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Dai Z, Song L, Luo C, Liu D, Li M, Han Z. Hemispheric lateralization of language processing: insights from network-based symptom mapping and patient subgroups. Cereb Cortex 2024; 34:bhad437. [PMID: 38031356 DOI: 10.1093/cercor/bhad437] [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: 02/26/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
The hemispheric laterality of language processing has become a hot topic in modern neuroscience. Although most previous studies have reported left-lateralized language processing, other studies found it to be bilateral. A previous neurocomputational model has proposed a unified framework to explain that the above discrepancy might be from healthy and patient individuals. This model posits an initial symmetry but imbalanced capacity in language processing for healthy individuals, with this imbalance contributing to language recovery disparities following different hemispheric injuries. The present study investigated this model by analyzing the lateralization patterns of language subnetworks across multiple attributes with a group of 99 patients (compared to nonlanguage processing) and examining the lateralization patterns of language subnetworks in subgroups with damage to different hemispheres. Subnetworks were identified using a whole-brain network-based lesion-symptom mapping method, and the lateralization index was quantitatively measured. We found that all the subnetworks in language processing were left-lateralized, while subnetworks in nonlanguage processing had different lateralization patterns. Moreover, diverse hemisphere-injury subgroups exhibited distinct language recovery effects. These findings provide robust support for the proposed neurocomputational model of language processing.
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Affiliation(s)
- Zhiyun Dai
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China
| | - Luping Song
- Shenzhen Sixth People's Hospital (Nanshan Hospital), Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen 518052, China
| | - Chongjing Luo
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China
| | - Di Liu
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China
| | - Mingyang Li
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Yuquan Campus, Hangzhou 310027, China
| | - Zaizhu Han
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China
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Muayqil T, Alhaluli A, Alzamil L, AlKanaan RK, Almousa Y, Alshamrani R. Assessing the Relationship Between Religious Beliefs and Ethnicity and Handedness and Footedness. Cureus 2023; 15:e50688. [PMID: 38111809 PMCID: PMC10726082 DOI: 10.7759/cureus.50688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 12/20/2023] Open
Abstract
Objectives The objective of the study is to explore the correlation between handedness and footedness and various demographic factors, including sex, age, faith, ethnicity, and perceived social pressures on limb use, among Muslims and non-Muslims. Methods This is an analytical cross-sectional study conducted in Saudi Arabia from September 2020 to February 2021. This research involved healthy community members aged 18 and above. An electronic survey was administered to collect demographic information on age, sex, faith, ethnicity, and the perceived degree of social pressure favoring the use of the right hand. The Waterloo handedness questionnaire (WHQ-Ar) and Waterloo footedness questionnaire (WFQ-Ar) were utilized for the assessments. Results A total of 728 respondents completed the survey. The mean (SD) age was 34.54 (11.53). Among them, 454 (62.4%) were ethnically Arab, and 507 (69.64%) identified as Muslims. The mean (SD) WHQ-Ar and WFQ-Ar scores were 42 (31.6) and 10.51 (8.1), respectively, with higher scores indicating "right" preference. Older age was associated with higher scores (p = 0.01) and men with lower handedness scores (p = 0.003). Participants who did not perceive social pressure had significantly lower scores (p < 0.001). Footedness was associated with slightly lower scores in Muslims (p = 0.001). Conclusion The degree of pressure perceived to use a particular hand has a major influence on handedness scores in Muslims and non-Muslims alike; this was true even when comparing populations with different levels of permissiveness to specific hand use due to varying religious or cultural backgrounds. Social pressure, regardless of routine religious practices, is more likely to influence handedness scores. Age and sex influence the scores similar to international reports, and footedness appears less likely to fall under the influence of cultural pressures.
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Affiliation(s)
- Taim Muayqil
- Neurology, King Saud University Medical City, Riyadh, SAU
| | | | - Lama Alzamil
- Medicine, King Saud University Medical City, Riyadh, SAU
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Lawrence A, Carvajal M, Ormsby J. Beyond Broca's and Wernicke's: Functional Mapping of Ancillary Language Centers Prior to Brain Tumor Surgery. Tomography 2023; 9:1254-1275. [PMID: 37489468 PMCID: PMC10366753 DOI: 10.3390/tomography9040100] [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: 04/20/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/26/2023] Open
Abstract
Functional MRI is a well-established tool used for pre-surgical planning to help the neurosurgeon have a roadmap of critical functional areas that should be avoided, if possible, during surgery to minimize morbidity for patients with brain tumors (though this also has applications for surgical resection of epileptogenic tissue and vascular lesions). This article reviews the locations of secondary language centers within the brain along with imaging findings to help improve our confidence in our knowledge on language lateralization. Brief overviews of these language centers and their contributions to the language networks will be discussed. These language centers include primary language centers of "Broca's Area" and "Wernicke's Area". However, there are multiple secondary language centers such as the dorsal lateral prefrontal cortex (DLPFC), frontal eye fields, pre- supplemental motor area (pre-SMA), Basal Temporal Language Area (BTLA), along with other areas of activation. Knowing these foci helps to increase self-assurance when discussing the nature of laterality with the neurosurgeon. By knowing secondary language centers for language lateralization, via fMRI, one can feel confident on providing neurosurgeon colleagues with appropriate information on the laterality of language in preparation for surgery.
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Affiliation(s)
- Ashley Lawrence
- Center for Neuropsychological Services, University of New Mexico, MSC 10 5530 1 University of New Mexico, Albuquerque, NM 87131-5001, USA
| | - Michael Carvajal
- Center for Neuropsychological Services, University of New Mexico, MSC 10 5530 1 University of New Mexico, Albuquerque, NM 87131-5001, USA
| | - Jacob Ormsby
- Department of Radiology, University of New Mexico, MSC 10 5530 1 University of New Mexico, Albuquerque, NM 87131-5001, USA
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Caciagli L, Paquola C, He X, Vollmar C, Centeno M, Wandschneider B, Braun U, Trimmel K, Vos SB, Sidhu MK, Thompson PJ, Baxendale S, Winston GP, Duncan JS, Bassett DS, Koepp MJ, Bernhardt BC. Disorganization of language and working memory systems in frontal versus temporal lobe epilepsy. Brain 2022; 146:935-953. [PMID: 35511160 PMCID: PMC9976988 DOI: 10.1093/brain/awac150] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 02/28/2022] [Accepted: 03/12/2022] [Indexed: 02/06/2023] Open
Abstract
Cognitive impairment is a common comorbidity of epilepsy and adversely impacts people with both frontal lobe (FLE) and temporal lobe (TLE) epilepsy. While its neural substrates have been investigated extensively in TLE, functional imaging studies in FLE are scarce. In this study, we profiled the neural processes underlying cognitive impairment in FLE and directly compared FLE and TLE to establish commonalities and differences. We investigated 172 adult participants (56 with FLE, 64 with TLE and 52 controls) using neuropsychological tests and four functional MRI tasks probing expressive language (verbal fluency, verb generation) and working memory (verbal and visuo-spatial). Patient groups were comparable in disease duration and anti-seizure medication load. We devised a multiscale approach to map brain activation and deactivation during cognition and track reorganization in FLE and TLE. Voxel-based analyses were complemented with profiling of task effects across established motifs of functional brain organization: (i) canonical resting-state functional systems; and (ii) the principal functional connectivity gradient, which encodes a continuous transition of regional connectivity profiles, anchoring lower-level sensory and transmodal brain areas at the opposite ends of a spectrum. We show that cognitive impairment in FLE is associated with reduced activation across attentional and executive systems, as well as reduced deactivation of the default mode system, indicative of a large-scale disorganization of task-related recruitment. The imaging signatures of dysfunction in FLE are broadly similar to those in TLE, but some patterns are syndrome-specific: altered default-mode deactivation is more prominent in FLE, while impaired recruitment of posterior language areas during a task with semantic demands is more marked in TLE. Functional abnormalities in FLE and TLE appear overall modulated by disease load. On balance, our study elucidates neural processes underlying language and working memory impairment in FLE, identifies shared and syndrome-specific alterations in the two most common focal epilepsies and sheds light on system behaviour that may be amenable to future remediation strategies.
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Affiliation(s)
- Lorenzo Caciagli
- Correspondence to: Lorenzo Caciagli, MD, PhD Department of Bioengineering University of Pennsylvania, 240 Skirkanich Hall 210 South 33rd Street, Philadelphia, PA 19104, USA E-mail: ;
| | - Casey Paquola
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, Quebec H3A 2B4, Canada
| | - Xiaosong He
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Christian Vollmar
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK,Department of Neurology, Ludwig-Maximilians-Universität, 81377 Munich, Germany
| | - Maria Centeno
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK,Epilepsy Unit, Hospital Clínic de Barcelona, IDIBAPS, 08036 Barcelona, Spain
| | - Britta Wandschneider
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK
| | - Urs Braun
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA,Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Karin Trimmel
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK,Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Sjoerd B Vos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK,Centre for Medical Image Computing, University College London, London, UK,Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Meneka K Sidhu
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK
| | - Pamela J Thompson
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK
| | - Sallie Baxendale
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK,Department of Medicine, Division of Neurology, Queen’s University, Kingston, Ontario, Canada
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK
| | - Dani S Bassett
- Correspondence may also be addressed to: Dani S. Bassett, PhD E-mail:
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Stasenko A, Schadler A, Kaestner E, Reyes A, Díaz-Santos M, Połczyńska M, McDonald CR. Can bilingualism increase neuroplasticity of language networks in epilepsy? Epilepsy Res 2022; 182:106893. [PMID: 35278806 PMCID: PMC9050932 DOI: 10.1016/j.eplepsyres.2022.106893] [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: 10/21/2021] [Revised: 01/17/2022] [Accepted: 02/22/2022] [Indexed: 11/03/2022]
Abstract
Individuals with left temporal lobe epilepsy (TLE) have a higher rate of atypical (i.e., bilateral or right hemisphere) language lateralization compared to healthy controls. In addition, bilinguals have been observed to have a less left-lateralized pattern of language representation. We examined the combined influence of bilingual language experience and side of seizure focus on language lateralization profiles in TLE to determine whether bilingualism promotes re-organization of language networks. Seventy-two monolingual speakers of English (21 left TLE; LTLE, 22 right TLE; RTLE, 29 age-matched healthy controls; HC) and 24 English-dominant bilinguals (6 LTLE, 7 RTLE, 11 HC) completed a lexical-semantic functional MRI task and standardized measures of language in English. Language lateralization was determined using laterality indices based on activations in left vs right homologous perisylvian regions-of-interest (ROIs). In a fronto-temporal ROI, LTLE showed the expected pattern of weaker left language lateralization relative to HC, and monolinguals showed a trend of weaker left language lateralization relative to bilinguals. Importantly, these effects were qualified by a significant group by language status interaction, revealing that bilinguals with LTLE had greater rightward language lateralization relative to monolingual LTLE, with a large effect size particularly in the lateral temporal region. Rightward language lateralization was associated with better language scores in bilingual LTLE. These preliminary findings suggest a combined effect of bilingual language experience and a left hemisphere neurologic insult, which may together increase the likelihood of language re-organization to the right hemisphere. Our data underscore the need to consider bilingualism as an important factor contributing to language laterality in patients with TLE. Bilingualism may be neuroprotective pre-surgically and may mitigate post-surgical language decline following left anterior temporal lobectomy, which will be important to test in larger samples.
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Affiliation(s)
- Alena Stasenko
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA.
| | - Adam Schadler
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | - Erik Kaestner
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | - Anny Reyes
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Mirella Díaz-Santos
- Department of Neurology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA; Mary S. Easton Center for Alzheimer's Disease Research, University of California, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Monika Połczyńska
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Carrie R McDonald
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA; Department of Radiation Medicine and Applied Sciences, University of California, San Diego, CA, USA
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Kaestner E, Stasenko A, Ben-Haim S, Shih J, Paul BM, McDonald CR. The importance of basal-temporal white matter to pre- and post-surgical naming ability in temporal lobe epilepsy. Neuroimage Clin 2022; 34:102963. [PMID: 35220106 PMCID: PMC8888987 DOI: 10.1016/j.nicl.2022.102963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/15/2021] [Accepted: 02/07/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Emerging research highlights the importance of basal-temporal cortex, centered on the fusiform gyrus, to both pre-surgical naming ability and post-surgical naming outcomes in temporal lobe epilepsy (TLE). In this study, we investigate whether integrity of the white matter network that interconnects this basal region to the distributed language network affects naming ability and risk for post-surgical naming decline. METHODS Patients with drug-resistant TLE were recruited from two epilepsy centers in a prospective longitudinal study. The pre-surgical dataset included 50 healthy controls, 47 left TLE (L-TLE), and 41 right TLE (R-TLE) patients. All participants completed pre-surgical T1- and diffusion-weighted MRI (dMRI), as well as neuropsychological tests of auditory and visual naming. Nineteen L-TLE and 18 R-TLE patients underwent anterior temporal lobectomy (ATL) and also completed post-surgical neuropsychological testing. Pre-surgical fractional anisotropy (FA) of the white matter directly beneath the fusiform neocortex (i.e., superficial white matter; SWM) and of deep white matter tracts with connections to the basal-temporal cortex [inferior longitudinal fasciculus (ILF) and inferior frontal occipital fasciculus (IFOF)] was calculated. Clinical variables, hippocampal volume, and FA of each white matter tract or region were examined in linear regressions with naming scores, or change in naming scores, as the primary outcomes. RESULTS Pre-surgically, higher FA in the bilateral ILF, bilateral IFOF, and left fusiform SWM was associated with better visual and auditory naming scores (all ps < 0.05 with FDR correction). In L-TLE, higher pre-surgical FA was also associated with less naming decline post-surgically, but results varied across tracts. When including only patients with typical language dominance, only integrity of the right fusiform SWM was associated with less visual naming decline (p = .0018). DISCUSSION Although a broad network of white matter network matter may contribute to naming ability pre-surgically, the reserve capacity of the contralateral (right) fusiform SWM may be important for mitigating visual naming decline following ATL in L-TLE. This shows that the study of the structural network interconnecting the basal-temporal region to the wider language network has implications for understanding both pre- and post-surgical naming in TLE.
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Affiliation(s)
- Erik Kaestner
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | - Alena Stasenko
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | - Sharona Ben-Haim
- Department of Neurosurgery, University of California, San Diego, CA, USA
| | - Jerry Shih
- Department of Neurosurgery, University of California, San Diego, CA, USA
| | - Brianna M Paul
- Department of Neurology, University of California -San Francisco, San Francisco, CA, USA
| | - Carrie R McDonald
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
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Połczyńska MM, Beck L, Kuhn T, Benjamin CF, Ly TK, Japardi K, Cavanagh L, Bookheimer SY. Tumor location and reduction in functional MRI estimates of language laterality. J Neurosurg 2021; 135:1674-1684. [PMID: 33799298 PMCID: PMC8909357 DOI: 10.3171/2020.9.jns202036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/10/2020] [Indexed: 12/04/2022]
Abstract
OBJECTIVE Brain tumors located close to the language cortex may distort functional MRI (fMRI)-based estimates of language dominance. The nature of this distortion, and whether this is an artifact of numerous confounders, remains unknown. The authors hypothesized tumor bias based on laterality estimates independent of confounders and that the effects are the greatest for tumors proximal to Broca's area. METHODS To answer this question, the authors reviewed more than 1113 patients who underwent preoperative fMRI to match samples on 11 known confounders (tumor location, size, type, and grade; seizure history; prior neurosurgery; aphasia presence and severity; and patient age, sex, and handedness). The samples included 30 patients with left hemisphere tumors (15 anterior and 15 posterior) and 30 with right hemisphere tumors (15 anterior and 15 posterior), thus totaling 60 patients (25 women; 18 left-handed and 4 ambidextrous; mean age 47 [SD 14.1] years). Importantly, the authors matched not only patients with left and right hemisphere tumors but also those with anterior and posterior tumors. Standard fMRI laterality indices (LIs) were calculated using whole-brain and region of interest (ROI) approaches (Broca's and Wernicke's areas). RESULTS Tumors close to Broca's area in the left hemisphere decreased LIs independently of known confounders. At the whole-brain level, this appeared to reflect a decrease in LI values in patients with left anterior tumors compared with patients with right anterior tumors. ROI analysis replicated these findings. Broca's area LIs were significantly lower (p = 0.02) in patients with left anterior tumors (mean LI 0.28) when compared with patients with right anterior tumors (mean LI 0.70). Changes in Wernicke's area-based LIs did not differ as a function of the tumor hemisphere. Therefore, in patients with left anterior tumors, it is essential to assess language laterality using left posterior ROIs. In all remaining tumor groups (left posterior tumors and right hemisphere tumors), language laterality derived from the anterior language ROI was the most robust measure of language dominance. CONCLUSIONS Patients with tumors close to Broca's area showed more bilateral fMRI language maps independent of known confounders. The authors caution against the assumption that this reduced language laterality suggests no or little risk to language function following tumor resection in the left inferior frontal gyrus. Their results address how to interpret fMRI data for neurosurgical purposes, along with theoretical questions of contralesional functional compensation and disinhibition.
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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, California
| | - Lilian Beck
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California
| | - Taylor Kuhn
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California
| | - Christopher F. Benjamin
- Department of Neurology, Yale University, New Haven, Connecticut
- Department of Neurosurgery, Yale University, New Haven, Connecticut
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Timothy K. Ly
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California
| | - Kevin Japardi
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California
| | - Lucia Cavanagh
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California
| | - Susan Y. Bookheimer
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California
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Clinical Speech fMRI in Children and Adolescents : Development of an Optimal Protocol and Analysis Algorithm. Clin Neuroradiol 2021; 32:185-196. [PMID: 34613421 PMCID: PMC8894226 DOI: 10.1007/s00062-021-01097-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 08/31/2021] [Indexed: 11/28/2022]
Abstract
Purpose In patients with drug-resistant focal epilepsy, surgical resection is often the only treatment option to achieve long-term seizure control. Prior to brain surgery involving potential language areas, identification of hemispheric language dominance is crucial. Our group developed and validated a functional magnetic resonance imaging (fMRI) battery of four pediatric language tasks. The present study aimed at optimizing fMRI data acquisition and analysis using these tasks. Methods We retrospectively analyzed speech fMRI examinations of 114 neuropediatric patients (age range 5.8–17.8 years) who were examined prior to possible epilepsy surgery. In order to evaluate hemispheric language dominance, 1–4 language tasks (vowel identification task VIT, word-chain task WCT, beep-story task BST, synonym task SYT) were measured. Results Language dominance was classified using fMRI activation in the 13 validly lateralizing ROIs (VLR) in frontal, temporal and parietal lobes and cerebellum of the recent validation study from our group: 47/114 patients were classified as left-dominant, 34/114 as bilateral and 6/114 as right-dominant. In an attempt to enlarge the set of VLR, we then compared for each task agreement of these ROI activations with the classified language dominance. We found four additional task-specific ROIs showing concordant activation and activation in ≥ 10 sessions, which we termed validly lateralizing (VLRnew). The new VLRs were: for VIT the temporal language area and for SYT the middle frontal gyrus, the intraparietal sulcus and cerebellum. Finally, in order to find the optimal sequence of measuring the different tasks, we analyzed the success rates of single tasks and all possible task combinations. The sequence 1) VIT 2) WCT 3) BST 4) SYT was identified as the optimal sequence, yielding the highest chance to obtain reliable results even when the fMRI examination has to be stopped, e.g., due to lack of cooperation. Conclusion Our suggested task order together with the enlarged set of VLRnew may contribute to optimize pediatric speech fMRI in a clinical setting. Supplementary Information The online version of this article (10.1007/s00062-021-01097-z) contains supplementary material, which is available to authorized users.
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Sharawat IK, Panda PK, Kasinathan A. Atypical handedness and its clinicoradiological predictors in children with focal epilepsy. Epilepsy Res 2021; 173:106622. [PMID: 33813361 DOI: 10.1016/j.eplepsyres.2021.106622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 03/09/2021] [Accepted: 03/20/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE Handedness has been strongly linked to cerebral lateralisation for language. Literature on atypical handedness and its association with focal epilepsy starting from early childhood is limited and needs exploration. METHODS In this cross-sectional study, the prevalence of atypical handedness (left-handedness and ambidexterity) was compared between children with left/right focal epilepsy aged 3-14 years without any definite motor deficit, between August 2019 and July 2020. Cognition, behavioral abnormalities, working memory, and executive function were also compared between the groups. Various clinical, demographic, and radiological variables were explored to determine any association with the presence of atypical handedness. RESULTS Of the total 79 children (45 boys, 57 % mean age 6.5 ± 2.3 years, 41-left focal epilepsy) with focal epilepsy enrolled for the study, the prevalence of atypical handedness was found to be 12.6 % (10/79). No association between atypical handedness and clinical/demographic variables including left/right focal epilepsy was observed in the study excepting neuroimaging abnormality (p = 0.0008 and 0.02 respectively). This increased prevalence of neuroimaging abnormality in patients with atypical handedness was significant in multivariate analysis, after adjusting for confounding variables. Similarly, intelligence quotient (full scale, verbal and non-verbal, as well as sub-domains), behavioral abnormality (internalizing and externalizing score on CBCL), scores on picture memory, simple copying, and missing scan task were not significantly different between children with left and right focal epilepsy or children with atypical handedness and right-handedness. CONCLUSION Atypical handedness is not more frequent in children with left focal epilepsy as compared to right focal epilepsy.
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Affiliation(s)
- Indar Kumar Sharawat
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Prateek Kumar Panda
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
| | - Ananthanarayanan Kasinathan
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, 605006, India
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Reh R, Williams LJ, Todd RM, Ward LM. Warped rhythms: Epileptic activity during critical periods disrupts the development of neural networks for human communication. Behav Brain Res 2020; 399:113016. [PMID: 33212087 DOI: 10.1016/j.bbr.2020.113016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/27/2022]
Abstract
It is well established that temporal lobe epilepsy-the most common and well-studied form of epilepsy-can impair communication by disrupting social-emotional and language functions. In pediatric epilepsy, where seizures co-occur with the development of critical brain networks, age of onset matters: The earlier in life seizures begin, the worse the disruption in network establishment, resulting in academic hardship and social isolation. Yet, little is known about the processes by which epileptic activity disrupts developing human brain networks. Here we take a synthetic perspective-reviewing a range of research spanning studies on molecular and oscillatory processes to those on the development of large-scale functional networks-in support of a novel model of how such networks can be disrupted by epilepsy. We seek to bridge the gap between research on molecular processes, on the development of human brain circuitry, and on clinical outcomes to propose a model of how epileptic activity disrupts brain development.
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Affiliation(s)
- Rebecca Reh
- University of British Columbia, Department of Psychology, 2136 West Mall, Vancouver BC V6T 1Z4, Canada
| | - Lynne J Williams
- BC Children's Hospital MRI Research Facility, 4480 Oak Street, Vancouver, BC V6H 0B3, Canada
| | - Rebecca M Todd
- University of British Columbia, Department of Psychology, 2136 West Mall, Vancouver BC V6T 1Z4, Canada; University of British Columbia, Djavad Mowafaghian Centre for Brain Health, 2215 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada.
| | - Lawrence M Ward
- University of British Columbia, Department of Psychology, 2136 West Mall, Vancouver BC V6T 1Z4, Canada; University of British Columbia, Djavad Mowafaghian Centre for Brain Health, 2215 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada
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11
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Villar-Rodríguez E, Palomar-García MÁ, Hernández M, Adrián-Ventura J, Olcina-Sempere G, Parcet MA, Ávila C. Left-handed musicians show a higher probability of atypical cerebral dominance for language. Hum Brain Mapp 2020; 41:2048-2058. [PMID: 32034834 PMCID: PMC7268010 DOI: 10.1002/hbm.24929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/02/2019] [Accepted: 01/07/2020] [Indexed: 12/18/2022] Open
Abstract
Music processing and right hemispheric language lateralization share a common network in the right auditory cortex and its frontal connections. Given that the development of hemispheric language dominance takes place over several years, this study tested whether musicianship could increase the probability of observing right language dominance in left-handers. Using a classic fMRI language paradigm, results showed that atypical lateralization was more predominant in musicians (40%) than in nonmusicians (5%). Comparison of left-handers with typical left and atypical right lateralization revealed that: (a) atypical cases presented a thicker right pars triangularis and more gyrified left Heschl's gyrus; and (b) the right pars triangularis of atypical cases showed a stronger intra-hemispheric functional connectivity with the right angular gyrus, but a weaker interhemispheric functional connectivity with part of the left Broca's area. Thus, musicianship is the first known factor related to a higher prevalence of atypical language dominance in healthy left-handed individuals. We suggest that differences in the frontal and temporal cortex might act as shared predisposing factors to both musicianship and atypical language lateralization.
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Affiliation(s)
- Esteban Villar-Rodríguez
- Neuropsychology and Functional Neuroimaging Group, Jaume I University, Edificio de Investigación II, Castellón de la Plana, Spain
| | - María-Ángeles Palomar-García
- Neuropsychology and Functional Neuroimaging Group, Jaume I University, Edificio de Investigación II, Castellón de la Plana, Spain
| | - Mireia Hernández
- Cognition and Brain Plasticity Group, Department of Cognition, Development and Educational Psychology, Institut de Neurociències, University of Barcelona, Barcelona, Spain
| | - Jesús Adrián-Ventura
- Neuropsychology and Functional Neuroimaging Group, Jaume I University, Edificio de Investigación II, Castellón de la Plana, Spain
| | - Gustau Olcina-Sempere
- Neuropsychology and Functional Neuroimaging Group, Jaume I University, Edificio de Investigación II, Castellón de la Plana, Spain
| | - María-Antònia Parcet
- Neuropsychology and Functional Neuroimaging Group, Jaume I University, Edificio de Investigación II, Castellón de la Plana, Spain
| | - César Ávila
- Neuropsychology and Functional Neuroimaging Group, Jaume I University, Edificio de Investigación II, Castellón de la Plana, Spain
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12
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Gonzalez LM, Wrennall JA. A neuropsychological model for the pre-surgical evaluation of children with focal-onset epilepsy: An integrated approach. Seizure 2020; 77:29-39. [DOI: 10.1016/j.seizure.2018.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/28/2018] [Accepted: 12/17/2018] [Indexed: 12/20/2022] Open
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13
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Bargalló N, Cano-López I, Rosazza C, Vernooij MW, Smits M, Vitali P, Alvarez-Linera J, Urbach H, Mancini L, Ramos A, Yousry T. Clinical practice of language fMRI in epilepsy centers: a European survey and conclusions by the ESNR Epilepsy Working Group. Neuroradiology 2020; 62:549-562. [PMID: 32170372 PMCID: PMC7186249 DOI: 10.1007/s00234-020-02397-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/04/2020] [Indexed: 01/08/2023]
Abstract
Purpose To assess current clinical practices throughout Europe with respect to acquisition, implementation, evaluation, and interpretation of language functional MRI (fMRI) in epilepsy patients. Methods An online survey was emailed to all European Society of Neuroradiology members (n = 1662), known associates (n = 6400), and 64 members of European Epilepsy network. The questionnaire featured 40 individual items on demographic data, clinical practice and indications, fMRI paradigms, radiological workflow, data post-processing protocol, and reporting. Results A total of 49 non-duplicate entries from European centers were received from 20 countries. Of these, 73.5% were board-certified neuroradiologists and 69.4% had an in-house epilepsy surgery program. Seventy-one percent of centers performed fewer than five scans per month for epilepsy. The most frequently used paradigms were phonemic verbal fluency (47.7%) and auditory comprehension (55.6%), but variants of 13 paradigms were described. Most centers assessed the fMRI task performance (75.5%), ensured cognitive-task adjustment (77.6%), trained the patient before scanning (85.7%), and assessed handedness (77.6%), but only 28.6% had special paradigms for patients with cognitive impairments. fMRI was post-processed mainly by neuroradiologists (42.1%), using open-source software (55.0%). Reporting was done primarily by neuroradiologists (74.2%). Interpretation was done mainly by visual inspection (65.3%). Most specialists (81.6%) were able to determine the hemisphere dominance for language in more than 75% of exams, attributing failure to the patient not performing the task correctly. Conclusion This survey shows that language fMRI is firmly embedded in the preoperative management of epilepsy patients. The wide variety of paradigms and the use of non-CE-marked software underline the need for establishing reference standards. Electronic supplementary material The online version of this article (10.1007/s00234-020-02397-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- N Bargalló
- Magnetic Resonance Image Core Facility, IDIBAPS and Center of Diagnostic Image (CDIC), Hospital Clinic, Barcelona, Spain.
| | - I Cano-López
- Valencian International University, Valencia, Spain
| | - C Rosazza
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
| | - M W Vernooij
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - P Vitali
- Neuroradiology and Brain MRI 3T Mondino Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - J Alvarez-Linera
- Neuroradiology Department, Hospital Ruber Internacional, Madrid, Spain
| | - H Urbach
- Department of Neuroradiology, Freiburg University Medical Center, Freiburg (i.Br.), Germany
| | - L Mancini
- Lysholm Department of Neuro-radiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK
| | - A Ramos
- Departments Radiology (A.H., A.R.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - T Yousry
- Lysholm Department of Neuro-radiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK
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Kaestner E, Balachandra AR, Bahrami N, Reyes A, Lalani SJ, Macari AC, Voets NL, Drane DL, Paul BM, Bonilha L, McDonald CR. The white matter connectome as an individualized biomarker of language impairment in temporal lobe epilepsy. Neuroimage Clin 2019; 25:102125. [PMID: 31927128 PMCID: PMC6953962 DOI: 10.1016/j.nicl.2019.102125] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/10/2019] [Accepted: 12/13/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The distributed white matter network underlying language leads to difficulties in extracting clinically meaningful summaries of neural alterations leading to language impairment. Here we determine the predictive ability of the structural connectome (SC), compared with global measures of white matter tract microstructure and clinical data, to discriminate language impaired patients with temporal lobe epilepsy (TLE) from TLE patients without language impairment. METHODS T1- and diffusion-MRI, clinical variables (CVs), and neuropsychological measures of naming and verbal fluency were available for 82 TLE patients. Prediction of language impairment was performed using a robust tree-based classifier (XGBoost) for three models: (1) a CV-model which included demographic and epilepsy-related clinical features, (2) an atlas-based tract-model, including four frontotemporal white matter association tracts implicated in language (i.e., the bilateral arcuate fasciculus, inferior frontal occipital fasciculus, inferior longitudinal fasciculus, and uncinate fasciculus), and (3) a SC-model based on diffusion MRI. For the association tracts, mean fractional anisotropy was calculated as a measure of white matter microstructure for each tract using a diffusion tensor atlas (i.e., AtlasTrack). The SC-model used measurement of cortical-cortical connections arising from a temporal lobe subnetwork derived using probabilistic tractography. Dimensionality reduction of the SC was performed with principal components analysis (PCA). Each model was trained on 49 patients from one epilepsy center and tested on 33 patients from a different center (i.e., an independent dataset). Randomization was performed to test the stability of the results. RESULTS The SC-model yielded a greater area under the curve (AUC; .73) and accuracy (79%) compared to both the tract-model (AUC: .54, p < .001; accuracy: 70%, p < .001) and the CV-model (AUC: .59, p < .001; accuracy: 64%, p < .001). Within the SC-model, lateral temporal connections had the highest importance to model performance, including connections similar to language association tracts such as links between the superior temporal gyrus to pars opercularis. However, in addition to these connections many additional connections that were widely distributed, bilateral and interhemispheric in nature were identified as contributing to SC-model performance. CONCLUSION The SC revealed a white matter network contributing to language impairment that was widely distributed, bilateral, and lateral temporal in nature. The distributed network underlying language may be why the SC-model has an advantage in identifying sub-components of the complex fiber networks most relevant for aspects of language performance.
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Affiliation(s)
- Erik Kaestner
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
| | - Akshara R Balachandra
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
| | - Naeim Bahrami
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
| | - Anny Reyes
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Sanam J Lalani
- Department of Neurology, University of California - San Francisco, San Francisco, CA, USA
| | - Anna Christina Macari
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
| | - Natalie L Voets
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Daniel L Drane
- Departments of Neurology and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, University of Washington, Seattle, WA, USA
| | - Brianna M Paul
- Department of Neurology, University of California - San Francisco, San Francisco, CA, USA
| | - Leonardo Bonilha
- Medical University of South Carolina, Department of Neurology, USA
| | - Carrie R McDonald
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA.
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15
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Kuchukhidze G, Siedentopf C, Unterberger I, Koppelstaetter F, Kronbichler M, Zamarian L, Haberlandt E, Ischebeck A, Delazer M, Felber S, Trinka E. Language Dominance in Patients With Malformations of Cortical Development and Epilepsy. Front Neurol 2019; 10:1209. [PMID: 31824399 PMCID: PMC6881376 DOI: 10.3389/fneur.2019.01209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/30/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Language function may be reorganized in patients with malformations of cortical development (MCD). This prospective cohort study aimed in assessing language dominance in a large group of patients with MCD and epilepsy using functional MRI (fMRI). Methods: Sixty-eight patients (40 women) aged 10-73 years (median, 28.0; interquartile range, 19) with MCD and epilepsy underwent 1.5 T MRI and fMRI (word generation task). Single-subject image analysis was performed with statistical parametric mapping (SPM12). Language lateralization indices (LIs) were defined for statistically significantly activated voxels in Broca's and Wernicke's areas using the formula: LI = (V L - V R)/(V L + V R) × 100, where V L and V R were sets of activated voxels on the left and on the right, respectively. Language laterality was considered typical if LI was between +20 and +100 or atypical if LI was between +19 and -100. Results: fMRI signal was elicited in 55 of 68 (81%) patients. In 18 of 55 (33%) patients, language dominance was typical, and in 37 of 55 (67%) patients, atypical (in 68%, right hemispheric; in 32%, bilateral). Language dominance was not influenced by handedness, electroclinical, and imaging features. Conclusions: In this prospective study on a large group of patients with MCD and epilepsy, about two-thirds had atypical language dominance. These results may contribute to assessing risks of postsurgical language deficits and could assist in planning of "cortical mapping" with intracranial electrodes in patients who undergo presurgical assessment.
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Affiliation(s)
- Giorgi Kuchukhidze
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Christian Siedentopf
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Iris Unterberger
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Koppelstaetter
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Radiology, Sanatorium Kettenbrücke, Innsbruck, Austria
| | - Martin Kronbichler
- Neuroscience Institute, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Salzburg, Austria
- Department of Psychology, University of Salzburg, Salzburg, Austria
- Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Laura Zamarian
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Edda Haberlandt
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
- Department of Pediatrics, City Hospital, Dornbirn, Austria
| | - Anja Ischebeck
- Institute of Psychology, University of Graz, Graz, Austria
| | - Margarete Delazer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stephan Felber
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Gemeinschaftsklinikum Mittelrhein, Koblenz, Germany
| | - Eugen Trinka
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Salzburg, Austria
- Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
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Kaestner E, Reyes A, Macari AC, Chang YH, Paul B, Hermann B, McDonald CR. Identifying the neural basis of a language-impaired phenotype of temporal lobe epilepsy. Epilepsia 2019; 60:1627-1638. [PMID: 31297795 PMCID: PMC6687533 DOI: 10.1111/epi.16283] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To identify neuroimaging and clinical biomarkers associated with a language-impaired phenotype in refractory temporal lobe epilepsy (TLE). METHODS Eighty-five patients with TLE were characterized as language-impaired (TLE-LI) or non-language-impaired (TLE-NLI) based on comprehensive neuropsychological testing. Structural magnetic resonance imaging (MRI), diffusion tensor imaging, and functional MRI (fMRI) were obtained in patients and 47 healthy controls (HC). fMRI activations and cortical thickness were calculated within language regions of interest, and fractional anisotropy (FA) was calculated within deep white matter tracts associated with language. Analyses of variance were performed to test for differences among the groups in imaging measures. Receiver operator characteristic curves were used to determine how well different clinical versus imaging measures discriminated TLE-LI from TLE-NLI. RESULTS TLE-LI patients showed significantly less activation within left superior temporal cortex compared to HC and TLE-NLI, regardless of side of seizure onset. TLE-LI also showed decreased FA in the inferior longitudinal fasciculus and arcuate fasciculus compared to HC. Cortical thickness did not differ between groups in any region. A model that included language-related fMRI activations within the superior temporal gyrus, age at onset, and demographic variables was the most predictive of language impairment (area under the curve = 0.80). SIGNIFICANCE These findings demonstrate a unique imaging signature associated with a language-impaired phenotype in TLE, characterized by functional and microstructural alterations within the language network. Reduced left superior temporal activation combined with compromise to language association tracts underlies this phenotype, extending our previous work on cognitive phenotypes that could have implications for treatment-planning or cognitive progression in TLE.
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Affiliation(s)
- Erik Kaestner
- Center for Multimodal Imaging and Genetics, University of California, San Diego
| | - Anny Reyes
- Center for Multimodal Imaging and Genetics, University of California, San Diego
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego
| | | | - Yu-Hsuan Chang
- Center for Multimodal Imaging and Genetics, University of California, San Diego
| | - Brianna Paul
- Department of Neurology, University of California – San Francisco, San Francisco
- UCSF Comprehensive Epilepsy Center, San Francisco
| | - Bruce Hermann
- Matthews Neuropsychology Section, University of Wisconsin
| | - Carrie R. McDonald
- Center for Multimodal Imaging and Genetics, University of California, San Diego
- UCSD Comprehensive Epilepsy Center, San Diego
- Department of Psychiatry, University of California, San Diego
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Lopes TM, Campos BM, Zanão TA, Balthazar MLF, Yasuda CL, Cendes F. Hippocampal atrophy disrupts the language network but not hemispheric language lateralization. Epilepsia 2019; 60:744-755. [DOI: 10.1111/epi.14694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Tátila Martins Lopes
- Neuroimaging LaboratoryDepartment of NeurologyUniversity of Campinas Campinas SP Brazil
| | - Brunno Machado Campos
- Neuroimaging LaboratoryDepartment of NeurologyUniversity of Campinas Campinas SP Brazil
| | - Tamires Araújo Zanão
- Neuroimaging LaboratoryDepartment of NeurologyUniversity of Campinas Campinas SP Brazil
| | | | - Clarissa Lin Yasuda
- Neuroimaging LaboratoryDepartment of NeurologyUniversity of Campinas Campinas SP Brazil
| | - Fernando Cendes
- Neuroimaging LaboratoryDepartment of NeurologyUniversity of Campinas Campinas SP Brazil
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Abstract
OBJECTIVES Naming assessment is a core component of neuropsychological evaluation, particularly in the surgical work up for patients with pharmacologically refractory epilepsy. Specifically, naming deficits are typically associated with left, but not right hemisphere epilepsy, thereby assisting with lateralization of seizure onset. We sought to determine whether bilingual (English as second language, ESL) and monolingual epilepsy patients with comparable education, intelligence, and objective vocabulary performance would perform similarly on standard naming measures, and whether ESL patients would demonstrate laterality effects in naming, similar to that observed in monolingual patients. METHODS Participants were 242 adults with epilepsy (186 native, 56 ESL) who underwent neuropsychological evaluation and obtained normal range or higher scores on the Wechsler Adult Intelligence Scale (R/III/IV) Vocabulary subtest (scaled score≥8). Groups were compared on demographic factors and language performances (i.e., Boston Naming Test, Auditory & Visual Naming Test, word reading, fluency). RESULTS Groups did not differ with respect to age, education, FSIQ, vocabulary, reading, or verbal fluency. However, ESL speakers earned poorer scores than native English speakers on all naming measures. Moreover, among ESL participants with unilateral epilepsy, a significant proportion of right hemisphere patients scored below cutoff for impairment. This contrasted with the more typical finding among native English speakers, whereby a significant proportion of left patients demonstrated naming impairment. CONCLUSIONS These results underscore the complexity of verbal assessment in bilinguals, suggesting that naming performances by ESL individuals, even those considered proficient, with strong performances on other English verbal measures, cannot be interpreted by the same standards applied for native speakers. (JINS, 2018, 24, 1057-1063).
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19
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Cano-López I, Calvo A, Boget T, Carreño M, Donaire A, Setoain X, Pintor L, Rumià J, González-Bono E, Junqué C, Bargalló N. Typical asymmetry in the hemispheric activation during an fMRI verbal comprehension paradigm is related to better performance in verbal and non-verbal tasks in patients with epilepsy. Neuroimage Clin 2018; 20:742-752. [PMID: 30238918 PMCID: PMC6154460 DOI: 10.1016/j.nicl.2018.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/05/2018] [Accepted: 09/14/2018] [Indexed: 01/28/2023]
Abstract
Chronic exposure to seizures in patients with left hemisphere (LH) epileptic focus could favor higher activation in the contralateral hemisphere during language processing, but the cognitive effects of this remain unclear. This study assesses the relationship between asymmetry in hemispheric activation during language fMRI and performance in verbal and non-verbal tasks. Whereas prior studies primarily used fMRI paradigms that favor frontal lobe activation and less prominent activation of the medial or superior temporal lobes, we used a verbal comprehension paradigm previously demonstrated to activate reliably receptive language areas. Forty-seven patients with drug-resistant epilepsy candidates for surgery underwent a multidisciplinary assessment, including a comprehensive neuropsychological evaluation and an fMRI verbal comprehension paradigm. Patients were distributed in two groups depending on laterality indexes (LI): typical hemispheric asymmetry (unilateral left activation preponderance; n = 23) and atypical hemispheric asymmetry (bilateral or unilateral right preponderance; n = 24). Right-handedness and right hemisphere (RH) focus were significant predictors of typical asymmetry. Patients with typical activation pattern presented better performance intelligence quotient and verbal learning than patients with atypical hemispheric asymmetry (for all, p < 0.014). Patients with LH focus had more frequently atypical hemispheric asymmetry than patients with RH focus (p = 0.05). Specifically, they showed lower LI and this was related to worse performance in verbal and non-verbal tasks. In conclusion, an increased activation of homologous RH areas for verbal comprehension processing could imply a competition of cognitive resources in the performance of the same task, disrupting cognitive performance.
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Affiliation(s)
- Irene Cano-López
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Valencia, Spain.
| | - Anna Calvo
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Teresa Boget
- Epilepsy Unit, Department of Psychiatry, Hospital Clínic, Barcelona, Spain
| | - Mar Carreño
- Epilepsy Unit, Department of Neurology, Hospital Clínic, Barcelona, Spain
| | - Antonio Donaire
- Epilepsy Unit, Department of Neurology, Hospital Clínic, Barcelona, Spain
| | - Xavier Setoain
- Epilepsy Unit, Department of Nuclear Medicine, Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona, Spain
| | - Luis Pintor
- Epilepsy Unit, Department of Psychiatry, Hospital Clínic, Barcelona, Spain
| | - Jordi Rumià
- Epilepsy Unit, Department of Neurosurgery, Hospital Clínic, Barcelona, Spain
| | - Esperanza González-Bono
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Valencia, Spain
| | - Carme Junqué
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain; Medical Psychology Unit, Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic, Barcelona, Spain
| | - Núria Bargalló
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain; Epilepsy Unit, Department of Radiology, Hospital Clínic, Barcelona, Spain
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20
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Frank B, Hurley L, Scott TM, Olsen P, Dugan P, Barr WB. Machine learning as a new paradigm for characterizing localization and lateralization of neuropsychological test data in temporal lobe epilepsy. Epilepsy Behav 2018; 86:58-65. [PMID: 30082202 DOI: 10.1016/j.yebeh.2018.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/05/2018] [Accepted: 07/05/2018] [Indexed: 10/28/2022]
Abstract
In this study, we employed a kernel support vector machine to predict epilepsy localization and lateralization for patients with a diagnosis of epilepsy (n = 228). We assessed the accuracy to which indices of verbal memory, visual memory, verbal fluency, and naming would localize and lateralize seizure focus in comparison to standard electroencephalogram (EEG). Classification accuracy was defined as models that produced the least cross-validated error (CVϵ). In addition, we assessed whether the inclusion of norm-based standard scores, demographics, and emotional functioning data would reduce CVϵ. Finally, we obtained class probabilities (i.e., the probability of a particular classification for each case) and produced receiver operating characteristic (ROC) curves for the primary analyses. We obtained the least error assessing localization data with the Gaussian radial basis kernel function (RBF; support vectors = 157, CVϵ = 0.22). There was no overlap between the localization and lateralization models, such that the poorest localization model (the hyperbolic tangent kernel function; support vectors = 91, CVϵ = 0.36) outperformed the strongest lateralization model (RBF; support vectors = 201, CVϵ = 0.39). Contrary to our hypothesis, the addition of norm, demographics, and emotional functioning data did not improve the accuracy of the models. Receiver operating characteristic curves suggested clinical utility in classifying epilepsy lateralization and localization using neuropsychological indicators, albeit with better discrimination for localizing determinations. This study adds to the existing literature by employing an analytic technique with inherent advantages in generalizability when compared to traditional single-sample, not cross-validated models. In the future, class probabilities extracted from these and similar analyses could supplement neuropsychological practice by offering a quantitative guide to clinical judgements.
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Affiliation(s)
- Brandon Frank
- Department of Psychology, Fordham University, 441 East Fordham Road, Bronx, NY 10458, United States of America
| | - Landon Hurley
- Department of Psychology, Fordham University, 441 East Fordham Road, Bronx, NY 10458, United States of America
| | - Travis M Scott
- Department of Psychology, Fordham University, 441 East Fordham Road, Bronx, NY 10458, United States of America
| | - Pat Olsen
- Department of Psychology, Fordham University, 441 East Fordham Road, Bronx, NY 10458, United States of America
| | - Patricia Dugan
- Department of Neurology, NYU School of Medicine, New York, NY 10016, United States of America
| | - William B Barr
- Department of Neurology, NYU School of Medicine, New York, NY 10016, United States of America.
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21
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Abstract
This article reviews the major paradigm shifts that have occurred in the area of the application of clinical and experimental neuropsychology to epilepsy and epilepsy surgery since the founding of the International Neuropsychological Society. The five paradigm shifts discussed include: 1) The neurobiology of cognitive disorders in epilepsy - expanding the landscape of syndrome-specific neuropsychological impairment; 2) pathways to comorbidities: bidirectional relationships and their clinical implications; 3) discovering quality of life: The concept, its quantification and applicability; 4) outcomes of epilepsy surgery: challenging conventional wisdom; and 5) Iatrogenic effects of treatment: cognitive and behavioral effects of antiepilepsy drugs. For each area we characterize the status of knowledge, the key developments that have occurred, and how they have altered our understanding of the epilepsies and their management. We conclude with a brief overview of where we believe the field will be headed in the next decade which includes changes in assessment paradigms, moving from characterization of comorbidities to interventions; increasing development of new measures, terminology and classification; increasing interest in neurodegenerative proteins; transitioning from clinical seizure features to modifiable risk factors; and neurobehavioral phenotypes. Overall, enormous progress has been made over the lifespan of the INS with promise of ongoing improvements in understanding of the cognitive and behavioral complications of the epilepsies and their treatment. (JINS, 2017, 23, 791-805).
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Affiliation(s)
- Bruce Hermann
- 1Department of Neurology,University of Wisconsin School of Medicine and Public Health,Madison Wisconsin
| | - David W Loring
- 2Departments of Neurology and Pediatrics,Emory University School of Medicine,Atlanta Georgia
| | - Sarah Wilson
- 3Department of Psychology,Melbourne University,Melbourne,Australia
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22
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Duncan JS, Winston GP, Koepp MJ, Ourselin S. Brain imaging in the assessment for epilepsy surgery. Lancet Neurol 2016; 15:420-33. [PMID: 26925532 DOI: 10.1016/s1474-4422(15)00383-x] [Citation(s) in RCA: 184] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 11/22/2015] [Accepted: 12/02/2015] [Indexed: 01/14/2023]
Abstract
Brain imaging has a crucial role in the presurgical assessment of patients with epilepsy. Structural imaging reveals most cerebral lesions underlying focal epilepsy. Advances in MRI acquisitions including diffusion-weighted imaging, post-acquisition image processing techniques, and quantification of imaging data are increasing the accuracy of lesion detection. Functional MRI can be used to identify areas of the cortex that are essential for language, motor function, and memory, and tractography can reveal white matter tracts that are vital for these functions, thus reducing the risk of epilepsy surgery causing new morbidities. PET, SPECT, simultaneous EEG and functional MRI, and electrical and magnetic source imaging can be used to infer the localisation of epileptic foci and assist in the design of intracranial EEG recording strategies. Progress in semi-automated methods to register imaging data into a common space is enabling the creation of multimodal three-dimensional patient-specific datasets. These techniques show promise for the demonstration of the complex relations between normal and abnormal structural and functional data and could be used to direct precise intracranial navigation and surgery for individual patients.
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Affiliation(s)
- John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK; National Hospital for Neurology and Neurosurgery, London, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, Gerrards Cross, UK.
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK; National Hospital for Neurology and Neurosurgery, London, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, Gerrards Cross, UK
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK; National Hospital for Neurology and Neurosurgery, London, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, Gerrards Cross, UK
| | - Sebastien Ourselin
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK; Translational Imaging Group, Centre for Medical Image Computing, University College London, London, UK; National Hospital for Neurology and Neurosurgery, London, UK
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23
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Jin SH, Chung CK. Functional substrate for memory function differences between patients with left and right mesial temporal lobe epilepsy associated with hippocampal sclerosis. Epilepsy Behav 2015; 51:251-8. [PMID: 26300534 DOI: 10.1016/j.yebeh.2015.07.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/24/2015] [Accepted: 07/24/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Little is known about the functional substrate for memory function differences in patients with left or right mesial temporal lobe epilepsy (mTLE) associated with hippocampal sclerosis (HS) from an electrophysiological perspective. To characterize these differences, we hypothesized that hippocampal theta connectivity in the resting-state might be different between patients with left and right mTLE with HS and be correlated with memory performance. METHODS Resting-state hippocampal theta connectivity, identified via whole-brain magnetoencephalography, was evaluated. Connectivity and memory function in 41 patients with mTLE with HS (left mTLE=22; right mTLE=19) were compared with those in 46 age-matched healthy controls and 28 patients with focal cortical dysplasia (FCD) but without HS. RESULTS Connectivity between the right hippocampus and the left middle frontal gyrus was significantly stronger in patients with right mTLE than in patients with left mTLE. Moreover, this connectivity was positively correlated with delayed verbal recall and recognition scores in patients with mTLE. Patients with left mTLE had greater delayed recall impairment than patients with right mTLE and FCD. Similarly, delayed recognition performance was worse in patients with left mTLE than in patients with right mTLE and FCD. No significant differences in memory function between patients with right mTLE and FCD were detected. Patients with right mTLE showed significantly stronger hippocampal theta connectivity between the right hippocampus and left middle frontal gyrus than patients with FCD and left mTLE. CONCLUSION Our results suggest that right hippocampal-left middle frontal theta connectivity could be a functional substrate that can account for differences in memory function between patients with left and right mTLE. This functional substrate might be related to different compensatory mechanisms against the structural hippocampal lesions in left and right mTLE groups. Given the positive correlation between connectivity and delayed verbal memory function, hemispheric-specific hippocampal-frontal theta connectivity assessment could be useful as an electrophysiological indicator of delayed verbal memory function in patients with mTLE with HS.
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Affiliation(s)
- Seung-Hyun Jin
- Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chun Kee Chung
- Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea; Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea.
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24
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Carey DP, Johnstone LT. Quantifying cerebral asymmetries for language in dextrals and adextrals with random-effects meta analysis. Front Psychol 2014; 5:1128. [PMID: 25408673 PMCID: PMC4219560 DOI: 10.3389/fpsyg.2014.01128] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 09/16/2014] [Indexed: 12/31/2022] Open
Abstract
Speech and language-related functions tend to depend on the left hemisphere more than the right in most right-handed (dextral) participants. This relationship is less clear in non-right handed (adextral) people, resulting in surprisingly polarized opinion on whether or not they are as lateralized as right handers. The present analysis investigates this issue by largely ignoring methodological differences between the different neuroscientific approaches to language lateralization, as well as discrepancies in how dextral and adextral participants were recruited or defined. Here we evaluate the tendency for dextrals to be more left hemisphere dominant than adextrals, using random effects meta analyses. In spite of several limitations, including sample size (in the adextrals in particular), missing details on proportions of groups who show directional effects in many experiments, and so on, the different paradigms all point to proportionally increased left hemispheric dominance in the dextrals. These results are analyzed in light of the theoretical importance of these subtle differences for understanding the cognitive neuroscience of language, as well as the unusual asymmetry in most adextrals.
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Affiliation(s)
- David P Carey
- Perception, Action and Memory Research Group, School of Psychology, Bangor University Bangor, UK
| | - Leah T Johnstone
- Perception, Action and Memory Research Group, School of Psychology, Bangor University Bangor, UK
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25
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Eddin AS, Wang J, Wu W, Sargolzaei S, Bjornson B, Jones RA, Gaillard WD, Adjouadi M. The effects of pediatric epilepsy on a language connectome. Hum Brain Mapp 2014; 35:5996-6010. [PMID: 25082062 DOI: 10.1002/hbm.22600] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 06/23/2014] [Accepted: 07/22/2014] [Indexed: 01/03/2023] Open
Abstract
This study introduces a new approach for assessing the effects of pediatric epilepsy on a language connectome. Two novel data-driven network construction approaches are presented. These methods rely on connecting different brain regions using either extent or intensity of language related activations as identified by independent component analysis of fMRI. An auditory word definition decision task paradigm was used to activate the language network for 29 patients and 30 controls. Evaluations illustrated that pediatric epilepsy is associated with a network efficiency reduction. Patients showed a propensity to inefficiently use the whole brain network to perform the language task; whereas, controls seemed to efficiently use smaller segregated network components to achieve the same task. To explain the causes of the decreased efficiency, graph theoretical analysis was performed. The analysis revealed substantial global network feature differences between the patients and controls for the extent of activation network. It also showed that for both subject groups the language network exhibited small-world characteristics; however, the patient's extent of activation network showed a tendency toward randomness. It was also shown that the intensity of activation network displayed ipsilateral hub reorganization on the local level. We finally showed that a clustering scheme was able to fairly separate the subjects into their respective patient or control groups. The clustering was initiated using local and global nodal measurements. Compared to the intensity of activation network, the extent of activation network clustering demonstrated better precision. This ascertained that the network differences presented by the networks were associated with pediatric epilepsy.
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Affiliation(s)
- Anas Salah Eddin
- Department of Computer Science and Information Technology, Florida Polytechnic University, Lakeland, Florida; Department of Electrical and Computer Engineering, Florida International University, Miami, Florida
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