USA
| | - Stephen J Gotts
- Laboratory of Brain and Cognition, National Institute of Mental Health, Bethesda, Maryland, 20852, USA
| | - Nathan E Crone
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, 21287, USA
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22
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Williams Roberson S, Shah P, Piai V, Gatens H, Krieger AM, Lucas TH, Litt B. Electrocorticography reveals spatiotemporal neuronal activation patterns of verbal fluency in patients with epilepsy. Neuropsychologia 2020; 141:107386. [PMID: 32105726 DOI: 10.1016/j.neuropsychologia.2020.107386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 01/01/2020] [Accepted: 02/09/2020] [Indexed: 02/05/2023]
Abstract
Verbal fluency is commonly used to evaluate cognitive dysfunction in a variety of neuropsychiatric diseases, yet the neurobiology underlying performance of this task is incompletely understood. Electrocorticography (ECoG) provides a unique opportunity to investigate temporal activation patterns during cognitive tasks with high spatial and temporal precision. We used ECoG to study high gamma activity (HGA) patterns in patients undergoing presurgical evaluation for intractable epilepsy as they completed an overt, free-recall verbal fluency task. We examined regions demonstrating changes in HGA during specific timeframes relative to speech onset. Early pre-speech high gamma activity was present in left frontal regions during letter fluency and in bifrontal regions during category fluency. During timeframes typically associated with word planning, a distributed network was engaged including left inferior frontal, orbitofrontal and posterior temporal regions. Peri-Rolandic activation was observed during speech onset, and there was post-speech activation in the bilateral posterior superior temporal regions. Based on these observations in the context of prior studies, we propose a model of neocortical activity patterns underlying verbal fluency.
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Affiliation(s)
- Shawniqua Williams Roberson
- University of Pennsylvania, Center for Neuroengineering and Therapeutics, 240 South 33rd Street, Philadelphia, PA, 19104, USA.
| | - Preya Shah
- University of Pennsylvania, Center for Neuroengineering and Therapeutics, 240 South 33rd Street, Philadelphia, PA, 19104, USA
| | - Vitória Piai
- Radboud University, Donders Centre for Cognition, Montessorilaan 3, 6525HR, Nijmegen, the Netherlands; Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Medical Psychology, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, the Netherlands
| | - Heather Gatens
- University of Pennsylvania, Center for Neuroengineering and Therapeutics, 240 South 33rd Street, Philadelphia, PA, 19104, USA
| | - Abba M Krieger
- University of Pennsylvania, The Wharton School, 3730 Walnut Street, Philadelphia, PA, 19104, USA
| | - Timothy H Lucas
- University of Pennsylvania, Center for Neuroengineering and Therapeutics, 240 South 33rd Street, Philadelphia, PA, 19104, USA
| | - Brian Litt
- University of Pennsylvania, Center for Neuroengineering and Therapeutics, 240 South 33rd Street, Philadelphia, PA, 19104, USA
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23
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Muh CR, Chou ND, Rahimpour S, Komisarow JM, Spears TG, Fuchs HE, Serafini S, Grant GA. Cortical stimulation mapping for localization of visual and auditory language in pediatric epilepsy patients. J Neurosurg Pediatr 2019; 25:168-177. [PMID: 31703207 DOI: 10.3171/2019.8.peds1922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 08/28/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine resection margins near eloquent tissue, electrical cortical stimulation (ECS) mapping is often used with visual naming tasks. In recent years, auditory naming tasks have been found to provide a more comprehensive map. Differences in modality-specific language sites have been found in adult patients, but there is a paucity of research on ECS language studies in pediatric patients. The goals of this study were to evaluate word-finding distinctions between visual and auditory modalities and identify which cortical subregions most often contain critical language function in a pediatric population. METHODS Twenty-one pediatric patients with epilepsy or temporal lobe pathology underwent ECS mapping using visual (n = 21) and auditory (n = 14) tasks. Fisher's exact test was used to determine whether the frequency of errors in the stimulated trials was greater than the patient's baseline error rate for each tested modality and subregion. RESULTS While the medial superior temporal gyrus was a common language site for both visual and auditory language (43.8% and 46.2% of patients, respectively), other subregions showed significant differences between modalities, and there was significant variability between patients. Visual language was more likely to be located in the anterior temporal lobe than was auditory language. The pediatric patients exhibited fewer parietal language sites and a larger range of sites overall than did adult patients in previously published studies. CONCLUSIONS There was no single area critical for language in more than 50% of patients tested in either modality for which more than 1 patient was tested (n > 1), affirming that language function is plastic in the setting of dominant-hemisphere pathology. The high rates of language function throughout the left frontal, temporal, and anterior parietal regions with few areas of overlap between modalities suggest that ECS mapping with both visual and auditory testing is necessary to obtain a comprehensive language map prior to epileptic focus or tumor resection.
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Affiliation(s)
- Carrie R Muh
- 1Department of Neurosurgery, Duke University Hospital, and
- 2Department of Neurosurgery, Maria Fareri Children's Hospital, Westchester Medical Center, Valhalla, New York; and
| | - Naomi D Chou
- 1Department of Neurosurgery, Duke University Hospital, and
| | | | | | - Tracy G Spears
- 3Duke Clinical Research Institute, Durham, North Carolina
| | | | | | - Gerald A Grant
- 4Department of Neurosurgery, Stanford University Hospital, Stanford, California
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24
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Babajani-Feremi A, Fulton SP, Holder CM, Choudhri AF, Boop FA, Wheless JW. Localization of Expressive Language Cortex in a 2-Year-Old Child Using High-Gamma Electrocorticography. J Child Neurol 2019; 34:837-841. [PMID: 31339411 DOI: 10.1177/0883073819863999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cortical stimulation mapping is the gold standard for presurgical language mapping; however, it cannot be reliably performed in very young patients. Language mapping using noninvasive modalities is also challenging in very young patients. Although utility of language mapping using power of high-gamma in electrocorticographic recordings was demonstrated in adults and older children, there is a gap of knowledge in the ability of this procedure for localizing language-specific cortex in very young patients. We describe a case of a 2-year-old patient who, to our knowledge, is the youngest person to undergo successful high-gamma electrocorticographic presurgical language mapping for localization of the expressive language cortex (Broca area). The surgical plan was to resect a cortical tuber within the left inferior frontal gyrus and there was a strong concern about postoperative language deficit after resection. Presurgical language mapping using noninvasive modalities were attempted without success. Cortical stimulation mapping was not feasible in this patient. Therefore, high-gamma electrocorticography was the only viable option for language mapping, and it successfully localized the expressive language cortex. The patient underwent surgery for resection of the IFG tuber based on results of high-gamma electrocorticography and had no postoperative language deficit. High-gamma electrocorticography can be used for localizing language-specific cortex, especially Broca's area, in very young patients.
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Affiliation(s)
- Abbas Babajani-Feremi
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.,Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA.,Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Stephen P Fulton
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.,Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Christen M Holder
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.,Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Asim F Choudhri
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.,Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Frederick A Boop
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.,Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - James W Wheless
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.,Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
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25
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Arya R, Babajani-Feremi A, Byars AW, Vannest J, Greiner HM, Wheless JW, Mangano FT, Holland KD. A model for visual naming based on spatiotemporal dynamics of ECoG high-gamma modulation. Epilepsy Behav 2019; 99:106455. [PMID: 31419636 DOI: 10.1016/j.yebeh.2019.106455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 07/22/2019] [Accepted: 07/26/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We studied spatiotemporal dynamics of electrocorticographic (ECoG) high-gamma modulation (HGM) during visual naming. METHODS In 8 patients, aged 4-19 years, with left hemisphere subdural electrodes, propagation of ECoG HGM during overt visual naming was mapped with trial-averaged time-frequency analysis. Group-level synthesis was performed by transforming all electrodes to a standard space and assigning cortical parcels based on a reference atlas. RESULTS After image display following cortical parcels were activated: inferior occipital, caudal angular, fusiform, and middle temporal gyri, and superior temporal sulcus [0-400 ms]; rostral pars triangularis (A45r), inferior frontal sulcus, caudal dorsolateral premotor cortex (A6cdl) [300-600 ms]; caudal ventrolateral premotor cortex (A6cvl), caudal pars triangularis (A45c), pars opercularis (A44) [400-800 ms]; primary sensorimotor cortex [600-1400 ms], with most prominent HGM in glossolaryngeal region (A4tl). Lastly, auditory cortex (A41/A42) and superior temporal gyrus (A22) were activated [900 ms-1.4 s]. After 1.5 s, HGM decreased globally, except in ventrolateral premotor cortex. CONCLUSIONS During visual naming, ECoG HGM shows a sequential but overlapping spatiotemporal course through cortical regions. We provide neurophysiologic validation for a model of visual naming incorporating both modular and distributed cortical processing. This may explain cognitive deficits seen in some patients after surgery involving HGM naming sites outside perisylvian language cortex.
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Affiliation(s)
- Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America.
| | - Abbas Babajani-Feremi
- Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, TN, United States of America; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, United States of America; Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Anna W Byars
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
| | - Jennifer Vannest
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America; Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
| | - Hansel M Greiner
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - James W Wheless
- Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, TN, United States of America; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, United States of America
| | - Francesco T Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
| | - Katherine D Holland
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
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Kreidenhuber R, De Tiège X, Rampp S. Presurgical Functional Cortical Mapping Using Electromagnetic Source Imaging. Front Neurol 2019; 10:628. [PMID: 31249552 PMCID: PMC6584755 DOI: 10.3389/fneur.2019.00628] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/28/2019] [Indexed: 02/03/2023] Open
Abstract
Preoperative localization of functionally eloquent cortex (functional cortical mapping) is common clinical practice in order to avoid or reduce postoperative morbidity. This review aims at providing a general overview of magnetoencephalography (MEG) and high-density electroencephalography (hdEEG) based methods and their clinical role as compared to common alternatives for functional cortical mapping of (1) verbal language function, (2) sensorimotor cortex, (3) memory, (4) visual, and (5) auditory cortex. We highlight strengths, weaknesses and limitations of these functional cortical mapping modalities based on findings in the recent literature. We also compare their performance relative to other non-invasive functional cortical mapping methods, such as functional Magnetic Resonance Imaging (fMRI), Transcranial Magnetic Stimulation (TMS), and to invasive methods like the intracarotid Amobarbital Test (WADA-Test) or intracranial investigations.
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Affiliation(s)
- Rudolf Kreidenhuber
- Department of Neurology, Christian-Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Xavier De Tiège
- Laboratoire de Cartographie Fonctionelle du Cerveau, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium.,Department of Functional Neuroimaging, Service of Nuclear Medicine, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Stefan Rampp
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany.,Department of Neurosurgery, University Hospital Halle, Halle, Germany
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Ikegaya N, Motoi H, Iijima K, Takayama Y, Kambara T, Sugiura A, Silverstein BH, Iwasaki M, Asano E. Spatiotemporal dynamics of auditory and picture naming-related high-gamma modulations: A study of Japanese-speaking patients. Clin Neurophysiol 2019; 130:1446-1454. [PMID: 31056408 DOI: 10.1016/j.clinph.2019.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/03/2019] [Accepted: 04/15/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To characterize the spatiotemporal dynamics of auditory and picture naming-related cortical activation in Japanese-speaking patients. METHODS Ten patients were assigned auditory naming and picture naming tasks during extraoperative intracranial EEG recording in a tertiary epilepsy center. Time-frequency analysis determined at what electrode sites and at what time windows during each task the amplitude of high-gamma activity (65-95 Hz) was modulated. RESULTS The superior-temporal gyrus on each hemisphere showed high-gamma augmentation during sentence listening, whereas the left middle-temporal and inferior-frontal gyri showed high-gamma augmentation peaking around stimulus offset. Auditory naming-specific high-gamma augmentation was noted in the bilateral superior-temporal gyri as well as left frontal-parietal-temporal perisylvian network regions, whereas picture naming-specific augmentation was noted in the occipital-fusiform regions, bilaterally. The inferior pre- and postcentral gyri on each hemisphere showed modality-common high-gamma augmentation time-locked to overt responses. CONCLUSIONS The spatiotemporal dynamics of auditory and picture naming-related high-gamma augmentation in Japanese-speaking patients were qualitatively similar to those previously reported in studies of English-speaking patients. SIGNIFICANCE The cortical dynamics for auditory sentence recognition are at least partly shared by cohorts speaking two distinct languages. Multicenter studies regarding the clinical utility of high-gamma language mapping across Eastern and Western hemispheres may be feasible.
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Affiliation(s)
- Naoki Ikegaya
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo 1878551, Japan; Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama 2360004, Japan
| | - Hirotaka Motoi
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama 2360004, Japan; Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI 48201, USA
| | - Keiya Iijima
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo 1878551, Japan
| | - Yutaro Takayama
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo 1878551, Japan; Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama 2360004, Japan
| | - Toshimune Kambara
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI 48201, USA; Department of Psychology, Hiroshima University, Hiroshima 7398524, Japan
| | - Ayaka Sugiura
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI 48201, USA
| | - Brian H Silverstein
- Translational Neuroscience Program, Wayne State University, Detroit, MI 48202, USA
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo 1878551, Japan.
| | - Eishi Asano
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI 48201, USA; Department of Neurology, Wayne State University, Children's Hospital of Michigan, Detroit, MI 48201, USA.
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28
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Nakai Y, Sugiura A, Brown EC, Sonoda M, Jeong JW, Rothermel R, Luat AF, Sood S, Asano E. Four-dimensional functional cortical maps of visual and auditory language: Intracranial recording. Epilepsia 2019; 60:255-267. [PMID: 30710356 DOI: 10.1111/epi.14648] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/21/2018] [Accepted: 12/27/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The strength of presurgical language mapping using electrocorticography (ECoG) is its outstanding signal fidelity and temporal resolution, but the weakness includes limited spatial sampling at an individual patient level. By averaging naming-related high-gamma activity at nonepileptic regions across a large number of patients, we provided the functional cortical atlases animating the neural dynamics supporting visual-object and auditory-description naming at the whole brain level. METHODS We studied 79 patients who underwent extraoperative ECoG recording as epilepsy presurgical evaluation, and generated time-frequency plots and animation videos delineating the dynamics of naming-related high-gamma activity at 70-110 Hz. RESULTS Naming task performance elicited high-gamma augmentation in domain-specific lower-order sensory areas and inferior-precentral gyri immediately after stimulus onset. High-gamma augmentation subsequently involved widespread neocortical networks with left hemisphere dominance. Left posterior temporal high-gamma augmentation at several hundred milliseconds before response onset exhibited a double dissociation; picture naming elicited high-gamma augmentation preferentially in regions medial to the inferior-temporal gyrus, whereas auditory naming elicited high-gamma augmentation more laterally. The left lateral prefrontal regions including Broca's area initially exhibited high-gamma suppression subsequently followed by high-gamma augmentation at several hundred milliseconds before response onset during both naming tasks. Early high-gamma suppression within Broca's area was more intense during picture compared to auditory naming. Subsequent lateral-prefrontal high-gamma augmentation was more intense during auditory compared to picture naming. SIGNIFICANCE This study revealed contrasting characteristics in the spatiotemporal dynamics of naming-related neural modulations between tasks. The dynamic atlases of visual and auditory language might be useful for planning of epilepsy surgery. Differential neural activation well explains some of the previously reported observations of domain-specific language impairments following resective epilepsy surgery. Video materials might be beneficial for the education of lay people about how the brain functions differentially during visual and auditory naming.
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Affiliation(s)
- Yasuo Nakai
- Department of Pediatrics, Detroit Medical Center, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan.,Department of Neurological Surgery, Wakayama Medical University, Wakayama-shi, Japan
| | - Ayaka Sugiura
- Department of Pediatrics, Detroit Medical Center, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan
| | - Erik C Brown
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon
| | - Masaki Sonoda
- Department of Pediatrics, Detroit Medical Center, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan
| | - Jeong-Won Jeong
- Department of Pediatrics, Detroit Medical Center, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan.,Department of Neurology, Detroit Medical Center, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan
| | - Robert Rothermel
- Department of Psychiatry, Detroit Medical Center, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan
| | - Aimee F Luat
- Department of Pediatrics, Detroit Medical Center, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan.,Department of Neurology, Detroit Medical Center, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan
| | - Sandeep Sood
- Department of Neurosurgery, Detroit Medical Center, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan
| | - Eishi Asano
- Department of Pediatrics, Detroit Medical Center, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan.,Department of Neurology, Detroit Medical Center, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan
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Arya R, Roth C, Leach JL, Middeler D, Wilson JA, Vannest J, Rozhkov L, Greiner HM, Buroker J, Scholle C, Fujiwara H, Horn PS, Rose DF, Crone NE, Mangano FT, Byars AW, Holland KD. Neuropsychological outcomes after resection of cortical sites with visual naming associated electrocorticographic high-gamma modulation. Epilepsy Res 2019; 151:17-23. [PMID: 30721879 DOI: 10.1016/j.eplepsyres.2019.01.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/24/2018] [Accepted: 01/28/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Language mapping with high-gamma modulation (HGM) has compared well with electrical cortical stimulation mapping (ESM). However, there is limited prospective data about its functional validity. We compared changes in neuropsychological evaluation (NPE) performed before and 1-year after epilepsy surgery, between patients with/without resection of cortical sites showing HGM during a visual naming task. METHODS Pediatric drug-resistant epilepsy (DRE) patients underwent pre-surgical language localization with ESM and HGM using a visual naming task. Surgical decisions were based solely on ESM results. NPE difference scores were compared between patients with/without resection of HGM naming sites using principal component (PC) analysis. Follow-up NPE scores were modeled with resection group as main effect and respective pre-surgical score as a covariate, using analysis of covariance. RESULTS Seventeen native English speakers (12 females), aged 6.5-20.2 years, were included. One year after epilepsy surgery, first PC score increased by (mean ± standard deviation) 14.4 ± 16.5 points in patients without resection, whereas it decreased by 7.6 ± 24.6 points in those with resection of HGM naming sites (p = 0.040). This PC score represented verbal comprehension, working memory, perceptual reasoning (Wechsler subscales); Woodcock-Johnson Tests of Achievement; and Peabody Picture Vocabulary Test. Subsequent analysis showed significant difference in working memory score between patients with/without resection of HGM naming sites (-15.2 points, 95% confidence limits -29.7 to -0.7, p = 0.041). CONCLUSION We highlight the functional consequences of resecting HGM language sites, and suggest that NPE of DRE patients should include comprehensive assessment of multiple linguistic and cognitive domains besides naming ability.
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Affiliation(s)
- Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Celie Roth
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James L Leach
- Division of Pediatric Neuroradiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Denise Middeler
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - J Adam Wilson
- Pediatric Neuroimaging Research Consortium, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jennifer Vannest
- Pediatric Neuroimaging Research Consortium, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Leonid Rozhkov
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Hansel M Greiner
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jason Buroker
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Division of Clinical Engineering, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Craig Scholle
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Division of Clinical Engineering, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Hisako Fujiwara
- Pediatric Neuroimaging Research Consortium, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Paul S Horn
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Douglas F Rose
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nathan E Crone
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Francesco T Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Anna W Byars
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Katherine D Holland
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Swift JR, Coon WG, Guger C, Brunner P, Bunch M, Lynch T, Frawley B, Ritaccio AL, Schalk G. Passive functional mapping of receptive language areas using electrocorticographic signals. Clin Neurophysiol 2018; 129:2517-2524. [PMID: 30342252 DOI: 10.1016/j.clinph.2018.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To validate the use of passive functional mapping using electrocorticographic (ECoG) broadband gamma signals for identifying receptive language cortex. METHODS We mapped language function in 23 patients using ECoG and using electrical cortical stimulation (ECS) in a subset of 15 subjects. RESULTS The qualitative comparison between cortical sites identified by ECoG and ECS show a high concordance. A quantitative comparison indicates a high level of sensitivity (95%) and a lower level of specificity (59%). Detailed analysis reveals that 82% of all cortical sites identified by ECoG were within one contact of a site identified by ECS. CONCLUSIONS These results show that passive functional mapping reliably localizes receptive language areas, and that there is a substantial concordance between the ECoG- and ECS-based methods. They also point to a more refined understanding of the differences between ECoG- and ECS-based mappings. This refined understanding helps to clarify the instances in which the two methods disagree and can explain why neurosurgical practice has established the concept of a "safety margin." SIGNIFICANCE Passive functional mapping using ECoG signals provides a fast, robust, and reliable method for identifying receptive language areas without many of the risks and limitations associated with ECS.
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Affiliation(s)
- J R Swift
- g.tec neurotechnology USA, Rensselaer, NY, USA; Dept. of Biomedical Sciences, State University of New York at Albany, Albany, NY, USA; National Ctr. for Adaptive Neurotechnologies, Wadsworth Center, NY State Dept. of Health, Albany, NY, USA.
| | - W G Coon
- g.tec neurotechnology USA, Rensselaer, NY, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA; Dept. of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; National Ctr. for Adaptive Neurotechnologies, Wadsworth Center, NY State Dept. of Health, Albany, NY, USA.
| | - C Guger
- g.tec neurotechnology USA, Rensselaer, NY, USA.
| | - P Brunner
- Dept. of Neurology, Albany Medical College, Albany, NY, USA; National Ctr. for Adaptive Neurotechnologies, Wadsworth Center, NY State Dept. of Health, Albany, NY, USA.
| | - M Bunch
- Dept. of Neurology, Albany Medical College, Albany, NY, USA.
| | - T Lynch
- Dept. of Neurology, Albany Medical College, Albany, NY, USA.
| | - B Frawley
- Dept. of Neurology, Albany Medical College, Albany, NY, USA.
| | - A L Ritaccio
- Dept. of Neurology, Mayo Clinic, Jacksonville, FL, USA; National Ctr. for Adaptive Neurotechnologies, Wadsworth Center, NY State Dept. of Health, Albany, NY, USA.
| | - G Schalk
- Dept. of Biomedical Sciences, State University of New York at Albany, Albany, NY, USA; Dept. of Neurology, Albany Medical College, Albany, NY, USA; National Ctr. for Adaptive Neurotechnologies, Wadsworth Center, NY State Dept. of Health, Albany, NY, USA.
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Wen J, Yu T, Wang X, Liu C, Zhou T, Li Y, Li X. Continuous behavioral tracing-based online functional brain mapping with intracranial electroencephalography. J Neural Eng 2018; 15:054002. [DOI: 10.1088/1741-2552/aad405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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32
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Flinker A, Knight RT. Broca’s area in comprehension and production, insights from intracranial studies in humans. Curr Opin Behav Sci 2018. [DOI: 10.1016/j.cobeha.2018.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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33
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On the relative merits of invasive and non-invasive pre-surgical brain mapping: New tools in ablative epilepsy surgery. Epilepsy Res 2018; 142:153-155. [DOI: 10.1016/j.eplepsyres.2017.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/01/2017] [Accepted: 07/01/2017] [Indexed: 11/23/2022]
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34
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Lehtinen H, Mäkelä JP, Mäkelä T, Lioumis P, Metsähonkala L, Hokkanen L, Wilenius J, Gaily E. Language mapping with navigated transcranial magnetic stimulation in pediatric and adult patients undergoing epilepsy surgery: Comparison with extraoperative direct cortical stimulation. Epilepsia Open 2018; 3:224-235. [PMID: 29881801 PMCID: PMC5983150 DOI: 10.1002/epi4.12110] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2018] [Indexed: 12/04/2022] Open
Abstract
Objective Navigated transcranial magnetic stimulation (nTMS) is becoming increasingly popular in noninvasive preoperative language mapping, as its results correlate well enough with those obtained by direct cortical stimulation (DCS) during awake surgery in adult patients with tumor. Reports in the context of epilepsy surgery or extraoperative DCS in adults are, however, sparse, and validation of nTMS with DCS in children is lacking. Furthermore, little is known about the risk of inducing epileptic seizures with nTMS in pediatric epilepsy patients. We provide the largest validation study to date in an epilepsy surgery population. Methods We compared language mapping with nTMS and extraoperative DCS in 20 epilepsy surgery patients (age range 9‐32 years; 14 children and adolescents). Results In comparison with DCS, sensitivity of nTMS was 68%, specificity 76%, positive predictive value 27%, and negative predictive value 95%. Age, location of ictal‐onset zone near or within DCS‐mapped language areas or severity of cognitive deficits had no significant effect on these values. None of our patients had seizures during nTMS. Significance Our study suggests that nTMS language mapping is clinically useful and safe in epilepsy surgery patients, including school‐aged children and patients with extensive cognitive dysfunction. Similar to in tumor surgery, mapping results in the frontal region are most reliable. False negative findings may be slightly more likely in epilepsy than in tumor surgery patients. Mapping results should always be verified by other methods in individual patients.
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Affiliation(s)
- Henri Lehtinen
- Epilepsy UnitDepartment of Pediatric NeurologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
- Department of Psychology and LogopedicsFaculty of MedicineUniversity of HelsinkiHelsinkiFinland
| | - Jyrki P. Mäkelä
- BioMag LaboratoryHUS Medical Imaging CenterUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Teemu Mäkelä
- HUS Medical Imaging CenterRadiologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
- Department of PhysicsUniversity of HelsinkiHelsinkiFinland
| | - Pantelis Lioumis
- Temerty Centre for Therapeutic Brain Intervention at the Centre for Addiction and Mental HealthTorontoOntarioCanada
| | - Liisa Metsähonkala
- Epilepsy UnitDepartment of Pediatric NeurologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Laura Hokkanen
- Department of Psychology and LogopedicsFaculty of MedicineUniversity of HelsinkiHelsinkiFinland
| | - Juha Wilenius
- Clinical NeurosciencesDepartment of Clinical NeurophysiologyHUS Medical Imaging CenterUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Eija Gaily
- Epilepsy UnitDepartment of Pediatric NeurologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
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ECoG high-gamma modulation versus electrical stimulation for presurgical language mapping. Epilepsy Behav 2018; 79:26-33. [PMID: 29247963 PMCID: PMC5815885 DOI: 10.1016/j.yebeh.2017.10.044] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/17/2017] [Accepted: 10/30/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This meta-analysis compared diagnostic validity of electrocorticographic (ECoG) high-γ modulation (HGM) with electrical stimulation mapping (ESM) for presurgical language localization. METHODS From a structured literature search, studies with electrode level data comparing ECoG HGM and ESM for language localization were included in the meta-analysis. Outcomes included global measures of diagnostic validity: area under the summary receiver operating characteristic (SROC) curve (AUC), and diagnostic odds ratio (DOR); as well as pooled estimates of sensitivity and specificity. Clinical and technical determinants of sensitivity/specificity were explored. RESULTS Fifteen studies were included in qualitative synthesis, and 10 studies included in the meta-analysis (number of patients 1-17, mean age 10.3-53.6years). Overt picture naming was the most commonly used task for language mapping with either method. Electrocorticographic high-γ modulation was analyzed at 50-400Hz with different bandwidths in individual studies. For ESM, pulse duration, train duration, and maximum current varied greatly among studies. Sensitivity (0.23-0.99), specificity (0.48-0.96), and DOR (1.45-376.28) varied widely across studies. The pooled estimates are: sensitivity 0.61 (95% CI 0.44, 0.76), specificity 0.79 (95% CI 0.68, 0.88), and DOR 6.44 (95% CI 3.47, 11.94). Area under the SROC curve was 0.77. Results of bivariate meta-regression were limited by small samples for individual variables. CONCLUSION Electrocorticographic high-γ modulation is a specific but not sensitive method for language localization compared with gold-standard ESM. Given the pooled DOR of 6.44 and AUC of 0.77, ECoG HGM can fairly reliably ascertain electrodes overlying ESM cortical language sites.
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Babajani-Feremi A, Holder CM, Narayana S, Fulton SP, Choudhri AF, Boop FA, Wheless JW. Predicting postoperative language outcome using presurgical fMRI, MEG, TMS, and high gamma ECoG. Clin Neurophysiol 2018; 129:560-571. [PMID: 29414401 DOI: 10.1016/j.clinph.2017.12.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/17/2017] [Accepted: 12/05/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To predict the postoperative language outcome using the support vector regression (SVR) and results of multimodal presurgical language mapping. METHODS Eleven patients with epilepsy received presurgical language mapping using functional MRI (fMRI), magnetoencephalography (MEG), transcranial magnetic stimulation (TMS), and high-gamma electrocorticography (hgECoG), as well as pre- and postoperative neuropsychological evaluation of language. We constructed 15 (24-1) SVR models by considering the extent of resected language areas identified by all subsets of four modalities as input feature vector and the postoperative language outcome as output. We trained and cross-validated SVR models, and compared the cross-validation (CV) errors of all models for prediction of language outcome. RESULTS Seven patients had some level of postoperative language decline and two of them had significant postoperative decline in naming. Some parts of language areas identified by four modalities were resected in these patients. We found that an SVR model consisting of fMRI, MEG, and hgECoG provided minimum CV error, although an SVR model consisting of fMRI and MEG was the optimal model that facilitated the best trade-off between model complexity and prediction accuracy. CONCLUSIONS A multimodal SVR can be used to predict the language outcome. SIGNIFICANCE The developed multimodal SVR models in this study can be utilized to calculate the language outcomes of different resection plans prior to surgery and select the optimal surgical plan.
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Affiliation(s)
- Abbas Babajani-Feremi
- University of Tennessee Health Science Center, Department of Pediatrics and Department of Anatomy and Neurobiology, Le Bonheur Children's Hospital, Neuroscience Institute, Memphis, TN, USA.
| | - Christen M Holder
- University of Tennessee Health Science Center, Department of Pediatrics, Le Bonheur Children's Hospital, Neuroscience Institute, Memphis, TN, USA
| | - Shalini Narayana
- University of Tennessee Health Science Center, Department of Pediatrics and Department of Anatomy and Neurobiology, Le Bonheur Children's Hospital, Neuroscience Institute, Memphis, TN, USA
| | - Stephen P Fulton
- University of Tennessee Health Science Center, Department of Pediatrics, Le Bonheur Children's Hospital, Neuroscience Institute, Memphis, TN, USA
| | - Asim F Choudhri
- University of Tennessee Health Science Center, Department of Pediatrics, Le Bonheur Children's Hospital, Neuroscience Institute, Memphis, TN, USA
| | - Frederick A Boop
- University of Tennessee Health Science Center, Department of Pediatrics, Le Bonheur Children's Hospital, Neuroscience Institute, Memphis, TN, USA
| | - James W Wheless
- University of Tennessee Health Science Center, Department of Pediatrics, Le Bonheur Children's Hospital, Neuroscience Institute, Memphis, TN, USA
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Nakai Y, Nagashima A, Hayakawa A, Osuki T, Jeong JW, Sugiura A, Brown EC, Asano E. Four-dimensional map of the human early visual system. Clin Neurophysiol 2017; 129:188-197. [PMID: 29190524 DOI: 10.1016/j.clinph.2017.10.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 09/29/2017] [Accepted: 10/06/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We generated a large-scale, four-dimensional map of neuronal modulations elicited by full-field flash stimulation. METHODS We analyzed electrocorticography (ECoG) recordings from 63 patients with focal epilepsy, and delineated the spatial-temporal dynamics of visually-elicited high-gamma70-110 Hz amplitudes on a standard brain template. We then clarified the neuronal events underlying visual evoked potential (VEP) components, by correlating with high-gamma amplitude measures. RESULTS The medial-occipital cortex initially revealed rapid neural activation followed by prolonged suppression, reflected by augmentation of high-gamma activity lasting up to 100 ms followed by attenuation lasting up to 1000 ms, respectively. With a number of covariate factors incorporated into a prediction model, the eccentricity representation independently predicted the magnitude of post-activation suppression, which was more intense in regions representing more parafoveal visual fields compared to those of more peripheral fields. The initial negative component on VEP was sharply contoured and co-occurred with early high-gamma augmentation, whose offset then co-occurred with a large positive VEP peak. A delayed negative VEP peak was blunt and co-occurred with prolonged high-gamma attenuation. CONCLUSIONS Eccentricity-dependent gradient in neural suppression in the medial-occipital region may explain the functional difference between peripheral and parafoveal/central vision. Early negative and positive VEP components may reflect neural activation, whereas a delayed negative VEP peak reflecting neural suppression. SIGNIFICANCE Our observation provides the mechanistic rationale for transient scotoma or mild flash-blindness, characterized by physiological afterimage preferentially formed in central vision following intense but non-injurious light exposure.
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Affiliation(s)
- Yasuo Nakai
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI 48201, USA; Department of Neurological Surgery, Wakayama Medical University, Wakayama-shi, Wakayama 6418510, Japan
| | - Akari Nagashima
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI 48201, USA
| | - Akane Hayakawa
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI 48201, USA
| | - Takuya Osuki
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI 48201, USA
| | - Jeong-Won Jeong
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI 48201, USA; Department of Neurology, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI 48201, USA
| | - Ayaka Sugiura
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI 48201, USA
| | - Erik C Brown
- Department of Neurological Surgery, Oregon Health and Science University, Portland, OR 97239, USA
| | - Eishi Asano
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI 48201, USA; Department of Neurology, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI 48201, USA.
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Kambara T, Sood S, Alqatan Z, Klingert C, Ratnam D, Hayakawa A, Nakai Y, Luat AF, Agarwal R, Rothermel R, Asano E. Presurgical language mapping using event-related high-gamma activity: The Detroit procedure. Clin Neurophysiol 2017; 129:145-154. [PMID: 29190521 DOI: 10.1016/j.clinph.2017.10.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/25/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
Abstract
A number of investigators have reported that event-related augmentation of high-gamma activity at 70-110 Hz on electrocorticography (ECoG) can localize functionally-important brain regions in children and adults who undergo epilepsy surgery. The advantages of ECoG-based language mapping over the gold-standard stimulation include: (i) lack of stimulation-induced seizures, (ii) better sensitivity of localization of language areas in young children, and (iii) shorter patient participant time. Despite its potential utility, ECoG-based language mapping is far less commonly practiced than stimulation mapping. Here, we have provided video presentations to explain, point-by-point, our own hardware setting and time-frequency analysis procedures. We also have provided standardized auditory stimuli, in multiple languages, ready to be used for ECoG-based language mapping. Finally, we discussed the technical aspects of ECoG-based mapping, including its pitfalls, to facilitate appropriate interpretation of the data.
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Affiliation(s)
- Toshimune Kambara
- Wayne State University, School of Medicine, Detroit, MI 48201, USA; Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI 48201, USA; Postdoctoral Fellowship for Research Abroad, Japan Society for the Promotion of Science (JSPS), Chiyoda-ku, Tokyo 1020083, Japan
| | - Sandeep Sood
- Wayne State University, School of Medicine, Detroit, MI 48201, USA; Department of Neurosurgery, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI 48201, USA
| | - Zahraa Alqatan
- Wayne State University, School of Medicine, Detroit, MI 48201, USA
| | | | - Diksha Ratnam
- Wayne State University, School of Medicine, Detroit, MI 48201, USA
| | - Akane Hayakawa
- Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI 48201, USA
| | - Yasuo Nakai
- Wayne State University, School of Medicine, Detroit, MI 48201, USA; Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI 48201, USA
| | - Aimee F Luat
- Wayne State University, School of Medicine, Detroit, MI 48201, USA; Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI 48201, USA; Department of Neurology, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI 48201, USA
| | - Rajkumar Agarwal
- Wayne State University, School of Medicine, Detroit, MI 48201, USA; Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI 48201, USA; Department of Neurology, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI 48201, USA
| | - Robert Rothermel
- Wayne State University, School of Medicine, Detroit, MI 48201, USA; Department of Psychiatry, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI 48201, USA
| | - Eishi Asano
- Wayne State University, School of Medicine, Detroit, MI 48201, USA; Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI 48201, USA; Department of Neurology, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI 48201, USA.
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Nakai Y, Jeong JW, Brown EC, Rothermel R, Kojima K, Kambara T, Shah A, Mittal S, Sood S, Asano E. Three- and four-dimensional mapping of speech and language in patients with epilepsy. Brain 2017; 140:1351-1370. [PMID: 28334963 PMCID: PMC5405238 DOI: 10.1093/brain/awx051] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 01/14/2017] [Indexed: 11/13/2022] Open
Abstract
We have provided 3-D and 4D mapping of speech and language function based upon the results of direct cortical stimulation and event-related modulation of electrocorticography signals. Patients estimated to have right-hemispheric language dominance were excluded. Thus, 100 patients who underwent two-stage epilepsy surgery with chronic electrocorticography recording were studied. An older group consisted of 84 patients at least 10 years of age (7367 artefact-free non-epileptic electrodes), whereas a younger group included 16 children younger than age 10 (1438 electrodes). The probability of symptoms transiently induced by electrical stimulation was delineated on a 3D average surface image. The electrocorticography amplitude changes of high-gamma (70-110 Hz) and beta (15-30 Hz) activities during an auditory-naming task were animated on the average surface image in a 4D manner. Thereby, high-gamma augmentation and beta attenuation were treated as summary measures of cortical activation. Stimulation data indicated the causal relationship between (i) superior-temporal gyrus of either hemisphere and auditory hallucination; (ii) left superior-/middle-temporal gyri and receptive aphasia; (iii) widespread temporal/frontal lobe regions of the left hemisphere and expressive aphasia; and (iv) bilateral precentral/left posterior superior-frontal regions and speech arrest. On electrocorticography analysis, high-gamma augmentation involved the bilateral superior-temporal and precentral gyri immediately following question onset; at the same time, high-gamma activity was attenuated in the left orbitofrontal gyrus. High-gamma activity was augmented in the left temporal/frontal lobe regions, as well as left inferior-parietal and cingulate regions, maximally around question offset, with high-gamma augmentation in the left pars orbitalis inferior-frontal, middle-frontal, and inferior-parietal regions preceded by high-gamma attenuation in the contralateral homotopic regions. Immediately before verbal response, high-gamma augmentation involved the posterior superior-frontal and pre/postcentral regions, bilaterally. Beta-attenuation was spatially and temporally correlated with high-gamma augmentation in general but with exceptions. The younger and older groups shared similar spatial-temporal profiles of high-gamma and beta modulation; except, the younger group failed to show left-dominant activation in the rostral middle-frontal and pars orbitalis inferior-frontal regions around stimulus offset. The human brain may rapidly and alternately activate and deactivate cortical areas advantageous or obtrusive to function directed toward speech and language at a given moment. Increased left-dominant activation in the anterior frontal structures in the older age group may reflect developmental consolidation of the language system. The results of our functional mapping may be useful in predicting, across not only space but also time and patient age, sites specific to language function for presurgical evaluation of focal epilepsy.
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Affiliation(s)
- Yasuo Nakai
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, 48201, USA.,Department of Neurological Surgery, Wakayama Medical University, Wakayama-shi, Wakayama, 6418510, Japan
| | - Jeong-Won Jeong
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, 48201, USA.,Department of Neurology, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, 48201, USA
| | - Erik C Brown
- Department of Neurological Surgery, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Robert Rothermel
- Department of Psychiatry, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, 48201, USA
| | - Katsuaki Kojima
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, 48201, USA.,Department of Pediatrics, University of California San Francisco, CA, 94143, USA
| | - Toshimune Kambara
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, 48201, USA.,Postdoctoral Fellowship for Research Abroad, Japan Society for the Promotion of Science (JSPS), Chiyoda-ku, Tokyo, 1020083, Japan
| | - Aashit Shah
- Department of Neurology, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, 48201, USA
| | - Sandeep Mittal
- Department of Neurosurgery, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, 48201, USA
| | - Sandeep Sood
- Department of Neurosurgery, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, 48201, USA
| | - Eishi Asano
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, 48201, USA.,Department of Neurology, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, 48201, USA
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Non-invasive detection of language-related prefrontal high gamma band activity with beamforming MEG. Sci Rep 2017; 7:14262. [PMID: 29079768 PMCID: PMC5660237 DOI: 10.1038/s41598-017-14452-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 10/11/2017] [Indexed: 12/14/2022] Open
Abstract
High gamma band (>50 Hz) activity is a key oscillatory phenomenon of brain activation. However, there has not been a non-invasive method established to detect language-related high gamma band activity. We used a 160-channel whole-head magnetoencephalography (MEG) system equipped with superconducting quantum interference device (SQUID) gradiometers to non-invasively investigate neuromagnetic activities during silent reading and verb generation tasks in 15 healthy participants. Individual data were divided into alpha (8–13 Hz), beta (13–25 Hz), low gamma (25–50 Hz), and high gamma (50–100 Hz) bands and analysed with the beamformer method. The time window was consecutively moved. Group analysis was performed to delineate common areas of brain activation. In the verb generation task, transient power increases in the high gamma band appeared in the left middle frontal gyrus (MFG) at the 550–750 ms post-stimulus window. We set a virtual sensor on the left MFG for time-frequency analysis, and high gamma event-related synchronization (ERS) induced by a verb generation task was demonstrated at 650 ms. In contrast, ERS in the high gamma band was not detected in the silent reading task. Thus, our study successfully non-invasively measured language-related prefrontal high gamma band activity.
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Połczyńska MM, Japardi K, Bookheimer SY. Lateralizing language function with pre-operative functional magnetic resonance imaging in early proficient bilingual patients. BRAIN AND LANGUAGE 2017; 170:1-11. [PMID: 28343082 DOI: 10.1016/j.bandl.2017.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 10/17/2016] [Accepted: 03/15/2017] [Indexed: 06/06/2023]
Abstract
Research on bilinguals with brain lesions is complicated by high patient variability, making it difficult to find well-matched controls. We benefitted from a database of over 700 patients and conducted an analysis of pre-operative functional magnetic resonance imaging data to assess language dominance in 25 early, highly proficient Spanish-English bilinguals, and 25 carefully matched monolingual controls. Our results showed that early bilingualism is associated with greater bilateral hemispheric involvement, and monolingualism is associated with stronger left hemisphere lateralization (p=0.009). The bilinguals showed more pronounced right hemisphere activation (p=0.008). Although language dominance values were concordant in the bilingual group, there were a few (12%) atypical cases with different lateralization patterns in L1 and L2. Finally, we found distinct areas of activity in first and second language within the language network, in addition to regions of convergence. These data underscore the need to map all languages proficiently spoken by surgical candidates.
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Affiliation(s)
- Monika M Połczyńska
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA; Faculty of English, Adam Mickiewicz University, Poznań, Poland.
| | - Kevin Japardi
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA.
| | - Susan Y Bookheimer
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA.
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Połczyńska M, Japardi K, Curtiss S, Moody T, Benjamin C, Cho A, Vigil C, Kuhn T, Jones M, Bookheimer S. Improving language mapping in clinical fMRI through assessment of grammar. NEUROIMAGE-CLINICAL 2017; 15:415-427. [PMID: 28616382 PMCID: PMC5458087 DOI: 10.1016/j.nicl.2017.05.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 05/03/2017] [Accepted: 05/25/2017] [Indexed: 11/27/2022]
Abstract
Introduction Brain surgery in the language dominant hemisphere remains challenging due to unintended post-surgical language deficits, despite using pre-surgical functional magnetic resonance (fMRI) and intraoperative cortical stimulation. Moreover, patients are often recommended not to undergo surgery if the accompanying risk to language appears to be too high. While standard fMRI language mapping protocols may have relatively good predictive value at the group level, they remain sub-optimal on an individual level. The standard tests used typically assess lexico-semantic aspects of language, and they do not accurately reflect the complexity of language either in comprehension or production at the sentence level. Among patients who had left hemisphere language dominance we assessed which tests are best at activating language areas in the brain. Method We compared grammar tests (items testing word order in actives and passives, wh-subject and object questions, relativized subject and object clauses and past tense marking) with standard tests (object naming, auditory and visual responsive naming), using pre-operative fMRI. Twenty-five surgical candidates (13 females) participated in this study. Sixteen patients presented with a brain tumor, and nine with epilepsy. All participants underwent two pre-operative fMRI protocols: one including CYCLE-N grammar tests (items testing word order in actives and passives, wh-subject and object questions, relativized subject and object clauses and past tense marking); and a second one with standard fMRI tests (object naming, auditory and visual responsive naming). fMRI activations during performance in both protocols were compared at the group level, as well as in individual candidates. Results The grammar tests generated more volume of activation in the left hemisphere (left/right angular gyrus, right anterior/posterior superior temporal gyrus) and identified additional language regions not shown by the standard tests (e.g., left anterior/posterior supramarginal gyrus). The standard tests produced more activation in left BA 47. Ten participants had more robust activations in the left hemisphere in the grammar tests and two in the standard tests. The grammar tests also elicited substantial activations in the right hemisphere and thus turned out to be superior at identifying both right and left hemisphere contribution to language processing. Conclusion The grammar tests may be an important addition to the standard pre-operative fMRI testing. We added comprehensive grammar tests to standard presurgical fMRI of language. The grammar tests generated more volume of activation bilaterally. The tests identified additional language regions not shown by the standard tests. The grammar tests may be an important addition to standard pre-operative fMRI.
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Affiliation(s)
- Monika Połczyńska
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA; Faculty of English, Adam Mickiewicz University, Poznań, Poland.
| | - Kevin Japardi
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA
| | | | - Teena Moody
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA.
| | | | - Andrew Cho
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA
| | - Celia Vigil
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA
| | - Taylor Kuhn
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA.
| | - Michael Jones
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA
| | - Susan Bookheimer
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA.
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Nishida M, Korzeniewska A, Crone NE, Toyoda G, Nakai Y, Ofen N, Brown EC, Asano E. Brain network dynamics in the human articulatory loop. Clin Neurophysiol 2017. [PMID: 28622530 DOI: 10.1016/j.clinph.2017.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The articulatory loop is a fundamental component of language function, involved in the short-term buffer of auditory information followed by its vocal reproduction. We characterized the network dynamics of the human articulatory loop, using invasive recording and stimulation. METHODS We measured high-gamma activity70-110 Hz recorded intracranially when patients with epilepsy either only listened to, or listened to and then reproduced two successive tones by humming. We also conducted network analyses, and analyzed behavioral responses to cortical stimulation. RESULTS Presentation of the initial tone elicited high-gamma augmentation bilaterally in the superior-temporal gyrus (STG) within 40ms, and in the precentral and inferior-frontal gyri (PCG and IFG) within 160ms after sound onset. During presentation of the second tone, high-gamma augmentation was reduced in STG but enhanced in IFG. The task requiring tone reproduction further enhanced high-gamma augmentation in PCG during and after sound presentation. Event-related causality (ERC) analysis revealed dominant flows within STG immediately after sound onset, followed by reciprocal interactions involving PCG and IFG. Measurement of cortico-cortical evoked-potentials (CCEPs) confirmed connectivity between distant high-gamma sites in the articulatory loop. High-frequency stimulation of precentral high-gamma sites in either hemisphere induced speech arrest, inability to control vocalization, or forced vocalization. Vocalization of tones was accompanied by high-gamma augmentation over larger extents of PCG. CONCLUSIONS Bilateral PCG rapidly and directly receives feed-forward signals from STG, and may promptly initiate motor planning including sub-vocal rehearsal for short-term buffering of auditory stimuli. Enhanced high-gamma augmentation in IFG during presentation of the second tone may reflect high-order processing of the tone sequence. SIGNIFICANCE The articulatory loop employs sustained reciprocal propagation of neural activity across a network of cortical sites with strong neurophysiological connectivity.
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Affiliation(s)
- Masaaki Nishida
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit Medical Center, Detroit, MI 48201, USA; Department of Anesthesiology, Hanyu General Hospital, Hanyu City, Saitama 348-8508, Japan
| | - Anna Korzeniewska
- Department of Neurology, Johns Hopkins University, Baltimore, MD 21287, USA.
| | - Nathan E Crone
- Department of Neurology, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Goichiro Toyoda
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit Medical Center, Detroit, MI 48201, USA
| | - Yasuo Nakai
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit Medical Center, Detroit, MI 48201, USA
| | - Noa Ofen
- Institute of Gerontology, Wayne State University, Detroit, MI 48202, USA; Department of Psychology, Wayne State University, Detroit, MI 48202, USA
| | - Erik C Brown
- Department of Neurosurgery, Oregon Health and Science University, Portland, OR, USA
| | - Eishi Asano
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit Medical Center, Detroit, MI 48201, USA; Department of Neurology, Children's Hospital of Michigan, Wayne State University, Detroit Medical Center, Detroit, MI 48201, USA.
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44
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Malinowska U, Crone NE, Lenz FA, Cervenka M, Boatman-Reich D. Multi-Regional Adaptation in Human Auditory Association Cortex. Front Hum Neurosci 2017; 11:247. [PMID: 28536516 PMCID: PMC5422464 DOI: 10.3389/fnhum.2017.00247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 04/26/2017] [Indexed: 11/13/2022] Open
Abstract
In auditory cortex, neural responses decrease with stimulus repetition, known as adaptation. Adaptation is thought to facilitate detection of novel sounds and improve perception in noisy environments. Although it is well established that adaptation occurs in primary auditory cortex, it is not known whether adaptation also occurs in higher auditory areas involved in processing complex sounds, such as speech. Resolving this issue is important for understanding the neural bases of adaptation and to avoid potential post-operative deficits after temporal lobe surgery for treatment of focal epilepsy. Intracranial electrocorticographic recordings were acquired simultaneously from electrodes implanted in primary and association auditory areas of the right (non-dominant) temporal lobe in a patient with complex partial seizures originating from the inferior parietal lobe. Simple and complex sounds were presented in a passive oddball paradigm. We measured changes in single-trial high-gamma power (70–150 Hz) and in regional and inter-regional network-level activity indexed by cross-frequency coupling. Repetitive tones elicited the greatest adaptation and corresponding increases in cross-frequency coupling in primary auditory cortex. Conversely, auditory association cortex showed stronger adaptation for complex sounds, including speech. This first report of multi-regional adaptation in human auditory cortex highlights the role of the non-dominant temporal lobe in suppressing neural responses to repetitive background sounds (noise). These results underscore the clinical utility of functional mapping to avoid potential post-operative deficits including increased listening difficulties in noisy, real-world environments.
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Affiliation(s)
- Urszula Malinowska
- Departments of Neurology, Johns Hopkins School of Medicine, BaltimoreMD, USA
| | - Nathan E Crone
- Departments of Neurology, Johns Hopkins School of Medicine, BaltimoreMD, USA
| | - Frederick A Lenz
- Department of Neurosurgery, Johns Hopkins School of Medicine, BaltimoreMD, USA
| | - Mackenzie Cervenka
- Departments of Neurology, Johns Hopkins School of Medicine, BaltimoreMD, USA
| | - Dana Boatman-Reich
- Departments of Neurology, Johns Hopkins School of Medicine, BaltimoreMD, USA.,Department of Otolaryngology, Johns Hopkins School of Medicine, BaltimoreMD, USA
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45
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Abel TJ, Rhone AE, Nourski KV, Ando TK, Oya H, Kovach CK, Kawasaki H, Howard MA, Tranel D. Beta modulation reflects name retrieval in the human anterior temporal lobe: an intracranial recording study. J Neurophysiol 2016; 115:3052-61. [PMID: 27075536 DOI: 10.1152/jn.00012.2016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/18/2016] [Indexed: 11/22/2022] Open
Abstract
Naming people, places, and things is a fundamental human ability that is often impaired in patients with language-dominant anterior temporal lobe (ATL) dysfunction or ATL resection as part of epilepsy treatment. Convergent lines of evidence point to the importance of the ATL in name retrieval. The physiologic mechanisms that mediate name retrieval in the ATL, however, are not well understood. The purpose of this study was to characterize the electrophysiologic responses of the human ATL during overt cued naming of famous people and objects. Eight neurosurgical patients with suspected temporal lobe epilepsy who underwent implantation of intracranial electrodes for seizure focus localization were the subjects of this study. Specialized coverage of the ATL was achieved in each subject. The subjects named pictures of U.S. presidents and images of common hand-held tools. Event-related band power was measured for each ATL recording site. Both the left and right ATL demonstrated robust and focal increases in beta-band (14-30 Hz) power during person and tool naming. The onset of this response typically occurred at 400 ms but sometimes as early as 200 ms. Visual naming of famous people and tools is associated with robust and localized modulation of the beta band in both the left and right ATL. Measurement of visual naming responses may provide the groundwork for future mapping modalities to localize eloquent cortex in the ATL.
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Affiliation(s)
- Taylor J Abel
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Ariane E Rhone
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
| | - Kirill V Nourski
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
| | - Timothy K Ando
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
| | - Hiroyuki Oya
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
| | - Christopher K Kovach
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
| | - Hiroto Kawasaki
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
| | - Matthew A Howard
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
| | - Daniel Tranel
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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46
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Nonoda Y, Miyakoshi M, Ojeda A, Makeig S, Juhász C, Sood S, Asano E. Interictal high-frequency oscillations generated by seizure onset and eloquent areas may be differentially coupled with different slow waves. Clin Neurophysiol 2016; 127:2489-99. [PMID: 27178869 DOI: 10.1016/j.clinph.2016.03.022] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 03/17/2016] [Accepted: 03/22/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE High-frequency oscillations (HFOs) can be spontaneously generated by seizure-onset and functionally-important areas. We determined if consideration of the spectral frequency bands of coupled slow-waves could distinguish between epileptogenic and physiological HFOs. METHODS We studied a consecutive series of 13 children with focal epilepsy who underwent extraoperative electrocorticography. We measured the occurrence rate of HFOs during slow-wave sleep at each electrode site. We subsequently determined the performance of HFO rate for localization of seizure-onset sites and undesirable detection of nonepileptic sensorimotor-visual sites defined by neurostimulation. We likewise determined the predictive performance of modulation index: MI(XHz)&(YHz), reflecting the strength of coupling between amplitude of HFOsXHz and phase of slow-waveYHz. The predictive accuracy was quantified using the area under the curve (AUC) on receiver-operating characteristics analysis. RESULTS Increase in HFO rate localized seizure-onset sites (AUC⩾0.72; p<0.001), but also undesirably detected nonepileptic sensorimotor-visual sites (AUC⩾0.58; p<0.001). Increase in MI(HFOs)&(3-4Hz) also detected both seizure-onset (AUC⩾0.74; p<0.001) and nonepileptic sensorimotor-visual sites (AUC⩾0.59; p<0.001). Increase in subtraction-MIHFOs [defined as subtraction of MI(HFOs)&(0.5-1Hz) from MI(HFOs)&(3-4Hz)] localized seizure-onset sites (AUC⩾0.71; p<0.001), but rather avoided detection of nonepileptic sensorimotor-visual sites (AUC⩽0.42; p<0.001). CONCLUSION Our data suggest that epileptogenic HFOs may be coupled with slow-wave3-4Hz more preferentially than slow-wave0.5-1Hz, whereas physiologic HFOs with slow-wave0.5-1Hz more preferentially than slow-wave3-4Hz during slow-wave sleep. SIGNIFICANCE Further studies in larger samples are warranted to determine if consideration of the spectral frequency bands of slow-waves coupled with HFOs can positively contribute to presurgical evaluation of patients with focal epilepsy.
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Affiliation(s)
- Yutaka Nonoda
- Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA
| | - Makoto Miyakoshi
- Swartz Center for Computational Neuroscience, Institute for Neural Computation, University of California San Diego, La Jolla, CA, USA
| | - Alejandro Ojeda
- Swartz Center for Computational Neuroscience, Institute for Neural Computation, University of California San Diego, La Jolla, CA, USA
| | - Scott Makeig
- Swartz Center for Computational Neuroscience, Institute for Neural Computation, University of California San Diego, La Jolla, CA, USA
| | - Csaba Juhász
- Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA; Neurology, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA
| | - Sandeep Sood
- Neurosurgery, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA
| | - Eishi Asano
- Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA; Neurology, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA.
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Alagapan S, Schmidt SL, Lefebvre J, Hadar E, Shin HW, Frӧhlich F. Modulation of Cortical Oscillations by Low-Frequency Direct Cortical Stimulation Is State-Dependent. PLoS Biol 2016; 14:e1002424. [PMID: 27023427 PMCID: PMC4811434 DOI: 10.1371/journal.pbio.1002424] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 03/02/2016] [Indexed: 01/05/2023] Open
Abstract
Cortical oscillations play a fundamental role in organizing large-scale functional brain networks. Noninvasive brain stimulation with temporally patterned waveforms such as repetitive transcranial magnetic stimulation (rTMS) and transcranial alternating current stimulation (tACS) have been proposed to modulate these oscillations. Thus, these stimulation modalities represent promising new approaches for the treatment of psychiatric illnesses in which these oscillations are impaired. However, the mechanism by which periodic brain stimulation alters endogenous oscillation dynamics is debated and appears to depend on brain state. Here, we demonstrate with a static model and a neural oscillator model that recurrent excitation in the thalamo-cortical circuit, together with recruitment of cortico-cortical connections, can explain the enhancement of oscillations by brain stimulation as a function of brain state. We then performed concurrent invasive recording and stimulation of the human cortical surface to elucidate the response of cortical oscillations to periodic stimulation and support the findings from the computational models. We found that (1) stimulation enhanced the targeted oscillation power, (2) this enhancement outlasted stimulation, and (3) the effect of stimulation depended on behavioral state. Together, our results show successful target engagement of oscillations by periodic brain stimulation and highlight the role of nonlinear interaction between endogenous network oscillations and stimulation. These mechanistic insights will contribute to the design of adaptive, more targeted stimulation paradigms. This study presents mathematical models that explain the effect of temporally patterned electrical stimulation on cortical oscillations and provides supporting evidence using data recorded directly from human cortex during transcranial electrical stimulation. Rhythms in the brain are believed to play an important role in cognition. Disruptions in these oscillations are associated with a number of neurological and psychiatric disorders. Therefore, noninvasive brain stimulation techniques that target these oscillations offer promise as therapeutic tools. In particular, transcranial alternating current stimulation (tACS) applies a periodic stimulation waveform to engage specific oscillations in the cortex. Although recent studies provide evidence for the modulation of cortical oscillations by tACS, the exact mechanism by which the effects are produced is poorly understood. We propose two mathematical models of interaction between periodic electrical stimulation and ongoing brain activity that may explain the effects of tACS. In addition, we present a unique dataset in which we stimulated the patients’ cortical surface with subdural electrodes and observed the responses to stimulation in neighboring electrodes. We found that stimulation enhanced ongoing oscillations both during and immediately after stimulation. This enhancement depended on the brain state, thereby supporting our proposed models. Our results demonstrate the effect of electrical stimulation on cortical oscillations and highlight the importance of considering the state of the brain when designing electrical stimulation therapies for disorders of the central nervous system.
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Affiliation(s)
- Sankaraleengam Alagapan
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Stephen L Schmidt
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.,UNC/NCSU Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jérémie Lefebvre
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Department of Mathematics, University of Toronto, Toronto, Ontario, Canada
| | - Eldad Hadar
- Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Hae Won Shin
- Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.,Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Flavio Frӧhlich
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.,UNC/NCSU Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.,Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.,Neurobiology Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.,Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.,Neuroscience Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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48
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de Pesters A, Taplin AM, Adamo MA, Ritaccio AL, Schalk G. Electrocorticographic mapping of expressive language function without requiring the patient to speak: A report of three cases. EPILEPSY & BEHAVIOR CASE REPORTS 2016; 6:13-8. [PMID: 27408803 PMCID: PMC4925928 DOI: 10.1016/j.ebcr.2016.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 02/25/2016] [Accepted: 02/26/2016] [Indexed: 01/24/2023]
Abstract
Objective Patients requiring resective brain surgery often undergo functional brain mapping during perioperative planning to localize expressive language areas. Currently, all established protocols to perform such mapping require substantial time and patient participation during verb generation or similar tasks. These issues can make language mapping impractical in certain clinical circumstances (e.g., during awake craniotomies) or with certain populations (e.g., pediatric patients). Thus, it is important to develop new techniques that reduce mapping time and the requirement for active patient participation. Several neuroscientific studies reported that the mere auditory presentation of speech stimuli can engage not only receptive but also expressive language areas. Here, we tested the hypothesis that submission of electrocorticographic (ECoG) recordings during a short speech listening task to an appropriate analysis procedure can identify eloquent expressive language cortex without requiring the patient to speak. Methods Three patients undergoing temporary placement of subdural electrode grids passively listened to stories while we recorded their ECoG activity. We identified those sites whose activity in the broadband gamma range (70–170 Hz) changed immediately after presentation of the speech stimuli with respect to a prestimulus baseline. Results Our analyses revealed increased broadband gamma activity at distinct locations in the inferior frontal cortex, superior temporal gyrus, and/or perisylvian areas in all three patients and premotor and/or supplementary motor areas in two patients. The sites in the inferior frontal cortex that we identified with our procedure were either on or immediately adjacent to locations identified using electrical cortical stimulation (ECS) mapping. Conclusions The results of this study provide encouraging preliminary evidence that it may be possible that a brief and practical protocol can identify expressive language areas without requiring the patient to speak. This protocol could provide the clinician with a map of expressive language cortex within a few minutes. This may be useful as an adjunct to ECS interrogation or as an alternative to mapping using functional magnetic resonance imaging (fMRI). In conclusion, with further development and validation in more subjects, the approach presented here could help in identifying expressive language areas in situations where patients cannot speak in response to task instructions.
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Affiliation(s)
- Adriana de Pesters
- National Center for Adaptive Neurotechnologies, Wadsworth Center, New York State Department of Health, Albany, NY, USA; Department of Biomedical Sciences, State University of New York at Albany, Albany, NY, USA
| | - AmiLyn M Taplin
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Matthew A Adamo
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | | | - Gerwin Schalk
- National Center for Adaptive Neurotechnologies, Wadsworth Center, New York State Department of Health, Albany, NY, USA; Department of Biomedical Sciences, State University of New York at Albany, Albany, NY, USA; Department of Neurology, Albany Medical College, Albany, NY, USA
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49
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Wang Y, Fifer MS, Flinker A, Korzeniewska A, Cervenka MC, Anderson WS, Boatman-Reich DF, Crone NE. Spatial-temporal functional mapping of language at the bedside with electrocorticography. Neurology 2016; 86:1181-9. [PMID: 26935890 DOI: 10.1212/wnl.0000000000002525] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/27/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the feasibility and clinical utility of using passive electrocorticography (ECoG) for online spatial-temporal functional mapping (STFM) of language cortex in patients being monitored for epilepsy surgery. METHODS We developed and tested an online system that exploits ECoG's temporal resolution to display the evolution of statistically significant high gamma (70-110 Hz) responses across all recording sites activated by a discrete cognitive task. We illustrate how this spatial-temporal evolution can be used to study the function of individual recording sites engaged during different language tasks, and how this approach can be particularly useful for mapping eloquent cortex. RESULTS Using electrocortical stimulation mapping (ESM) as the clinical gold standard for localizing language cortex, the average sensitivity and specificity of online STFM across 7 patients were 69.9% and 83.5%, respectively. Moreover, relative to regions of interest where discrete cortical lesions have most reliably caused language impairments in the literature, the sensitivity of STFM was significantly greater than that of ESM, while its specificity was also greater than that of ESM, though not significantly so. CONCLUSIONS This study supports the feasibility and clinical utility of online STFM for mapping human language function, particularly under clinical circumstances in which time is limited and comprehensive ESM is impractical.
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Affiliation(s)
- Yujing Wang
- From the Departments of Neurology (Y.W., A.K., M.C.C., D.F.B.-R., N.E.C.), Biomedical Engineering (M.S.F.), and Neurosurgery (W.S.A.), Johns Hopkins University, Baltimore, MD; Fischell Department of Bioengineering (Y.W.), University of Maryland College Park; and Department of Psychology (A.F.), New York University, New York.
| | - Matthew S Fifer
- From the Departments of Neurology (Y.W., A.K., M.C.C., D.F.B.-R., N.E.C.), Biomedical Engineering (M.S.F.), and Neurosurgery (W.S.A.), Johns Hopkins University, Baltimore, MD; Fischell Department of Bioengineering (Y.W.), University of Maryland College Park; and Department of Psychology (A.F.), New York University, New York
| | - Adeen Flinker
- From the Departments of Neurology (Y.W., A.K., M.C.C., D.F.B.-R., N.E.C.), Biomedical Engineering (M.S.F.), and Neurosurgery (W.S.A.), Johns Hopkins University, Baltimore, MD; Fischell Department of Bioengineering (Y.W.), University of Maryland College Park; and Department of Psychology (A.F.), New York University, New York
| | - Anna Korzeniewska
- From the Departments of Neurology (Y.W., A.K., M.C.C., D.F.B.-R., N.E.C.), Biomedical Engineering (M.S.F.), and Neurosurgery (W.S.A.), Johns Hopkins University, Baltimore, MD; Fischell Department of Bioengineering (Y.W.), University of Maryland College Park; and Department of Psychology (A.F.), New York University, New York
| | - Mackenzie C Cervenka
- From the Departments of Neurology (Y.W., A.K., M.C.C., D.F.B.-R., N.E.C.), Biomedical Engineering (M.S.F.), and Neurosurgery (W.S.A.), Johns Hopkins University, Baltimore, MD; Fischell Department of Bioengineering (Y.W.), University of Maryland College Park; and Department of Psychology (A.F.), New York University, New York
| | - William S Anderson
- From the Departments of Neurology (Y.W., A.K., M.C.C., D.F.B.-R., N.E.C.), Biomedical Engineering (M.S.F.), and Neurosurgery (W.S.A.), Johns Hopkins University, Baltimore, MD; Fischell Department of Bioengineering (Y.W.), University of Maryland College Park; and Department of Psychology (A.F.), New York University, New York
| | - Dana F Boatman-Reich
- From the Departments of Neurology (Y.W., A.K., M.C.C., D.F.B.-R., N.E.C.), Biomedical Engineering (M.S.F.), and Neurosurgery (W.S.A.), Johns Hopkins University, Baltimore, MD; Fischell Department of Bioengineering (Y.W.), University of Maryland College Park; and Department of Psychology (A.F.), New York University, New York
| | - Nathan E Crone
- From the Departments of Neurology (Y.W., A.K., M.C.C., D.F.B.-R., N.E.C.), Biomedical Engineering (M.S.F.), and Neurosurgery (W.S.A.), Johns Hopkins University, Baltimore, MD; Fischell Department of Bioengineering (Y.W.), University of Maryland College Park; and Department of Psychology (A.F.), New York University, New York
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50
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Asano E, Gotman J. Is electrocorticography-based language mapping ready to replace stimulation? Neurology 2016; 86:1174-6. [PMID: 26935896 DOI: 10.1212/wnl.0000000000002533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Eishi Asano
- From the Departments of Pediatrics and Neurology (E.A.), Wayne State University; Department of Neurodiagnostics (E.A.), Children's Hospital of Michigan, Detroit; and Montreal Neurological Institute (J.G.), McGill University, Montréal, Canada.
| | - Jean Gotman
- From the Departments of Pediatrics and Neurology (E.A.), Wayne State University; Department of Neurodiagnostics (E.A.), Children's Hospital of Michigan, Detroit; and Montreal Neurological Institute (J.G.), McGill University, Montréal, Canada
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