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Lucas A, Revell A, Davis KA. Artificial intelligence in epilepsy - applications and pathways to the clinic. Nat Rev Neurol 2024; 20:319-336. [PMID: 38720105 DOI: 10.1038/s41582-024-00965-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 06/06/2024]
Abstract
Artificial intelligence (AI) is rapidly transforming health care, and its applications in epilepsy have increased exponentially over the past decade. Integration of AI into epilepsy management promises to revolutionize the diagnosis and treatment of this complex disorder. However, translation of AI into neurology clinical practice has not yet been successful, emphasizing the need to consider progress to date and assess challenges and limitations of AI. In this Review, we provide an overview of AI applications that have been developed in epilepsy using a variety of data modalities: neuroimaging, electroencephalography, electronic health records, medical devices and multimodal data integration. For each, we consider potential applications, including seizure detection and prediction, seizure lateralization, localization of the seizure-onset zone and assessment for surgical or neurostimulation interventions, and review the performance of AI tools developed to date. We also discuss methodological considerations and challenges that must be addressed to successfully integrate AI into clinical practice. Our goal is to provide an overview of the current state of the field and provide guidance for leveraging AI in future to improve management of epilepsy.
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Affiliation(s)
- Alfredo Lucas
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew Revell
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kathryn A Davis
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
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Noorizadeh N, Rezaie R, Varner JA, Wheless JW, Fulton SP, Mudigoudar BD, Nevill L, Holder CM, Narayana S. Concordance between Wada, Transcranial Magnetic Stimulation, and Magnetoencephalography for Determining Hemispheric Dominance for Language: A Retrospective Study. Brain Sci 2024; 14:336. [PMID: 38671988 PMCID: PMC11047819 DOI: 10.3390/brainsci14040336] [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: 02/14/2024] [Revised: 03/15/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
Determination of language hemispheric dominance (HD) in patients undergoing evaluation for epilepsy surgery has traditionally relied on the sodium amobarbital (Wada) test. The emergence of non-invasive methods for determining language laterality has increasingly shown to be a viable alternative. In this study, we assessed the efficacy of transcranial magnetic stimulation (TMS) and magnetoencephalography (MEG), compared to the Wada test, in determining language HD in a sample of 12 patients. TMS-induced speech errors were classified as speech arrest, semantic, or performance errors, and the HD was based on the total number of errors in each hemisphere with equal weighting of all errors (classic) and with a higher weighting of speech arrests and semantic errors (weighted). Using MEG, HD for language was based on the spatial extent of long-latency activity sources localized to receptive language regions. Based on the classic and weighted language laterality index (LI) in 12 patients, TMS was concordant with the Wada in 58.33% and 66.67% of patients, respectively. In eight patients, MEG language mapping was deemed conclusive, with a concordance rate of 75% with the Wada test. Our results indicate that TMS and MEG have moderate and strong agreement, respectively, with the Wada test, suggesting they could be used as non-invasive substitutes.
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Affiliation(s)
- Negar Noorizadeh
- Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (N.N.); (R.R.); (J.W.W.); (S.P.F.); (B.D.M.); (C.M.H.)
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA; (J.A.V.); (L.N.)
| | - Roozbeh Rezaie
- Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (N.N.); (R.R.); (J.W.W.); (S.P.F.); (B.D.M.); (C.M.H.)
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA; (J.A.V.); (L.N.)
| | - Jackie A. Varner
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA; (J.A.V.); (L.N.)
| | - James W. Wheless
- Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (N.N.); (R.R.); (J.W.W.); (S.P.F.); (B.D.M.); (C.M.H.)
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA; (J.A.V.); (L.N.)
| | - Stephen P. Fulton
- Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (N.N.); (R.R.); (J.W.W.); (S.P.F.); (B.D.M.); (C.M.H.)
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA; (J.A.V.); (L.N.)
| | - Basanagoud D. Mudigoudar
- Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (N.N.); (R.R.); (J.W.W.); (S.P.F.); (B.D.M.); (C.M.H.)
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA; (J.A.V.); (L.N.)
| | - Leigh Nevill
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA; (J.A.V.); (L.N.)
| | - Christen M. Holder
- Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (N.N.); (R.R.); (J.W.W.); (S.P.F.); (B.D.M.); (C.M.H.)
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA; (J.A.V.); (L.N.)
| | - Shalini Narayana
- Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (N.N.); (R.R.); (J.W.W.); (S.P.F.); (B.D.M.); (C.M.H.)
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA; (J.A.V.); (L.N.)
- Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
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Voets NL, Bartsch AJ, Plaha P. Functional MRI applications for intra-axial brain tumours: uses and nuances in surgical practise. Br J Neurosurg 2023; 37:1544-1559. [PMID: 36148501 DOI: 10.1080/02688697.2022.2123893] [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: 03/18/2022] [Accepted: 09/07/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Functional MRI (fMRI) has well-established uses to inform risks and plan maximally safe approaches in neurosurgery. In the field of brain tumour surgery, however, fMRI is currently in a state of clinical equipoise due to debate around both its sensitivity and specificity. MATERIALS AND METHODS In this review, we summarise the role and our experience of fMRI in neurosurgery for gliomas and metastases. We discuss nuances in the conduct and interpretation of fMRI that, based on our practise, most directly impact fMRI's usefulness in the neurosurgical setting. RESULTS Illustrated examples in which fMRI in our hands directly influences the neurosurgical treatment of brain tumours include evaluating the probability and nature of functional risks, especially for language functions. These presurgical risk assessments, in turn, help to predict the resectability of tumours, select or deselect patients for awake surgery, indicate the need for neurophysiological monitoring and guide the optimal use of intra-operative stimulation mapping. A further emerging application of fMRI is in measuring functional adaptation of functional networks after (partial) surgery, of potential use in the timing of further surgery. CONCLUSIONS In appropriately selected patients with a clearly defined surgical question, fMRI offers a valuable complementary tool in the pre-surgical evaluation of brain tumours. However, there is a great need for standards in the administration and analysis of fMRI as much as in the techniques that it is commonly evaluated against. Surprisingly little data exists that evaluates the accuracy of fMRI not just against complementary methods, but in terms of its ultimate clinical aim of minimising post-surgical morbidity.
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Affiliation(s)
- Natalie L Voets
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- GenesisCare Ltd, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Andreas J Bartsch
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Puneet Plaha
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Neurosurgery, University of Oxford, Oxford, UK
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Campbell JM, Kundu B, Lee JN, Miranda M, Arain A, Taussky P, Grandhi R, Rolston JD. Evaluating the concordance of functional MRI-based language lateralization and Wada testing in epilepsy patients: A single-center analysis. Interv Neuroradiol 2023; 29:599-604. [PMID: 35979608 PMCID: PMC10549711 DOI: 10.1177/15910199221121384] [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: 06/21/2022] [Revised: 07/20/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND For patients with drug-resistant epilepsy, surgery may be effective in controlling their disease. Surgical evaluation may involve localization of the language areas using functional magnetic resonance imaging (fMRI) or Wada testing. We evaluated the accuracy of task-based fMRI versus Wada-based language lateralization in a cohort of our epilepsy patients. METHODS In a single-center, retrospective analysis, we identified patients with medically intractable epilepsy who participated in presurgical language mapping (n = 35) with fMRI and Wada testing. Demographic variables and imaging metrics were obtained. We calculated the laterality index (LI) from task-evoked fMRI activation maps across language areas during auditory and reading tasks to determine lateralization. Possible scores for LI range from -1 (strongly left-hemisphere dominant) to 1 (strongly right-hemisphere dominant). Concordance between fMRI and Wada was estimated using Cohen's Kappa coefficient. Association between the LI scores from the auditory and reading tasks was tested using Spearman's rank correlation coefficient. RESULTS The fMRI-based laterality indices were concordant with results from Wada testing in 91.4% of patients during the reading task (κ = .55) and 96.9% of patients during the auditory task (κ = .79). The mean LIs for the reading and auditory tasks were -0.52 ± 0.43 and -0.68 ± 0.42, respectively. The LI scores for the language and reading tasks were strongly correlated, r(30) = 0.57 (p = 0.001). CONCLUSION Our findings suggest that fMRI is generally an accurate, low-risk alternative to Wada testing for language lateralization. However, when fMRI indicates atypical language lateralization (e.g., bilateral dominance), patients may benefit from subsequent Wada testing or intraoperative language mapping.
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Affiliation(s)
- Justin M Campbell
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
- Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City, Utah, USA
| | - Bornali Kundu
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - James N Lee
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Michelle Miranda
- Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Amir Arain
- Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Philipp Taussky
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - John D Rolston
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
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Labache L, Ge T, Yeo BTT, Holmes AJ. Language network lateralization is reflected throughout the macroscale functional organization of cortex. Nat Commun 2023; 14:3405. [PMID: 37296118 PMCID: PMC10256741 DOI: 10.1038/s41467-023-39131-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Hemispheric specialization is a fundamental feature of human brain organization. However, it is not yet clear to what extent the lateralization of specific cognitive processes may be evident throughout the broad functional architecture of cortex. While the majority of people exhibit left-hemispheric language dominance, a substantial minority of the population shows reverse lateralization. Using twin and family data from the Human Connectome Project, we provide evidence that atypical language dominance is associated with global shifts in cortical organization. Individuals with atypical language organization exhibit corresponding hemispheric differences in the macroscale functional gradients that situate discrete large-scale networks along a continuous spectrum, extending from unimodal through association territories. Analyses reveal that both language lateralization and gradient asymmetries are, in part, driven by genetic factors. These findings pave the way for a deeper understanding of the origins and relationships linking population-level variability in hemispheric specialization and global properties of cortical organization.
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Affiliation(s)
- Loïc Labache
- Department of Psychology, Yale University, New Haven, CT, 06520, US.
| | - Tian Ge
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, 02114, US
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, US
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, 02142, US
| | - B T Thomas Yeo
- Department of Electrical and Computer Engineering, Centre for Sleep and Cognition, National University of Singapore, Singapore, SG, 119077, Singapore
- Department of Electrical and Computer Engineering, Centre for Translational Magnetic Resonance Research, National University of Singapore, Singapore, SG, 119077, Singapore
- N.1 Institute for Health, National University of Singapore, Singapore, SG, 119077, Singapore
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, 02129, US
- National University of Singapore Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore, SG, 119077, Singapore
| | - Avram J Holmes
- Department of Psychology, Yale University, New Haven, CT, 06520, US.
- Department of Psychiatry, Yale University, New Haven, CT, 06520, US.
- Wu Tsai Institute, Yale University, New Haven, CT, 06520, US.
- Department of Psychiatry, Brain Health Institute, Rutgers University, Piscataway, NJ, 08854, US.
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Bruzsa AK, Walther K, Kasper BS, Gollwitzer S, Hamer H, Schwarz M. WADA test for postoperative memory prediction in left TLE. Is it still useful in the 21st century? Clin Neurol Neurosurg 2023; 225:107580. [PMID: 36638639 DOI: 10.1016/j.clineuro.2022.107580] [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: 11/22/2022] [Revised: 12/19/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Epilepsy surgery offers an effective treatment to achieve seizure freedom in refractory temporal lobe epilepsy. Since left temporal lobe surgery can be associated with verbal memory deterioration, control of cognitive decline is a main goal of therapy. This study analyzes the prognostic value of intracarotid amobarbital procedure (Wada test) in addition to specific neuropsychological and clinical variables for postoperative memory changes. METHOD Between 2013 and 2021 thirty-six patients (18 females, 18 males, mean age 41.0 years) from the Epilepsy Center Erlangen (ECE) with left hemispheric temporal lobe epilepsy underwent neuropsychological assessment preoperatively - including the Wada test - and six months postoperatively. In addition, a group of 92 patients (40 females, 52 males, mean age 36.1 years) with left or right hemispheric focus who underwent Wada test and surgery before 2013 was included as a standardization group. In all patients Wada test was carried out preoperatively to determine language dominance and memory capacity. RESULTS Postoperative verbal memory scores showed no significant difference from preoperative performance. Preoperative verbal memory performance as well as the hippocampal resection extent is particularly important in predicting postoperative verbal memory change. After left temporal lobe surgery, a significantly higher postoperative functional level was shown for figural memory. Specifically, a good contralateral hemispheric performance level assessed by the Wada test proved to be a compensatory factor for postoperative losses. CONCLUSION The Wada test is no longer necessary as a diagnostic tool for a broad group of patients with temporal lobe epilepsy. However, it can be useful for a subgroup of patients with clinical indicators such as nonspecific or incongruent preoperative verbal and figural memory impairments. In this study, Wada test data about the functional level of the contralateral hemisphere specifically allowed estimation of postoperative figural memory changes.
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Affiliation(s)
- Ann-Kathrin Bruzsa
- Department of Neurology, Epilepsy Center Erlangen, University Hospital Erlangen, Germany; Full member of ERN EpiCARE, Germany
| | - Katrin Walther
- Department of Neurology, Epilepsy Center Erlangen, University Hospital Erlangen, Germany; Full member of ERN EpiCARE, Germany
| | - Burkhard S Kasper
- Department of Neurology, Epilepsy Center Erlangen, University Hospital Erlangen, Germany; Full member of ERN EpiCARE, Germany
| | - Stefanie Gollwitzer
- Department of Neurology, Epilepsy Center Erlangen, University Hospital Erlangen, Germany; Full member of ERN EpiCARE, Germany
| | - Hajo Hamer
- Department of Neurology, Epilepsy Center Erlangen, University Hospital Erlangen, Germany; Full member of ERN EpiCARE, Germany
| | - Michael Schwarz
- Department of Neurology, Epilepsy Center Erlangen, University Hospital Erlangen, Germany; Full member of ERN EpiCARE, Germany.
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Sánchez Fernández I, Amengual-Gual M, Barcia Aguilar C, Romeu A, Jonas R, Torres A, Gaínza-Lein M, Douglass L. Health care resource utilization and costs before and after epilepsy surgery. Seizure 2023; 104:22-31. [PMID: 36463710 DOI: 10.1016/j.seizure.2022.11.012] [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: 07/29/2022] [Revised: 11/11/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe the demographics of epilepsy surgery utilization and its impact on health care resource use. METHODS Retrospective descriptive study using the MarketScan commercial claims database. We studied children and adults who underwent epilepsy surgery in the USA in the period 2006-2019. Our main outcome was health care resource utilization. RESULTS Among the 87,368 patients with refractory epilepsy, 2,011 (2.3%) patients underwent resective epilepsy surgery, 188 (0.2%) patients underwent partial or total hemispherectomy, and 183 (0.2%) patients underwent corpus callosotomy. The proportion of patients undergoing epilepsy surgery has barely increased in the period 2006 to 2019. The year of resective epilepsy surgery was associated with high healthcare costs per person-year [median (p25-p75): $140,322 ($88,749-$225,862)], but healthcare costs per person-year substantially decreased in the 5 years after compared to the 5 years before the year of resective epilepsy surgery [$7,691 ($2,738-$22,092) versus $18,750 ($7,361-$47,082), p-value < 0.0001]. This result held in all resective epilepsy surgery subgroups: children, adults, temporal, extratemporal, subdural EEG monitoring, stereoEEG monitoring, and no intracranial monitoring. Similarly, the year of hemispherectomy was associated with high healthcare costs per person-year [$260,983 ($154,791-$453,986)], but healthcare costs per person-year substantially decreased in the 5 years after compared to the 5 years before the year of hemispherectomy [$26,834 ($12,842-$52,627) versus $54,596 ($19,547-$136,412), p-value < 0.0001]. In contrast, the year of corpus callosotomy was associated with high healthcare costs per person-year [$162,399 ($108,150-$253,156)], but healthcare costs per person-year did not substantially decrease in the 5 years after than in the 5 years before the year of corpus callosotomy [$25,464 ($10,764-$69,338) versus $36,221 ($12,841-$85,747), p-value = 0.2142]. CONCLUSION In privately insured patients in the USA, resective epilepsy surgery and hemispherectomy substantially decrease healthcare utilization in subsequent years. Epilepsy surgery may help contain costs in the field of epilepsy.
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Affiliation(s)
| | - Marta Amengual-Gual
- Pediatric Neurology Unit, Department of Pediatrics, Hospital Universitari Son Llàtzer, Universitat de les Illes Balears, Palma, Spain
| | - Cristina Barcia Aguilar
- Pediatric Neurology Unit, Department of Pediatrics, Complejo Hospitalario Universitario de La Coruña, La Coruña, Spain
| | - Amanda Romeu
- Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Rinat Jonas
- Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Alcy Torres
- Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Marina Gaínza-Lein
- Facultad de Medicina, Instituto de Pediatría, Universidad Austral de Chile, Valdivia, Chile; Servicio de Neuropsiquiatría Infantil. Hospital Clínico San Borja Arriarán, Universidad de Chile, Santiago, Chile
| | - Laurie Douglass
- Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
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Rødland E, Melleby KM, Specht K. Evaluation of a Simple Clinical Language Paradigm With Respect to Sensory Independency, Functional Asymmetry, and Effective Connectivity. Front Behav Neurosci 2022; 16:806520. [PMID: 35309683 PMCID: PMC8928437 DOI: 10.3389/fnbeh.2022.806520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/10/2022] [Indexed: 01/18/2023] Open
Abstract
The present study replicates a known visual language paradigm, and extends it to a paradigm that is independent from the sensory modality of the stimuli and, hence, could be administered either visually or aurally, such that both patients with limited sight or hearing could be examined. The stimuli were simple sentences, but required the subject not only to understand the content of the sentence but also to formulate a response that had a semantic relation to the content of the presented sentence. Thereby, this paradigm does not only test perception of the stimuli, but also to some extend sentence and semantic processing, and covert speech production within one task. When the sensory base-line condition was subtracted, both the auditory and visual version of the paradigm demonstrated a broadly overlapping and asymmetric network, comprising distinct areas of the left posterior temporal lobe, left inferior frontal areas, left precentral gyrus, and supplementary motor area. The consistency of activations and their asymmetry was evaluated with a conjunction analysis, probability maps, and intraclass correlation coefficients (ICC). This underlying network was further analyzed with dynamic causal modeling (DCM) to explore whether not only the same brain areas were involved, but also the network structure and information flow were the same between the sensory modalities. In conclusion, the paradigm reliably activated the most central parts of the speech and language network with a great consistency across subjects, and independently of whether the stimuli were administered aurally or visually. However, there was individual variability in the degree of functional asymmetry between the two sensory conditions.
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Affiliation(s)
- Erik Rødland
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Division of Psychiatry, Department of Child and Adolescent, Haukeland University Hospital, Bergen, Norway
| | - Kathrine Midgaard Melleby
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Adult Habilitation Section, Telemark Hospital Skien, Skien, Norway
| | - Karsten Specht
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Bergen, Norway
- Department of Education, UiT The Arctic University of Norway, Tromsø, Norway
- *Correspondence: Karsten Specht,
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Riley SP, Chu DY, Nair VA, Baskaya MK, Kuo JS, Meyerand ME, Prabhakaran V. Characterizing the relationship between lesion-activation distance using fMRI and verbal measures in brain tumor patients. INTERDISCIPLINARY NEUROSURGERY 2022; 27. [PMID: 34950570 PMCID: PMC8691738 DOI: 10.1016/j.inat.2021.101391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
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10
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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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11
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Li R, Mukadam N, Kiran S. Functional MRI evidence for reorganization of language networks after stroke. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:131-150. [PMID: 35078595 DOI: 10.1016/b978-0-12-823384-9.00007-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In this chapter, we review fMRI evidence for language reorganization in individuals with poststroke aphasia. Several studies in the current literature have utilized fMRI as a tool to understand patterns of functional reorganization in poststroke aphasia. Consistent with previous models that have been proposed to explain the trajectory of language recovery, differential patterns of language processing and language recovery have been identified across individuals with poststroke aphasia in different stages of recovery. Overall, a global network breakdown typically occurs in the early stages of aphasia recovery, followed by normalization in "traditional" left hemisphere language networks. Depending on individual characteristics, right hemisphere regions and bilateral domain-general regions may be further recruited. The main takeaway of this chapter is that poststroke aphasia recovery does not depend on individual neural regions, but rather involves a complex interaction among regions in larger networks. Many of the unresolved issues and contrastive findings in the literature warrant further research with larger groups of participants and standard protocols of fMRI implementation.
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Affiliation(s)
- Ran Li
- Department of Speech, Language and Hearing Sciences, Boston University, Boston, MA, United States
| | - Nishaat Mukadam
- Department of Speech, Language and Hearing Sciences, Boston University, Boston, MA, United States
| | - Swathi Kiran
- Department of Speech, Language and Hearing Sciences, Boston University, Boston, MA, United States.
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12
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Polyanskaya M, Demushkina A, Kostylev F, Vasilyev I, Kholin A, Zavadenko N, Alikhanov A. The presurgical evaluation of patients with drug-resistant epilepsy. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:12-20. [DOI: 10.17116/jnevro202212208112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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13
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Samson S, Denos M. Neuropsychology of temporal lobe epilepsies. HANDBOOK OF CLINICAL NEUROLOGY 2022; 187:519-529. [PMID: 35964990 DOI: 10.1016/b978-0-12-823493-8.00012-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This chapter focuses on the neuropsychology of adults with temporal lobe epilepsy (TLE). First, a thorough description of the brain-behavior relationship characterizing focal TLE with and without hippocampal sclerosis is presented. Then, the aim and the specificity of the NPA in the care of epilepsy are described. Considering the high frequency of medically intractable TLE that can be treated by surgery, an assessment carried out in the context of pre- and postoperative evaluation is presented and discussed in light of insights from functional neuroimaging findings. Finally, we propose concluding remarks about the place of neuropsychology in the care of epilepsy in improving our understanding of the cognitive and emotional phenotypes associated with TLE.
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Affiliation(s)
- Séverine Samson
- Department of Psychology, University of Lille, Lille, France; Epilepsy Unit, Neurosciences Department, Hôpital de la Pitié-Salpêtrière, Paris, France.
| | - Marisa Denos
- Rehabilitation Unit, Neurosciences Department, Hôpital de la Pitié-Salpêtrière, Paris, France
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14
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Yazbek S, Hage S, Mallak I, Smayra T. Tractography of the arcuate fasciculus in healthy right-handed and left-handed multilingual subjects and its relation to language lateralization on functional MRI. Sci Rep 2021; 11:20936. [PMID: 34686728 PMCID: PMC8536719 DOI: 10.1038/s41598-021-00490-5] [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: 05/09/2021] [Accepted: 10/13/2021] [Indexed: 11/10/2022] Open
Abstract
Functional MRI (fMRI) enables evaluation of language cortical organization and plays a central role in surgical planning. Diffusion Tensor Imaging (DTI) or Tractography, allows evaluation of the white matter fibers involved in language. Unlike fMRI, DTI does not rely on the patient’s cooperation. In monolinguals, there is a significant correlation between the lateralization of language on fMRI and on DTI. Our objective is to delineate the arcuate fasciculus (AF) in right- and left-handed trilinguals and determine if the AF laterality on DTI is correlated to language lateralization on fMRI. 15 right and 15 left-handed trilingual volunteers underwent fMRI and DTI. Laterality Index was determined on fMRI (fMRI-LI). Mean Diffusivity, Fractional Anisotropy (FA), Number of Fibers, Fiber Length, Fiber Volume and Laterality Index (DTI-LI) of the AF were calculated on DTI. 28 of the 30 subjects presented a bilateral AF. Most subjects (52%) were found to have a bilateral language lateralization of the AF on DTI. Only 4 subjects had bilateral lateralization of language on fMRI. The right AF demonstrated lower diffusivity than the left AF in the total participants, the right-handed, and the left-handed subjects. FA, Volume and Length of the AF were not significantly different between the two hemispheres. No correlation was found between the DTI-LI of the AF and the fMRI-LI. A prominent role of the right AF and a bilateral structural organization of the AF was present in our multilingual population regardless of their handedness. While in prior studies DTI was able to determine language lateralization in monolingual subjects, this was not possible in trilingual highly educated subjects.
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Affiliation(s)
- Sandrine Yazbek
- Medical School, Hotel-Dieu de France Hospital, Saint Joseph University, Boulevard Alfred Naccache, Achrafieh, PO Box 166830, Beirut, Lebanon
| | - Stephanie Hage
- Medical School, Hotel-Dieu de France Hospital, Saint Joseph University, Boulevard Alfred Naccache, Achrafieh, PO Box 166830, Beirut, Lebanon
| | - Iyad Mallak
- Medical School, Hotel-Dieu de France Hospital, Saint Joseph University, Boulevard Alfred Naccache, Achrafieh, PO Box 166830, Beirut, Lebanon
| | - Tarek Smayra
- Medical School, Hotel-Dieu de France Hospital, Saint Joseph University, Boulevard Alfred Naccache, Achrafieh, PO Box 166830, Beirut, Lebanon.
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15
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Banjac S, Roger E, Cousin E, Perrone-Bertolotti M, Haldin C, Pichat C, Lamalle L, Minotti L, Kahane P, Baciu M. Interactive mapping of language and memory with the GE2REC protocol. Brain Imaging Behav 2021; 15:1562-1579. [PMID: 32761343 PMCID: PMC8286228 DOI: 10.1007/s11682-020-00355-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Previous studies have highlighted the importance of considering cognitive functions from a dynamic and interactive perspective and multiple evidence was brought for a language and memory interaction. In this study performed with healthy participants, we present a new protocol entitled GE2REC that interactively accesses the neural representation of language-and-memory network. This protocol consists of three runs related to each other, providing a link between tasks, in order to assure an interactive measure of linguistic and episodic memory processes. GE2REC consists of a sentence generation (GE) in the auditory modality and two recollecting (2REC) memory tasks, one recognition performed in the visual modality, and another one recall performed in the auditory modality. Its efficiency was evaluated in 20 healthy volunteers using a 3T MR imager. Our results corroborate the ability of GE2REC to robustly activate fronto-temporo-parietal language network as well as temporal mesial, prefrontal and parietal cortices in encoding during sentence generation and recognition. GE2REC is useful because it: (a) requires simultaneous and interactive language-and-memory processes and jointly maps their neural basis; (b) explores encoding and retrieval, managing to elicit activation of mesial temporal structures; (c) is easy to perform, hence being suitable for more restrictive settings, and (d) has an ecological dimension of tasks and stimuli. GE2REC may be useful for studying neuroplasticity of cognitive functions, especially in patients with temporal lobe epilepsy who show reorganization of both language and memory networks. Overall, GE2REC can provide valuable information in terms of the practical foundation of exploration language and memory interconnection.
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Affiliation(s)
- Sonja Banjac
- Univ. Grenoble Alpes, CNRS LPNC UMR 5105, F-38000, Grenoble, France
| | - Elise Roger
- Univ. Grenoble Alpes, CNRS LPNC UMR 5105, F-38000, Grenoble, France
| | - Emilie Cousin
- Univ. Grenoble Alpes, CNRS LPNC UMR 5105, F-38000, Grenoble, France.,Univ. Grenoble Alpes, UMS IRMaGe CHU Grenoble, F-38000, Grenoble, France
| | | | - Célise Haldin
- Univ. Grenoble Alpes, CNRS LPNC UMR 5105, F-38000, Grenoble, France
| | - Cédric Pichat
- Univ. Grenoble Alpes, CNRS LPNC UMR 5105, F-38000, Grenoble, France
| | - Laurent Lamalle
- Univ. Grenoble Alpes, UMS IRMaGe CHU Grenoble, F-38000, Grenoble, France
| | - Lorella Minotti
- Univ. Grenoble Alpes, GIN, Synchronisation et modulation des Réseaux Neuronaux dans l'Epilepsie' and Neurology Department, F-38000, Grenoble, France
| | - Philippe Kahane
- Univ. Grenoble Alpes, GIN, Synchronisation et modulation des Réseaux Neuronaux dans l'Epilepsie' and Neurology Department, F-38000, Grenoble, France
| | - Monica Baciu
- Univ. Grenoble Alpes, CNRS LPNC UMR 5105, F-38000, Grenoble, France.
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16
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Williamson BJ, De Domenico M, Kadis DS. Multilayer Connector Hub Mapping Reveals Key Brain Regions Supporting Expressive Language. Brain Connect 2021; 11:45-55. [PMID: 33317399 PMCID: PMC7891212 DOI: 10.1089/brain.2020.0776] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: How components of the distributed brain networks that support cognition participate in typical functioning remains a largely unanswered question. An important subgroup of regions in the larger network are connector hubs, which are areas that are highly connected to several other functionally specialized sets of regions, and are likely important for sensorimotor integration. The present study attempts to characterize connector hubs involved in typical expressive language functioning using a data-driven, multimodal, full multilayer magnetoencephalography (MEG) connectivity-based pipeline. Methods: Twelve adolescents, 16-18 years of age (five males), participated in this study. Participants underwent MEG scanning during a verb generation task. MEG and structural connectivity were calculated at the whole-brain level. Amplitude/amplitude coupling (AAC) was used to compute functional connections both within and between discrete frequency bins. AAC values were then multiplied by a binary structural connectivity matrix, and then entered into full multilayer network analysis. Initially, hubs were defined based on multilayer versatility and subsequently reranked by a novel measure called delta centrality on interconnectedness (DCI). DCI is defined as the percent change in interfrequency interconnectedness after removal of a hub. Results: We resolved regions that are important for between-frequency communication among other areas during expressive language, with several potential theoretical and clinical applications that can be generalized to other cognitive domains. Conclusion: Our multilayer, data-driven framework captures nonlinear connections that span across scales that are often missed in conventional analyses. The present study suggests that crucial hubs may be conduits for interfrequency communication between action and perception systems that are crucial for typical functioning.
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Affiliation(s)
- Brady J Williamson
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Manlio De Domenico
- Fondazione Bruno Kessler, Center for Information and Communication Technology, Trento, Italy
| | - Darren S Kadis
- Neurosciences and Mental Health, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
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17
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Comparison of Language and Memory Lateralization by Functional MRI and Wada Test in Epilepsy. FRONTIERS IN NEUROLOGY AND NEUROSCIENCE RESEARCH 2021; 2:100009. [PMID: 34189523 PMCID: PMC8238456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The intracarotid sodium amobarbital procedure (ISAP or Wada test) lateralizes cerebral functions to the cerebral hemispheres preoperatively. Functional magnetic resonance imaging (fMRI) is increasingly used to characterize preoperative language and memory lateralization. In this study, concordance of fMRI with Wada was examined in patients with medically intractable seizures. The relationship of the distance between the epileptogenic focus to functional activation area with patients' post-operative deficits in language was also analyzed. 27 epilepsy patients with preoperative fMRI and Wada data were analyzed using established fMRI paradigms for language and memory. Activation of Broca's and Wernicke's areas were measured in three dimensions. Language and memory lateralization were determined, and standard neuropsychiatry Wada test procedures were used for comparison. The shortest distance between a language area to the border of surgical focus (LAD) was also measured and compared with postoperative language deficits. Our study found that concordance between fMRI and Wada testing was 0.41 (Kappa's 'fair to good' concordance) for language dominance and 0.1 (Kappa's 'poor' concordance) for memory. No significant correlation was found between LAD and post-op language deficit (p=0.439). A correlation was found between LAD and post-op memory deficit (p=0.049; the further distance from surgical lesion to language area is associated with less post-operative memory loss). Females demonstrated significantly increased postoperative seizure improvement (Fisher's p-value=0.0296; female=8; male=6). A significant association between handedness (right-handed subjects) and postoperative seizure improvement was found (p=0.02) as well as a significant trend for interaction of gender and handedness on postoperative seizure improvement (p=0.09). Overall, our results demonstrate fMRI as a useful preoperative adjunct to Wada testing for language lateralization in patients with medically intractable seizures.
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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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Zheng W, Minama Reddy GK, Dai F, Chandramani A, Brang D, Hunter S, Kohrman MH, Rose S, Rossi M, Tao J, Wu S, Byrne R, Frim DM, Warnke P, Towle VL. Chasing language through the brain: Successive parallel networks. Clin Neurophysiol 2020; 132:80-93. [PMID: 33360179 DOI: 10.1016/j.clinph.2020.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/06/2020] [Accepted: 10/11/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the spatio-temporal dynamics and interactions during linguistic and memory tasks. METHODS Event-related electrocorticographic (ECoG) spectral patterns obtained during cognitive tasks from 26 epilepsy patients (aged: 9-60 y) were analyzed in order to examine the spatio-temporal patterns of activation of cortical language areas. ECoGs (1024 Hz/channel) were recorded from 1567 subdural electrodes and 510 depth electrodes chronically implanted over or within the frontal, parietal, occipital and/or temporal lobes as part of their surgical work-up for intractable seizures. Six language/memory tasks were performed, which required responding verbally to auditory or visual word stimuli. Detailed analysis of electrode locations allowed combining results across patients. RESULTS Transient increases in induced ECoG gamma power (70-100 Hz) were observed in response to hearing words (central superior temporal gyrus), reading text and naming pictures (occipital and fusiform cortex) and speaking (pre-central, post-central and sub-central cortex). CONCLUSIONS Between these activations there was widespread spatial divergence followed by convergence of gamma activity that reliably identified cortical areas associated with task-specific processes. SIGNIFICANCE The combined dataset supports the concept of functionally-specific locally parallel language networks that are widely distributed, partially interacting in succession to serve the cognitive and behavioral demands of the tasks.
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Affiliation(s)
- Weili Zheng
- Department of Engineering, The University of Illinois, Chicago, IL, USA
| | | | - Falcon Dai
- Department of Neurology, The University of Chicago, Chicago, IL, USA
| | | | - David Brang
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Scott Hunter
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Michael H Kohrman
- Department of Pediatrics, The University of Chicago, Chicago, IL 60487, USA
| | - Sandra Rose
- Department of Neurology, The University of Chicago, Chicago, IL, USA
| | - Marvin Rossi
- Department of Neurology, Rush University, Chicago, IL, USA
| | - James Tao
- Department of Neurology, The University of Chicago, Chicago, IL, USA
| | - Shasha Wu
- Department of Neurology, The University of Chicago, Chicago, IL, USA
| | - Richard Byrne
- Department of Surgery, Rush University, Chicago, IL, USA
| | - David M Frim
- Department of Surgery, The University of Chicago, 5841 S. Maryland Ave, 60487 Chicago, IL, USA
| | - Peter Warnke
- Department of Surgery, The University of Chicago, 5841 S. Maryland Ave, 60487 Chicago, IL, USA
| | - Vernon L Towle
- Department of Neurology, The University of Chicago, Chicago, IL, USA.
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20
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Omisade A, O'Grady C, Sadler RM. Divergence between functional magnetic resonance imaging and clinical indicators of language dominance in preoperative language mapping. Hum Brain Mapp 2020; 41:3867-3877. [PMID: 32519808 PMCID: PMC7469800 DOI: 10.1002/hbm.25092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 03/31/2020] [Accepted: 05/24/2020] [Indexed: 11/06/2022] Open
Abstract
Accurate determination of hemispheric language dominance prior to epilepsy surgery is critically important to minimize cognitive morbidity. Functional MRI (fMRI) is a noninvasive method that is highly concordant with other clinical indicators of language laterality, and is now commonly used to confirm language dominance. However, there is also a high frequency of divergence between fMRI findings and other clinical indices that complicate determination of dominance and surgical decision-making in individual patients. Despite this, divergent cases are rarely published or discussed. This article provides three illustrative examples to demonstrate common scenarios where fMRI may produce conflicting or otherwise difficult-to-interpret findings. We will also discuss potential reasons for divergence and propose a flow-chart to aid clinical decision making in such situations.
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Affiliation(s)
- Antonina Omisade
- Acquired Brain Injury (Epilepsy Program), Nova Scotia Health Authority, Halifax, Canada.,Department of Psychology & Neuroscience, Dalhousie University, Halifax, Canada
| | - Christopher O'Grady
- Department of Research, Nova Scotia Health Authority, Halifax, Canada.,Biomedical Translational Imaging Centre, Halifax, Canada
| | - R Mark Sadler
- Department of Medicine, Division of Neurology, Dalhousie University, Halifax, Canada
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21
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Potigailo V, Kohli A, Pakpoor J, Cain DW, Passi N, Mohsen N. Recent Advances in Computed Tomography and MR Imaging. PET Clin 2020; 15:381-402. [PMID: 32888544 DOI: 10.1016/j.cpet.2020.07.001] [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: 11/29/2022]
Abstract
Numerous advanced MR imaging and computed tomographic techniques have been developed and implemented in clinical practice over the past several years resulting in increased diagnostic accuracy and improved patient care. In this article, the authors highlight recent and emerging imaging techniques in functional and structural MR imaging, perfusion and vascular imaging, standardization of imaging practices, and selected applications of artificial intelligence in clinical practice.
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Affiliation(s)
- Valeria Potigailo
- Department of Radiology, University of Colorado Anschutz Medical Center, 12401 East 17th Avenue, Leprino, Mail Stop L954, Aurora, CO 80045, USA
| | - Ajay Kohli
- Department of Radiology, University of Pennsylvania, Hospital of the University of Pennsylvania, 1 Silverstein Suite 130, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Jina Pakpoor
- Department of Radiology, University of Pennsylvania, Hospital of the University of Pennsylvania, 1 Silverstein Suite 130, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Donald Wesley Cain
- Department of Radiology, University of Colorado Anschutz Medical Center, 12401 East 17th Avenue, Leprino, Mail Stop L954, Aurora, CO 80045, USA
| | - Neena Passi
- University of Pennsylvania, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Nancy Mohsen
- Department of Radiology, University of Pennsylvania, Hospital of the University of Pennsylvania, 1 Silverstein Suite 130, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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22
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Jansma JM, Rutten GJ, Ramsey LE, Snijders TJ, Bizzi A, Rosengarth K, Dodoo-Schittko F, Hattingen E, de la Peña MJ, von Campe G, Jehna M, Ramsey NF. Automatic identification of atypical clinical fMRI results. Neuroradiology 2020; 62:1677-1688. [PMID: 32812070 PMCID: PMC7666675 DOI: 10.1007/s00234-020-02510-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/30/2020] [Indexed: 01/03/2023]
Abstract
Purpose Functional MRI is not routinely used for neurosurgical planning despite potential important advantages, due to difficulty of determining quality. We introduce a novel method for objective evaluation of fMRI scan quality, based on activation maps. A template matching analysis (TMA) is presented and tested on data from two clinical fMRI protocols, performed by healthy controls in seven clinical centers. Preliminary clinical utility is tested with data from low-grade glioma patients. Methods Data were collected from 42 healthy subjects from seven centers, with standardized finger tapping (FT) and verb generation (VG) tasks. Copies of these “typical” data were deliberately analyzed incorrectly to assess feasibility of identifying them as “atypical.” Analyses of the VG task administered to 32 tumor patients assessed sensitivity of the TMA method to anatomical abnormalities. Results TMA identified all atypical activity maps for both tasks, at the cost of incorrectly classifying 3.6 (VG)–6.5% (FT) of typical maps as atypical. For patients, the average TMA was significantly higher than atypical healthy scans, despite localized anatomical abnormalities caused by a tumor. Conclusion This study supports feasibility of TMA for objective identification of atypical activation patterns for motor and verb generation fMRI protocols. TMA can facilitate the use and evaluation of clinical fMRI in hospital settings that have limited access to fMRI experts. In a clinical setting, this method could be applied to automatically flag fMRI scans showing atypical activation patterns for further investigation to determine whether atypicality is caused by poor scan data quality or abnormal functional topography.
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Affiliation(s)
- J Martijn Jansma
- Brain Center, Department of Neurology & Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Geert-Jan Rutten
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Lenny E Ramsey
- Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - T J Snijders
- Brain Center, Department of Neurology & Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alberto Bizzi
- Neuroradiology Unit, Istituto Clinico Humanitas IRCCS, Rozzano, Milan, Italy
| | - Katharina Rosengarth
- Institute for Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - Frank Dodoo-Schittko
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Elke Hattingen
- Institute of Neuroradiology, Goethe University, Frankfurt, Germany
| | | | - Gord von Campe
- Department of Neurosurgery, Medical University of Graz, Graz, Austria
| | - Margit Jehna
- Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria
| | - Nick F Ramsey
- Brain Center, Department of Neurology & Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands. .,Braincarta BV, Utrecht, The Netherlands.
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23
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Heunis S, Lamerichs R, Zinger S, Caballero‐Gaudes C, Jansen JFA, Aldenkamp B, Breeuwer M. Quality and denoising in real-time functional magnetic resonance imaging neurofeedback: A methods review. Hum Brain Mapp 2020; 41:3439-3467. [PMID: 32333624 PMCID: PMC7375116 DOI: 10.1002/hbm.25010] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/13/2020] [Accepted: 04/03/2020] [Indexed: 01/31/2023] Open
Abstract
Neurofeedback training using real-time functional magnetic resonance imaging (rtfMRI-NF) allows subjects voluntary control of localised and distributed brain activity. It has sparked increased interest as a promising non-invasive treatment option in neuropsychiatric and neurocognitive disorders, although its efficacy and clinical significance are yet to be determined. In this work, we present the first extensive review of acquisition, processing and quality control methods available to improve the quality of the neurofeedback signal. Furthermore, we investigate the state of denoising and quality control practices in 128 recently published rtfMRI-NF studies. We found: (a) that less than a third of the studies reported implementing standard real-time fMRI denoising steps, (b) significant room for improvement with regards to methods reporting and (c) the need for methodological studies quantifying and comparing the contribution of denoising steps to the neurofeedback signal quality. Advances in rtfMRI-NF research depend on reproducibility of methods and results. Notably, a systematic effort is needed to build up evidence that disentangles the various mechanisms influencing neurofeedback effects. To this end, we recommend that future rtfMRI-NF studies: (a) report implementation of a set of standard real-time fMRI denoising steps according to a proposed COBIDAS-style checklist (https://osf.io/kjwhf/), (b) ensure the quality of the neurofeedback signal by calculating and reporting community-informed quality metrics and applying offline control checks and (c) strive to adopt transparent principles in the form of methods and data sharing and support of open-source rtfMRI-NF software. Code and data for reproducibility, as well as an interactive environment to explore the study data, can be accessed at https://github.com/jsheunis/quality-and-denoising-in-rtfmri-nf.
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Affiliation(s)
- Stephan Heunis
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Department of Research and DevelopmentEpilepsy Centre KempenhaegheHeezeThe Netherlands
| | - Rolf Lamerichs
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Department of Research and DevelopmentEpilepsy Centre KempenhaegheHeezeThe Netherlands
- Philips ResearchEindhovenThe Netherlands
| | - Svitlana Zinger
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Department of Research and DevelopmentEpilepsy Centre KempenhaegheHeezeThe Netherlands
| | | | - Jacobus F. A. Jansen
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Department of RadiologyMaastricht University Medical CentreMaastrichtThe Netherlands
- School for Mental Health and NeuroscienceMaastrichtThe Netherlands
| | - Bert Aldenkamp
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Department of Research and DevelopmentEpilepsy Centre KempenhaegheHeezeThe Netherlands
- School for Mental Health and NeuroscienceMaastrichtThe Netherlands
- Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and NeuropsychologyGhent University HospitalGhentBelgium
- Department of NeurologyMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Marcel Breeuwer
- Department of Biomedical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Philips HealthcareBestThe Netherlands
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Yazbek S, Smayra T, Mallak I, Hage S, Sleilaty G, Atat C, Abdel Hay J, Moussa R. Functional MRI study of language organization in left-handed and right-handed trilingual subjects. Sci Rep 2020; 10:13165. [PMID: 32759954 PMCID: PMC7406510 DOI: 10.1038/s41598-020-70167-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/24/2020] [Indexed: 11/16/2022] Open
Abstract
Functional MRI (fMRI) is gaining importance in the preoperative assessment of language. Selecting the appropriate language to test by fMRI in trilingual patients is intricate. Our objective is to compare fMRI maps for all three languages in left- and right-handed trilingual subjects. 15 right- and 15 left-handed trilingual volunteers were included in the study. We performed fMRI for each volunteer with a visual responsive naming paradigm that was repeated three times, once in each language. The activated areas and the laterality indices were calculated and correlation with the age of acquisition and proficiency of each language was determined. Strong statistical correlation was found between the Laterality Index (LI) of the three languages, in both the right and left-handed groups. Discordant lateralization of language was only observed in four left-handed subjects who demonstrated bilateral and left-lateralization. In right-handed subjects, the activation maps for the first and the second acquired language were similar. The largest activation was seen with the last acquired language. Irrespective of language proficiency and age of acquisition, the language lateralization might change for left-handed subjects. In right-handed subjects, there is no change and the last acquired language results in the largest activation. fMRI performed for a single language can accurately determine language lateralization in right-handed subjects, whereas in left-handed subjects, it is mandatory to test all languages.
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Affiliation(s)
- Sandrine Yazbek
- Hotel Dieu de France Hospital, Boulevard Alfred Naccache, Achrafieh, PO Box: 166830, Beirut, Lebanon.
| | - Tarek Smayra
- Hotel Dieu de France Hospital, Boulevard Alfred Naccache, Achrafieh, PO Box: 166830, Beirut, Lebanon
| | - Iyad Mallak
- Hotel Dieu de France Hospital, Boulevard Alfred Naccache, Achrafieh, PO Box: 166830, Beirut, Lebanon
| | - Stephanie Hage
- Hotel Dieu de France Hospital, Boulevard Alfred Naccache, Achrafieh, PO Box: 166830, Beirut, Lebanon
| | - Ghassan Sleilaty
- Hotel Dieu de France Hospital, Boulevard Alfred Naccache, Achrafieh, PO Box: 166830, Beirut, Lebanon
| | - Chirine Atat
- Hotel Dieu de France Hospital, Boulevard Alfred Naccache, Achrafieh, PO Box: 166830, Beirut, Lebanon
| | - Joe Abdel Hay
- Hotel Dieu de France Hospital, Boulevard Alfred Naccache, Achrafieh, PO Box: 166830, Beirut, Lebanon
| | - Ronald Moussa
- Hotel Dieu de France Hospital, Boulevard Alfred Naccache, Achrafieh, PO Box: 166830, Beirut, Lebanon
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Chen WL, Wagner J, Heugel N, Sugar J, Lee YW, Conant L, Malloy M, Heffernan J, Quirk B, Zinos A, Beardsley SA, Prost R, Whelan HT. Functional Near-Infrared Spectroscopy and Its Clinical Application in the Field of Neuroscience: Advances and Future Directions. Front Neurosci 2020; 14:724. [PMID: 32742257 PMCID: PMC7364176 DOI: 10.3389/fnins.2020.00724] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/17/2020] [Indexed: 01/20/2023] Open
Abstract
Similar to functional magnetic resonance imaging (fMRI), functional near-infrared spectroscopy (fNIRS) detects the changes of hemoglobin species inside the brain, but via differences in optical absorption. Within the near-infrared spectrum, light can penetrate biological tissues and be absorbed by chromophores, such as oxyhemoglobin and deoxyhemoglobin. What makes fNIRS more advantageous is its portability and potential for long-term monitoring. This paper reviews the basic mechanisms of fNIRS and its current clinical applications, the limitations toward more widespread clinical usage of fNIRS, and current efforts to improve the temporal and spatial resolution of fNIRS toward robust clinical usage within subjects. Oligochannel fNIRS is adequate for estimating global cerebral function and it has become an important tool in the critical care setting for evaluating cerebral oxygenation and autoregulation in patients with stroke and traumatic brain injury. When it comes to a more sophisticated utilization, spatial and temporal resolution becomes critical. Multichannel NIRS has improved the spatial resolution of fNIRS for brain mapping in certain task modalities, such as language mapping. However, averaging and group analysis are currently required, limiting its clinical use for monitoring and real-time event detection in individual subjects. Advances in signal processing have moved fNIRS toward individual clinical use for detecting certain types of seizures, assessing autonomic function and cortical spreading depression. However, its lack of accuracy and precision has been the major obstacle toward more sophisticated clinical use of fNIRS. The use of high-density whole head optode arrays, precise sensor locations relative to the head, anatomical co-registration, short-distance channels, and multi-dimensional signal processing can be combined to improve the sensitivity of fNIRS and increase its use as a wide-spread clinical tool for the robust assessment of brain function.
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Affiliation(s)
- Wei-Liang Chen
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States.,Department of Neurology, Children's Hospital of Wisconsin, Milwaukee, WI, United States.,School of Medicine, University of Washington, Seattle, WA, United States
| | - Julie Wagner
- Department of Biochemical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, United States
| | - Nicholas Heugel
- Department of Biochemical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jeffrey Sugar
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Yu-Wen Lee
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States.,Department of Neurology, Children's Hospital of Wisconsin, Milwaukee, WI, United States
| | - Lisa Conant
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Marsha Malloy
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States.,Department of Neurology, Children's Hospital of Wisconsin, Milwaukee, WI, United States
| | - Joseph Heffernan
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Brendan Quirk
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Anthony Zinos
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States.,Department of Biochemical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, United States
| | - Scott A Beardsley
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States.,Department of Biochemical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, United States
| | - Robert Prost
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Harry T Whelan
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States.,Department of Neurology, Children's Hospital of Wisconsin, Milwaukee, WI, United States
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Schiller K, Choudhri AF, Jones T, Holder C, Wheless JW, Narayana S. Concordance Between Transcranial Magnetic Stimulation and Functional Magnetic Resonance Imaging (MRI) Derived Localization of Language in a Clinical Cohort. J Child Neurol 2020; 35:363-379. [PMID: 32122221 DOI: 10.1177/0883073820901415] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transcranial magnetic stimulation (TMS) is a newer noninvasive language mapping tool that is safe and well-tolerated by children. We examined the accuracy of TMS-derived language maps in a clinical cohort by comparing it against functional magnetic resonance imaging (MRI)-derived language map. The number of TMS-induced speech disruptions and the volume of activation during functional MRI tasks were localized to Brodmann areas for each modality in 40 patients with epilepsy or brain tumor. We examined the concordance between TMS- and functional MRI-derived language maps by deriving statistical performance metrics for TMS including sensitivity, specificity, accuracy, and diagnostic odds ratio. Brodmann areas 6, 44, and 9 in the frontal lobe and 22 and 40 in the temporal lobe were the most commonly identified language areas by both modalities. Overall accuracy of TMS compared to functional MRI in localizing language cortex was 71%, with a diagnostic odds ratio of 1.27 and higher sensitivity when identifying left hemisphere regions. TMS was more accurate in determining the dominant hemisphere for language with a diagnostic odds ratio of 6. This study is the first to examine the accuracy of the whole brain language map derived by TMS in the largest cohort examined to date. While this comparison against functional MRI confirmed that TMS reliably localizes cortical areas that are not essential for speech function, it demonstrated only slight concordance between TMS- and functional MRI-derived language areas. That the localization of specific language cortices by TMS demonstrated low accuracy reveals a potential need to use concordant tasks between the modalities and other avenues for further optimization of TMS parameters.
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Affiliation(s)
- Katherine Schiller
- Department of Pediatrics, Division of Pediatric Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Asim F Choudhri
- Le Bonheur Children's Hospital, Le Bonheur Neuroscience Institute, Memphis, TN, USA.,Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Tamekia Jones
- Department of Pediatrics, Division of Pediatric Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Christen Holder
- Department of Pediatrics, Division of Pediatric Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.,Le Bonheur Children's Hospital, Le Bonheur Neuroscience Institute, Memphis, TN, USA
| | - James W Wheless
- Department of Pediatrics, Division of Pediatric Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.,Le Bonheur Children's Hospital, Le Bonheur Neuroscience Institute, Memphis, TN, USA
| | - Shalini Narayana
- Department of Pediatrics, Division of Pediatric Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.,Le Bonheur Children's Hospital, Le Bonheur Neuroscience Institute, Memphis, TN, USA.,Department of Neurobiology and Anatomy, University of Tennessee Health Science Center, Memphis, TN, USA
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27
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Omisade A, O'Grady C, Sadler RM, Ikeda K. Functional MRI for language lateralization in individuals with intellectual and cognitive dysfunction: Two clinical case examples. Clin Neuropsychol 2020; 35:1471-1484. [PMID: 32167409 DOI: 10.1080/13854046.2020.1736163] [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: 10/24/2022]
Abstract
OBJECTIVE Task-based functional MRI (fMRI) is a common non-invasive method of confirming hemispheric language dominance prior to neurosurgery in epilepsy. However, the use of this method is not recommended for individuals with cognitive dysfunction and in those with IQ below 70 due to concerns about accuracy of task performance in the scanner. This manuscript describes successful use of task-based functional MRI to lateralize language dominance in two individuals with cognitive dysfunction and intellectual disability. METHODS Two patients completed a pre-surgical epilepsy work-up at the QEII Health Sciences Centre in Halifax, Nova Scotia, which included comprehensive neuropsychological assessment. They also completed an fMRI paradigm that involved semantic category fluency, sentence completion, naming to description and passage listening tasks with stimuli delivered both visually and auditorily. RESULTS In both cases, fMRI maps were successful in lateralizing language dominance in relation to other clinical data, including intraoperative cortical mapping in one of the cases. CONCLUSIONS This manuscript is the first to demonstrate that task-based fMRI can be used successfully to lateralize language in adult patients with cognitive and intellectual disabilities, and is the first to propose a specific paradigm for this purpose.
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Affiliation(s)
- A Omisade
- Acquired Brain Injury (Epilepsy Program), Nova Scotia Health Authority, Halifax, Canada.,Department of Psychology & Neuroscience, Dalhousie University, Halifax, Canada
| | - C O'Grady
- Department of Medicine, Nova Scotia Health Authority, Halifax, Canada
| | - R M Sadler
- Department of Medicine, Division of Neurology, Dalhousie University, Halifax, Canada
| | - K Ikeda
- Department of Medicine, Division of Neurology, Dalhousie University, Halifax, Canada
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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: 13] [Impact Index Per Article: 2.6] [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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30
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Bauman K, Devinsky O, Liu AA. Temporal lobe surgery and memory: Lessons, risks, and opportunities. Epilepsy Behav 2019; 101:106596. [PMID: 31711868 PMCID: PMC6885125 DOI: 10.1016/j.yebeh.2019.106596] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/04/2019] [Accepted: 10/04/2019] [Indexed: 11/19/2022]
Abstract
Careful study of the clinical outcomes of temporal lobe epilepsy (TLE) surgery has greatly advanced our knowledge of the neuroanatomy of human memory. After early cases resulted in profound amnesia, the critical role of the hippocampus and associated medial temporal lobe (MTL) structures to declarative memory became evident. Surgical approaches quickly changed to become unilateral and later, to be more precise, potentially reducing cognitive morbidity. Neuropsychological studies following unilateral temporal lobe resection (TLR) have challenged early models, which simplified the lateralization of verbal and visual memory function. Diagnostic tests, including intracarotid sodium amobarbital procedure (WADA), structural magnetic resonance imaging (MRI), and functional neuroimaging (functional MRI (fMRI), positron emission tomography (PET), and single-photon emission computed tomography (SPECT)), can more accurately lateralize and localize epileptogenic cortex and predict memory outcomes from surgery. Longitudinal studies have shown that memory may even improve in seizure-free patients. From 70 years of experience with epilepsy surgery, we now have a richer understanding of the clinical, neuroimaging, and surgical predictors of memory decline-and improvement-after TLR. "Special Issue: Epilepsy & Behavior's 20th Anniversary".
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Affiliation(s)
- Kristie Bauman
- NYU Langone Health, Department of Neurology, 222 East 41st Street 9th Floor, New York, NY 10017, United States of America
| | - Orrin Devinsky
- NYU Langone Health, Department of Neurology, 222 East 41st Street 9th Floor, New York, NY 10017, United States of America; NYU Comprehensive Epilepsy Center, 223 East 34th Street, New York, NY 10016, United States of America
| | - Anli A Liu
- NYU Langone Health, Department of Neurology, 222 East 41st Street 9th Floor, New York, NY 10017, United States of America; NYU Comprehensive Epilepsy Center, 223 East 34th Street, New York, NY 10016, United States of America.
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Role of Functional Imaging Techniques to Assess Motor and Language Cortical Plasticity in Glioma Patients: A Systematic Review. Neural Plast 2019; 2019:4056436. [PMID: 31814822 PMCID: PMC6878806 DOI: 10.1155/2019/4056436] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/05/2019] [Indexed: 01/19/2023] Open
Abstract
Cerebral plasticity is the ability of the central nervous system to reorganize itself in response to different injuries. The reshaping of functional areas is a crucial mechanism to compensate for damaged function. It is acknowledged that functional remodeling of cortical areas may occur also in glioma patients. Principal limits of previous investigations on cortical plasticity of motor and language functions included scarce reports of longitudinal evaluations and limited sample sizes. This systematic review is aimed at elucidating cortical brain plasticity for motor and language functions, in adult glioma patients, by means of preoperative and intraoperative mapping techniques. We systematically reviewed the literature for prospective studies, assessing cortical plasticity of motor and language functions in low-grade and high-grade gliomas. Eight longitudinal studies investigated cortical plasticity, evaluated by motor and language task-based functional MRI (fMRI), motor navigated transcranial magnetic stimulation (n-TMS), and intraoperative mapping with cortical direct electrocortical stimulation (DES) of language and motor function. Motor function reorganization appeared relatively limited and mostly characterized by intrahemispheric functional changes, including secondary motor cortices. On the other hand, a high level of functional reshaping was found for language function in DES studies. Occurrence of cortical functional reorganization of language function was described focusing on the intrahemispheric recruitment of perilesional areas. However, the association between these functional patterns and recovery of motor and language deficits still remains partially clear. A number of relevant methodological issues possibly affecting the finding generalization emerged, such as the complexity of plasticity outcome measures and the lack of large longitudinal studies. Future studies are required to further confirm these evidences on cortical plasticity in larger samples, combining both functional imaging and intraoperative mapping techniques in longitudinally evaluations.
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Kundu B, Rolston JD, Grandhi R. Mapping language dominance through the lens of the Wada test. Neurosurg Focus 2019; 47:E5. [PMID: 31473678 DOI: 10.3171/2019.6.focus19346] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/14/2019] [Indexed: 11/06/2022]
Abstract
The sodium amytal test, or Wada test, named after Juhn Wada, has remained a pillar of presurgical planning and is used to identify the laterality of the dominant language and memory areas in the brain. What is perhaps less well known is that the original intent of the test was to abort seizure activity from an affected hemisphere and also to protect that hemisphere from the effects of electroconvulsive treatment. Some 80 years after Paul Broca described the frontal operculum as an essential area of expressive language and well before the age of MRI, Wada used the test to determine language dominance. The test was later adopted to study hemispheric memory dominance but was met with less consistent success because of the vascular anatomy of the mesial temporal structures. With the advent of functional MRI, the use of the Wada test has narrowed to application in select patients. The concept of selectively inhibiting part of the brain to determine its function, however, remains crucial to understanding brain function. In this review, the authors discuss the rise and fall of the Wada test, an important historical example of the innovation of clinicians in neuroscience.
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Bailey LM, McMillan LE, Newman AJ. A sinister subject: Quantifying handedness-based recruitment biases in current neuroimaging research. Eur J Neurosci 2019; 51:1642-1656. [PMID: 31408571 DOI: 10.1111/ejn.14542] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/20/2019] [Accepted: 08/05/2019] [Indexed: 12/27/2022]
Abstract
Approximately ten per cent of humans are left-handed or ambidextrous (adextral). It has been suggested that, despite their sizable representation at the whole-population level, this demographic is largely avoided by researchers within the neuroimaging community. To date, however, no formal effort has been made to quantify the extent to which adextrals are excluded from neuroimaging-based research. Here, we aimed to address this question in a review of over 1,000 recent articles published in high-impact, peer-reviewed, neuroimaging-focused journals. Specifically, we sought to ascertain whether, and the extent to which adextrals are underrepresented in neuroimaging study samples, and to delineate potential trends in this bias. Handedness data were available for over 30,000 research subjects; only around 3%-4% of these individuals were adextral-considerably less than the 10% benchmark one would expect if neuroimaging samples were truly representative of the general population. This observation was generally consistent across different areas of research, but was modulated by the demographic characteristics of neuroimaging participants. The epistemological and ethical implications of these findings are discussed.
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Affiliation(s)
- Lyam M Bailey
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Laura E McMillan
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Aaron J Newman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
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Agarwal S, Sair HI, Gujar S, Pillai JJ. Language Mapping With fMRI: Current Standards and Reproducibility. Top Magn Reson Imaging 2019; 28:225-233. [PMID: 31385902 DOI: 10.1097/rmr.0000000000000216] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Clinical use of blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) is a relatively new phenomenon, with only about 3 decades of collective experience. Nevertheless, task-based BOLD fMRI has been widely accepted for presurgical planning, over traditional methods, which are invasive and at times perilous. Many studies have demonstrated the ability of BOLD fMRI to make substantial clinical impact with respect to surgical planning and preoperative risk assessment, especially to localize the eloquent motor and visual areas. Reproducibility and repeatability of language fMRI are important in the assessment of its clinical usefulness. There are national efforts currently underway to standardize language fMRI. The American Society of Functional Neuroradiology (ASFNR) has recently provided guidelines on fMRI paradigm algorithms for presurgical language assessment for language lateralization and localization. In this review article, we provide a comprehensive overview of current standards of language fMRI mapping and its reproducibility.
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Affiliation(s)
- Shruti Agarwal
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Haris I Sair
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sachin Gujar
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jay J Pillai
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Catapano JS, Whiting AC, Wang DJ, Hlubek RJ, Labib MA, Morgan CD, Brigeman S, Fredrickson VL, Cavalcanti DD, Smith KA, Ducruet AF, Albuquerque FC. Selective posterior cerebral artery amobarbital test: a predictor of memory following subtemporal selective amygdalohippocampectomy. J Neurointerv Surg 2019; 12:165-169. [PMID: 31320550 DOI: 10.1136/neurintsurg-2019-014984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/10/2019] [Accepted: 06/24/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND The selective posterior cerebral artery (PCA) amobarbital test, or PCA Wada test, is used to predict memory impairment after epilepsy surgery in patients who have previously had a failed internal carotid artery (ICA) amobarbital test. METHODS Medical records from 2012 to 2018 were retrospectively reviewed for all patients with seizures who underwent a selective PCA Wada test at our institution following a failed or inconclusive ICA Wada test. Standardized neuropsychological testing was performed before and during the Wada procedure and postoperatively in patients who underwent resection. RESULTS Thirty-three patients underwent a selective PCA Wada test, with no complications. Twenty-six patients with medically refractory epilepsy had a seizure focus amenable to selective amygdalohippocampectomy (AHE). Six patients (23%, n=26) had a failed PCA Wada test and did not undergo selective AHE, seven (27%) declined surgical resection, leaving 13 patients who underwent subtemporal selective AHE. Hippocampal sclerosis was found in all 13 patients (100%). Twelve patients (92%) subsequently underwent formal neuropsychological testing and all were found to have stable memory. Ten patients (77%) were seizure-free (Engel Class I), with average follow-up of 13 months. CONCLUSION The selective PCA Wada test is predictive of memory outcomes after subtemporal selective AHE in patients with a failed or inconclusive ICA Wada test. Furthermore, given the low risk of complications and potential benefit of seizure freedom, a selective PCA Wada test may be warranted in patients with medically intractable epilepsy who are candidates for a selective AHE and who have a prior failed or inconclusive ICA Wada test.
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Affiliation(s)
- Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Alexander C Whiting
- Department of Neurosurgery, Barrow Neurological Institute St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Derrick J Wang
- Department of Neurosurgery, Barrow Neurological Institute St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Randall J Hlubek
- Department of Neurosurgery, Barrow Neurological Institute St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Mohamed A Labib
- Department of Neurosurgery, Barrow Neurological Institute St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Clinton D Morgan
- Department of Neurosurgery, Barrow Neurological Institute St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Scott Brigeman
- Department of Neurosurgery, Barrow Neurological Institute St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Vance L Fredrickson
- Department of Neurosurgery, Barrow Neurological Institute St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Daniel D Cavalcanti
- Department of Neurosurgery, Barrow Neurological Institute St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kris A Smith
- Department of Neurosurgery, Barrow Neurological Institute St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Wegrzyn M, Mertens M, Bien CG, Woermann FG, Labudda K. Quantifying the Confidence in fMRI-Based Language Lateralisation Through Laterality Index Deconstruction. Front Neurol 2019; 10:655. [PMID: 31275236 PMCID: PMC6594217 DOI: 10.3389/fneur.2019.00655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/04/2019] [Indexed: 11/13/2022] Open
Abstract
In epilepsy patients, language lateralisation is an important part of the presurgical diagnostic process. Using task-based fMRI, language lateralisation can be determined by visual inspection of activity patterns or by quantifying the difference in left- and right-hemisphere activity using variations of a basic formula [(L-R)/(L+R)]. However, the values of this laterality index (LI) depend on the choice of activity thresholds and regions of interest. The diagnostic utility of the LI also depends on how its continuous values are translated into categorical decisions about a patient's language lateralisation. Here, we analysed fMRI data from 712 epilepsy patients who performed a verbal fluency task. Each fMRI data set was evaluated by a trained human rater as depicting left-sided, right-sided, or bilateral lateralisation or as being inconclusive. We used data-driven methods to define the activity thresholds and regions of interest used for LI computation and to define a classification scheme that allowed us to translate the LI values into categorical decisions. By deconstructing the LI into measures of laterality (L-R) and strength (L+R), we also modelled the relationship between activation strength and conclusiveness of a data set. In a held-out data set, predictions reached 91% correct when using only conclusive data and 82% when inconclusive data were included. Although only trained on human evaluations of fMRIs, the approach generalised to the prediction of language Wada test results, allowing for significant above-chance accuracies. Compared against different existing methods of LI-computation, our approach improved the identification and exclusion of inconclusive cases and ensured that decisions for the remaining data could be made with consistently high accuracies. We discuss how this approach can support clinicians in assessing fMRI data on a single-case level, deciding whether lateralisation can be determined with sufficient certainty or whether additional information is needed.
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Affiliation(s)
- Martin Wegrzyn
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Markus Mertens
- Bethel Epilepsy Center, Mara Hospital, Bielefeld, Germany
| | | | | | - Kirsten Labudda
- Department of Psychology, Bielefeld University, Bielefeld, Germany
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Hill VB, Cankurtaran CZ, Liu BP, Hijaz TA, Naidich M, Nemeth AJ, Gastala J, Krumpelman C, McComb EN, Korutz AW. A Practical Review of Functional MRI Anatomy of the Language and Motor Systems. AJNR Am J Neuroradiol 2019; 40:1084-1090. [PMID: 31196862 DOI: 10.3174/ajnr.a6089] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/24/2019] [Indexed: 11/07/2022]
Abstract
Functional MR imaging is being performed with increasing frequency in the typical neuroradiology practice; however, many readers of these studies have only a limited knowledge of the functional anatomy of the brain. This text will delineate the locations, anatomic boundaries, and functions of the cortical regions of the brain most commonly encountered in clinical practice-specifically, the regions involved in movement and language.
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Affiliation(s)
- V B Hill
- From the Departments of Radiology (V.B.H., C.Z.C., B.P.L., T.A.H., M.N., A.J.N., J.G., C.K., E.N.M., A.W.K.)
| | - C Z Cankurtaran
- From the Departments of Radiology (V.B.H., C.Z.C., B.P.L., T.A.H., M.N., A.J.N., J.G., C.K., E.N.M., A.W.K.)
| | - B P Liu
- From the Departments of Radiology (V.B.H., C.Z.C., B.P.L., T.A.H., M.N., A.J.N., J.G., C.K., E.N.M., A.W.K.).,Radiation Oncology (B.P.L.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - T A Hijaz
- From the Departments of Radiology (V.B.H., C.Z.C., B.P.L., T.A.H., M.N., A.J.N., J.G., C.K., E.N.M., A.W.K.)
| | - M Naidich
- From the Departments of Radiology (V.B.H., C.Z.C., B.P.L., T.A.H., M.N., A.J.N., J.G., C.K., E.N.M., A.W.K.)
| | - A J Nemeth
- From the Departments of Radiology (V.B.H., C.Z.C., B.P.L., T.A.H., M.N., A.J.N., J.G., C.K., E.N.M., A.W.K.).,Neurology (A.J.N.)
| | - J Gastala
- From the Departments of Radiology (V.B.H., C.Z.C., B.P.L., T.A.H., M.N., A.J.N., J.G., C.K., E.N.M., A.W.K.)
| | - C Krumpelman
- From the Departments of Radiology (V.B.H., C.Z.C., B.P.L., T.A.H., M.N., A.J.N., J.G., C.K., E.N.M., A.W.K.)
| | - E N McComb
- From the Departments of Radiology (V.B.H., C.Z.C., B.P.L., T.A.H., M.N., A.J.N., J.G., C.K., E.N.M., A.W.K.)
| | - A W Korutz
- From the Departments of Radiology (V.B.H., C.Z.C., B.P.L., T.A.H., M.N., A.J.N., J.G., C.K., E.N.M., A.W.K.)
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Balter S, Lin G, Leyden KM, Paul BM, McDonald CR. Neuroimaging correlates of language network impairment and reorganization in temporal lobe epilepsy. BRAIN AND LANGUAGE 2019; 193:31-44. [PMID: 27393391 PMCID: PMC5215985 DOI: 10.1016/j.bandl.2016.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/27/2016] [Accepted: 06/15/2016] [Indexed: 06/02/2023]
Abstract
Advanced, noninvasive imaging has revolutionized our understanding of language networks in the brain and is reshaping our approach to the presurgical evaluation of patients with epilepsy. Functional magnetic resonance imaging (fMRI) has had the greatest impact, unveiling the complexity of language organization and reorganization in patients with epilepsy both pre- and postoperatively, while volumetric MRI and diffusion tensor imaging have led to a greater appreciation of structural and microstructural correlates of language dysfunction in different epilepsy syndromes. In this article, we review recent literature describing how unimodal and multimodal imaging has advanced our knowledge of language networks and their plasticity in epilepsy, with a focus on the most frequently studied epilepsy syndrome in adults, temporal lobe epilepsy (TLE). We also describe how new analytic techniques (i.e., graph theory) are leading to a refined characterization of abnormal brain connectivity, and how subject-specific imaging profiles combined with clinical data may enhance the prediction of both seizure and language outcomes following surgical interventions.
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Affiliation(s)
- S Balter
- Department of Neurology, University of California, San Francisco, CA, United States; UCSF Comprehensive Epilepsy Center, United States
| | - G Lin
- Palo Alto University, Palo Alto, CA, United States
| | - K M Leyden
- Multimodal Imaging Laboratory, University of California, San Diego, CA, United States
| | - B M Paul
- Department of Neurology, University of California, San Francisco, CA, United States; UCSF Comprehensive Epilepsy Center, United States
| | - C R McDonald
- Multimodal Imaging Laboratory, University of California, San Diego, CA, United States; Department of Psychiatry, University of California, San Diego, CA, United States.
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Smitha KA, Arun KM, Rajesh PG, Thomas B, Radhakrishnan A, Sarma PS, Kesavadas C. Resting fMRI as an alternative for task-based fMRI for language lateralization in temporal lobe epilepsy patients: a study using independent component analysis. Neuroradiology 2019; 61:803-810. [PMID: 31020344 DOI: 10.1007/s00234-019-02209-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/02/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Our aim is to investigate whether rs-fMRI can be used as an effective technique to study language lateralization. We aim to find out the most appropriate language network among different networks identified using ICA. METHODS Fifteen healthy right-handed subjects, sixteen left, and sixteen right temporal lobe epilepsy patients prospectively underwent MR scanning in 3T MRI (GE Discovery™ MR750w), using optimized imaging protocol. We obtained task-fMRI data using a visual-verb generation paradigm. Rs-fMRI and language-fMRI analysis were conducted using FSL software. Independent component analysis (ICA) was used to estimate rs-fMRI networks. Dice coefficient was calculated to examine the similarity in activated voxels of a common language template and the rs-fMRI language networks. Laterality index (LI) was calculated from the task-based language activation and rs-fMRI language network, for a range of LI thresholds at different z scores. RESULTS Measurement of hemispheric language dominance with rs-fMRI was highly concordant with task-fMRI results. Among the evaluated z scores for a range of LI thresholds, rs-fMRI yielded a maximum accuracy of 95%, a sensitivity of 83%, and specificity of 92.8% for z = 2 at 0.05 LI threshold. CONCLUSION The present study suggests that rs-fMRI networks obtained using ICA technique can be used as an alternative for task-fMRI language laterality. The novel aspect of the work is suggestive of optimal thresholds while applying rs-fMRI, is an important endeavor given that many patients with epilepsy have co-morbid cognitive deficits. Thus, an accurate method to determine language laterality without requiring a patient to complete the language task would be advantageous.
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Affiliation(s)
- K A Smitha
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - K M Arun
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - P G Rajesh
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Bejoy Thomas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Ashalatha Radhakrishnan
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - P Sankara Sarma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, 695011, India
| | - C Kesavadas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India.
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Visual and Auditory fMRI Paradigms for Presurgical Language Mapping: Convergent Validity and Relationship to Individual Variables. Neurol Res Int 2019; 2019:6728120. [PMID: 31057966 PMCID: PMC6463566 DOI: 10.1155/2019/6728120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/13/2019] [Indexed: 11/18/2022] Open
Abstract
Functional MRI (fMRI) has emerged as a safe alternative to invasive procedures for determining hemispheric language dominance prior to neurosurgery. Despite this, there are currently no standardized fMRI protocols that have been explored in healthy controls to determine the influence of individual patient variables on the results, which poses challenges in clinical interpretation of ambiguous findings in patient populations. In addition, most fMRI protocols are not suitable for individuals with visual or intellectual disabilities (IQ<70). In the current study, 61 healthy adults (ages: 18-74 years) completed two fMRI paradigms for language mapping. One paradigm used visually based stimuli and has shown good face validity to date in our center. The second paradigm used auditory stimuli presented at slowed speed and was designed for individuals with visual or cognitive dysfunction but has not yet been used clinically. The paradigms demonstrated 97% agreement in classifying individuals as left-hemisphere, right-hemisphere, and bilaterally dominant. Cases that were classified differently showed bilateral dominance in response to either paradigm. Dominance classification rates for right- and left-handed individuals were largely in keeping with published data. Within the left-handed group, IQ and education were positively correlated with laterality indices generated by both paradigms (r values range: 0.44-0.95, p<0.01), suggesting that individuals with higher IQ and formal education were more likely to be classified as left-hemisphere dominant in the current sample. This study will help improve clinical interpretation of language fMRI maps by identifying factors that might impact results (like IQ). It also offers an alternative paradigm to make this procedure more accessible to a broader range of patients. Future studies will replicate results with a sample of patients with epilepsy across a broad range of intellectual abilities.
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Li M, Wang D, Ren J, Langs G, Stoecklein S, Brennan BP, Lu J, Chen H, Liu H. Performing group-level functional image analyses based on homologous functional regions mapped in individuals. PLoS Biol 2019; 17:e2007032. [PMID: 30908490 PMCID: PMC6448916 DOI: 10.1371/journal.pbio.2007032] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 04/04/2019] [Accepted: 03/05/2019] [Indexed: 12/13/2022] Open
Abstract
Functional MRI (fMRI) studies have traditionally relied on intersubject normalization based on global brain morphology, which cannot establish proper functional correspondence between subjects due to substantial intersubject variability in functional organization. Here, we reliably identified a set of discrete, homologous functional regions in individuals to improve intersubject alignment of fMRI data. These functional regions demonstrated marked intersubject variability in size, position, and connectivity. We found that previously reported intersubject variability in functional connectivity maps could be partially explained by variability in size and position of the functional regions. Importantly, individual differences in network topography are associated with individual differences in task-evoked activations, suggesting that these individually specified regions may serve as the "localizer" to improve the alignment of task-fMRI data. We demonstrated that aligning task-fMRI data using the regions derived from resting state fMRI may lead to increased statistical power of task-fMRI analyses. In addition, resting state functional connectivity among these homologous regions is able to capture the idiosyncrasies of subjects and better predict fluid intelligence (gF) than connectivity measures derived from group-level brain atlases. Critically, we showed that not only the connectivity but also the size and position of functional regions are related to human behavior. Collectively, these findings suggest that identifying homologous functional regions across individuals can benefit a wide range of studies in the investigation of connectivity, task activation, and brain-behavior associations.
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Affiliation(s)
- Meiling Li
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, United States of America
| | - Danhong Wang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, United States of America
| | - Jianxun Ren
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, United States of America
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Georg Langs
- Department of Biomedical Imaging and Image-guided Therapy, Computational Imaging Research Lab, Medical University of Vienna, Vienna, Austria
| | - Sophia Stoecklein
- Institute of Clinical Radiology, Ludwig-Maximilians University of Munich, Munich Germany
| | - Brian P. Brennan
- McLean Hospital, Harvard Medical School, Belmont, Massachusetts, United States of America
| | - Jie Lu
- Department of Radiology, Xuanwu Hospital, Beijing, China
| | - Huafu Chen
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Hesheng Liu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, United States of America
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
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Rolinski R, Austermuehle A, Wiggs E, Agrawal S, Sepeta L, Gaillard WD, Zaghloul K, Inati SK, Theodore WH. Functional MRI and direct cortical stimulation: Prediction of postoperative language decline. Epilepsia 2019; 60:560-570. [PMID: 30740700 PMCID: PMC6467056 DOI: 10.1111/epi.14666] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/16/2019] [Accepted: 01/16/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the ability of functional MRI (fMRI) to predict postoperative language decline compared to direct cortical stimulation (DCS) in epilepsy surgery patients. METHODS In this prospective case series, 17 patients with drug-resistant epilepsy had intracranial monitoring and resection from 2012 to 2016 with 1-year follow-up. All patients completed preoperative language fMRI, mapping with DCS of subdural electrodes, pre- and postoperative neuropsychological testing for language function, and resection. Changes in language function before and after surgery were assessed. fMRI activation and DCS electrodes in the resection were evaluated as potential predictors of language decline. RESULTS Four of 17 patients (12 female; median [range] age, 43 [23-59] years) experienced postoperative language decline 1 year after surgery. Two of 4 patients had overlap of fMRI activation, language-positive electrodes in basal temporal regions (within 1 cm), and resection. Two had overlap between resection volume and fMRI activation, but not DCS. fMRI demonstrated 100% sensitivity and 46% specificity for outcome compared to DCS (50% and 85%, respectively). When fMRI and DCS language findings were concordant, the combined tests showed 100% sensitivity and 75% specificity for language outcome. Seizure-onset age, resection side, type, volume, or 1 year seizure outcome did not predict language decline. SIGNIFICANCE Language localization overlap of fMRI and direct cortical stimulation in the resection influences postoperative language performance. Our preliminary study suggests that fMRI may be more sensitive and less specific than direct cortical stimulation. Together they may predict outcome better than either test alone.
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Affiliation(s)
- Rachel Rolinski
- Clinical Epilepsy Section, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
| | - Alison Austermuehle
- Clinical Epilepsy Section, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
| | - Edythe Wiggs
- Clinical Epilepsy Section, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
| | - Shubhi Agrawal
- Clinical Epilepsy Section, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
- Berman Brain & Spine Institute, Baltimore, MD
| | - Leigh Sepeta
- Clinical Epilepsy Section, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
- Department of Neurology Children’s National Medical
Center, Washington, D.C
| | - William D Gaillard
- Clinical Epilepsy Section, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
- Department of Neurology Children’s National Medical
Center, Washington, D.C
| | - Kareem Zaghloul
- Surgical Neurology Branch, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
| | - Sara K Inati
- Electroencephalography Section, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
| | - William H Theodore
- Clinical Epilepsy Section, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
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Labache L, Joliot M, Saracco J, Jobard G, Hesling I, Zago L, Mellet E, Petit L, Crivello F, Mazoyer B, Tzourio-Mazoyer N. A SENtence Supramodal Areas AtlaS (SENSAAS) based on multiple task-induced activation mapping and graph analysis of intrinsic connectivity in 144 healthy right-handers. Brain Struct Funct 2019; 224:859-882. [PMID: 30535758 PMCID: PMC6420474 DOI: 10.1007/s00429-018-1810-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 12/01/2018] [Indexed: 12/13/2022]
Abstract
We herein propose an atlas of 32 sentence-related areas based on a 3-step method combining the analysis of activation and asymmetry during multiple language tasks with hierarchical clustering of resting-state connectivity and graph analyses. 144 healthy right-handers performed fMRI runs based on language production, reading and listening, both with sentences and lists of over-learned words. Sentence minus word-list BOLD contrast and left-minus-right BOLD asymmetry for each task were computed in pairs of homotopic regions of interest (hROIs) from the AICHA atlas. Thirty-two hROIs were identified that were conjointly activated and leftward asymmetrical in each of the three language contrasts. Analysis of resting-state temporal correlations of BOLD variations between these 32 hROIs allowed the segregation of a core network, SENT_CORE including 18 hROIs. Resting-state graph analysis applied to SENT_CORE hROIs revealed that the pars triangularis of the inferior frontal gyrus and the superior temporal sulcus were hubs based on their degree centrality (DC), betweenness, and participation values corresponding to epicentres of sentence processing. Positive correlations between DC and BOLD activation values for SENT_CORE hROIs were observed across individuals and across regions regardless of the task: the more a SENT_CORE area is connected at rest the stronger it is activated during sentence processing. DC measurements in SENT_CORE may thus be a valuable index for the evaluation of inter-individual variations in language areas functional activity in relation to anatomical or clinical patterns in large populations. SENSAAS (SENtence Supramodal Areas AtlaS), comprising the 32 supramodal sentence areas, including SENT_CORE network, can be downloaded at http://www.gin.cnrs.fr/en/tools/ .
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Affiliation(s)
- L Labache
- Univ. Bordeaux, IMN, UMR 5293, 33000, Bordeaux, France
- CNRS, IMN, UMR 5293, 33000, Bordeaux, France
- CEA, GIN, IMN, UMR 5293, 33000, Bordeaux, France
- Univ. Bordeaux, IMB, UMR 5251, 33405, Talence, France
- INRIA Bordeaux Sud-Ouest, CQFD, UMR 5251, 33405, Talence, France
| | - M Joliot
- Univ. Bordeaux, IMN, UMR 5293, 33000, Bordeaux, France
- CNRS, IMN, UMR 5293, 33000, Bordeaux, France
- CEA, GIN, IMN, UMR 5293, 33000, Bordeaux, France
| | - J Saracco
- INRIA Bordeaux Sud-Ouest, CQFD, UMR 5251, 33405, Talence, France
- Bordeaux INP, IMB, UMR 5251, 33405, Talence, France
| | - G Jobard
- Univ. Bordeaux, IMN, UMR 5293, 33000, Bordeaux, France
- CNRS, IMN, UMR 5293, 33000, Bordeaux, France
- CEA, GIN, IMN, UMR 5293, 33000, Bordeaux, France
| | - I Hesling
- Univ. Bordeaux, IMN, UMR 5293, 33000, Bordeaux, France
- CNRS, IMN, UMR 5293, 33000, Bordeaux, France
- CEA, GIN, IMN, UMR 5293, 33000, Bordeaux, France
| | - L Zago
- Univ. Bordeaux, IMN, UMR 5293, 33000, Bordeaux, France
- CNRS, IMN, UMR 5293, 33000, Bordeaux, France
- CEA, GIN, IMN, UMR 5293, 33000, Bordeaux, France
| | - E Mellet
- Univ. Bordeaux, IMN, UMR 5293, 33000, Bordeaux, France
- CNRS, IMN, UMR 5293, 33000, Bordeaux, France
- CEA, GIN, IMN, UMR 5293, 33000, Bordeaux, France
| | - L Petit
- Univ. Bordeaux, IMN, UMR 5293, 33000, Bordeaux, France
- CNRS, IMN, UMR 5293, 33000, Bordeaux, France
- CEA, GIN, IMN, UMR 5293, 33000, Bordeaux, France
| | - F Crivello
- Univ. Bordeaux, IMN, UMR 5293, 33000, Bordeaux, France
- CNRS, IMN, UMR 5293, 33000, Bordeaux, France
- CEA, GIN, IMN, UMR 5293, 33000, Bordeaux, France
| | - B Mazoyer
- Univ. Bordeaux, IMN, UMR 5293, 33000, Bordeaux, France
- CNRS, IMN, UMR 5293, 33000, Bordeaux, France
- CEA, GIN, IMN, UMR 5293, 33000, Bordeaux, France
| | - Nathalie Tzourio-Mazoyer
- Univ. Bordeaux, IMN, UMR 5293, 33000, Bordeaux, France.
- CNRS, IMN, UMR 5293, 33000, Bordeaux, France.
- CEA, GIN, IMN, UMR 5293, 33000, Bordeaux, France.
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Celiker Uslu S, Yuksel B, Tekin B, Sariahmetoglu H, Atakli D. Cognitive impairment and drug responsiveness in mesial temporal lobe epilepsy. Epilepsy Behav 2019; 90:162-167. [PMID: 30576963 DOI: 10.1016/j.yebeh.2018.10.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/17/2018] [Accepted: 10/24/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Mesial temporal lobe epilepsy (MTLE) is the most common form of partial epilepsies. Seizures of MTLE with hippocampal sclerosis (MTLE-HS) are typically resistant to antiepileptic drug (AED) therapy. Although memory disturbances in patients with MTLE-HS are expected, verbal attention and frontal lobe functions may also be impaired. We aimed to examine the relationship between the clinical features and cognitive functions of patients by comparing cognitive test scores of patients with MTLE with few seizures (drug-responsive group) and those with frequent seizures (pharmacoresistant group). METHODS Seventy-nine patients with MTLE-HS and 30 healthy controls were enrolled. Thirty-four patients were accepted as the drug-responsive group (DrG), and 45 patients were included in the pharmacoresistant group (PRG). Tests evaluating attention, memory, and executive functions were performed on all participants. RESULTS Forty-nine (62%) female and 30 (38%) male patients with MTLE-HS, and 14 (46.7%) female and 16 (53.3%) male controls participated in the study. The mean age of the patients and controls was 33.53 ± 9.60 (range, 18-57) years and 35.90 ± 7.98 (range, 18-56) years, respectively. Both the DrG and PRG showed poorer performances in tests evaluating memory and frontal lobe functions when compared with the control group (CG). Additionally, attention test results were significantly worse in the PRG than in the DrG. CONCLUSION It is reasonable to say that increased seizure frequency is the main causative factor of verbal attention deficit due to the poorer attention test results in the PRG. Poor performances in memory and frontal lobe function tests of all patients with MTLE-HS emphasized the importance of the mutual connection between the temporal lobe and prefrontal cortices.
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Affiliation(s)
- Sibel Celiker Uslu
- Samsun Training and Research Hospital Neurology Department, İlkadım, 55090 Samsun, Turkey
| | - Burcu Yuksel
- Antalya Training and Research Hospital, Neurology Department, Muratpasa, 07050 Antalya, Turkey.
| | - Betul Tekin
- Rumeli Hospital Neurology Department, Kucukcekmece, 34295 Istanbul, Turkey
| | - Hande Sariahmetoglu
- Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Neurology Department, Bakirkoy, 34147 Istanbul, Turkey
| | - Dilek Atakli
- Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Neurology Department, Bakirkoy, 34147 Istanbul, Turkey
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Heunis S, Besseling R, Lamerichs R, de Louw A, Breeuwer M, Aldenkamp B, Bergmans J. Neu 3CA-RT: A framework for real-time fMRI analysis. Psychiatry Res Neuroimaging 2018; 282:90-102. [PMID: 30293911 DOI: 10.1016/j.pscychresns.2018.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 09/25/2018] [Accepted: 09/27/2018] [Indexed: 10/28/2022]
Abstract
Real-time functional magnetic resonance imaging (rtfMRI) allows visualisation of ongoing brain activity of the subject in the scanner. Denoising algorithms aim to rid acquired data of confounding effects, enhancing the blood oxygenation level-dependent (BOLD) signal. Further image processing and analysis methods, like general linear models (GLM) or multivariate analysis, then present application-specific information to the researcher. These processes are typically applied to regions of interest but, increasingly, rtfMRI techniques extract and classify whole brain functional networks and dynamics as correlates for brain states or behaviour, particularly in neuropsychiatric and neurocognitive disorders. We present Neu3CA-RT: a Matlab-based rtfMRI analysis framework aiming to advance scientific knowledge on real-time cognitive brain activity and to promote its translation into clinical practice. Design considerations are listed based on reviewing existing rtfMRI approaches. The toolbox integrates established SPM preprocessing routines, real-time GLM mapping of fMRI data to a basis set of spatial brain networks, correlation of activity with 50 behavioural profiles from the BrainMap database, and an intuitive user interface. The toolbox is demonstrated in a task-based experiment where a subject executes visual, auditory and motor tasks inside a scanner. In three out of four experiments, resulting behavioural profiles agreed with the expected brain state.
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Affiliation(s)
- Stephan Heunis
- Department of Electrical Engineering, Eindhoven University of Technology, Postal address: PO box 513; Flux buidling, room 7.066, 5600MB Eindhoven, The Netherlands.
| | - René Besseling
- Department of Electrical Engineering, Eindhoven University of Technology, Postal address: PO box 513; Flux buidling, room 7.066, 5600MB Eindhoven, The Netherlands; Department of Research and Development, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands
| | - Rolf Lamerichs
- Department of Electrical Engineering, Eindhoven University of Technology, Postal address: PO box 513; Flux buidling, room 7.066, 5600MB Eindhoven, The Netherlands; Philips Research Laboratories Eindhoven, Eindhoven, The Netherlands
| | - Anton de Louw
- Department of Electrical Engineering, Eindhoven University of Technology, Postal address: PO box 513; Flux buidling, room 7.066, 5600MB Eindhoven, The Netherlands; Department of Research and Development, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands
| | - Marcel Breeuwer
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Philips Healthcare, Best, The Netherlands
| | - Bert Aldenkamp
- Department of Electrical Engineering, Eindhoven University of Technology, Postal address: PO box 513; Flux buidling, room 7.066, 5600MB Eindhoven, The Netherlands; Department of Research and Development, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands; Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology, Ghent University Hospital, Ghent, Belgium; Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan Bergmans
- Department of Electrical Engineering, Eindhoven University of Technology, Postal address: PO box 513; Flux buidling, room 7.066, 5600MB Eindhoven, The Netherlands
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Wilke M, Groeschel S, Lorenzen A, Rona S, Schuhmann MU, Ernemann U, Krägeloh‐Mann I. Clinical application of advanced MR methods in children: points to consider. Ann Clin Transl Neurol 2018; 5:1434-1455. [PMID: 30480038 PMCID: PMC6243383 DOI: 10.1002/acn3.658] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/10/2018] [Accepted: 08/10/2018] [Indexed: 12/11/2022] Open
Abstract
The application of both functional MRI and diffusion MR tractography prior to a neurosurgical operation is well established in adults, but less so in children, for several reasons. For this review, we have identified several aspects (task design, subject preparation, actual scanning session, data processing, interpretation of results, and decision-making) where pediatric peculiarities should be taken into account. Further, we not only systematically identify common issues, but also provide solutions, based on our experience as well as a review of the pertinent literature. The aim is to provide the clinician as well as the imaging scientist with information that helps to plan, conduct, and interpret such a clinically-indicated exam in a way that maximizes benefit for, and minimizes the burden on the individual child.
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Affiliation(s)
- Marko Wilke
- Department of Pediatric Neurology and Developmental MedicineChildren's HospitalTuebingenGermany
- Children's Hospital and Department of NeuroradiologyExperimental Pediatric NeuroimagingTuebingenGermany
| | - Samuel Groeschel
- Department of Pediatric Neurology and Developmental MedicineChildren's HospitalTuebingenGermany
- Children's Hospital and Department of NeuroradiologyExperimental Pediatric NeuroimagingTuebingenGermany
| | - Anna Lorenzen
- Department of Pediatric Neurology and Developmental MedicineChildren's HospitalTuebingenGermany
- Children's Hospital and Department of NeuroradiologyExperimental Pediatric NeuroimagingTuebingenGermany
| | - Sabine Rona
- Department of NeurosurgeryUniversity HospitalTuebingenGermany
| | | | - Ulrike Ernemann
- Department of Diagnostic and Interventional NeuroradiologyUniversity HospitalUniversity of TübingenTuebingenGermany
| | - Ingeborg Krägeloh‐Mann
- Department of Pediatric Neurology and Developmental MedicineChildren's HospitalTuebingenGermany
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47
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Schmid E, Thomschewski A, Taylor A, Zimmermann G, Kirschner M, Kobulashvili T, Brigo F, Rados M, Helmstaedter C, Braun K, Trinka E. Diagnostic accuracy of functional magnetic resonance imaging, Wada test, magnetoencephalography, and functional transcranial Doppler sonography for memory and language outcome after epilepsy surgery: A systematic review. Epilepsia 2018; 59:2305-2317. [PMID: 30374948 DOI: 10.1111/epi.14588] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/27/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The European Union-funded E-PILEPSY project was launched to develop guidelines and recommendations for epilepsy surgery. In this systematic review, we aimed to assess the diagnostic accuracy of functional magnetic resonance imaging (fMRI), Wada test, magnetoencephalography (MEG), and functional transcranial Doppler sonography (fTCD) for memory and language decline after surgery. METHODS The literature search was conducted using PubMed, Embase, and CENTRAL. The diagnostic accuracy was expressed in terms of sensitivity and specificity for postoperative language or memory decline, as determined by pre- and postoperative neuropsychological assessments. If two or more estimates of sensitivity or specificity were extracted from a study, two meta-analyses were conducted, using the maximum ("best case") and the minimum ("worst case") of the extracted estimates, respectively. RESULTS Twenty-eight papers were eligible for data extraction and further analysis. All tests for heterogeneity were highly significant, indicating large between-study variability (P < 0.001). For memory outcomes, meta-analyses were conducted for Wada tests (n = 17) using both memory and language laterality quotients. In the best case, meta-analyses yielded a sensitivity estimate of 0.79 (95% confidence interval [CI] = 0.67-0.92) and a specificity estimate of 0.65 (95% CI = 0.47-0.83). For the worst case, meta-analyses yielded a sensitivity estimate of 0.65 (95% CI = 0.48-0.82) and a specificity estimate of 0.46 (95% CI = 0.28-0.65). The overall quality of evidence, which was assessed using Grading of Recommendations Assessment, Development, and Evaluation methodology, was rated as very low. Meta-analyses concerning diagnostic accuracy of fMRI, fTCD, and MEG were not feasible due to small numbers of studies (fMRI, n = 4; fTCD, n = 1; MEG, n = 0). This also applied to studies concerning language outcomes (Wada test, n = 6; fMRI, n = 2; fTCD, n = 1; MEG, n = 0). SIGNIFICANCE Meta-analyses could only be conducted in a few subgroups for the Wada test with low-quality evidence. Thus, more evidence from high-quality studies and improved data reporting are required. Moreover, the large between-study heterogeneity underlines the necessity for more homogeneous and thus comparable studies in future research.
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Affiliation(s)
- Elisabeth Schmid
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria
| | - Aljoscha Thomschewski
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria.,Center for Cognitive Neuroscience, Salzburg, Austria
| | - Alexandra Taylor
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Georg Zimmermann
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria.,Department of Mathematics, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Margarita Kirschner
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Teia Kobulashvili
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Francesco Brigo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Matea Rados
- Department of Child Neurology, University Medical Center, Utrecht, The Netherlands
| | | | - Kees Braun
- Department of Child Neurology, University Medical Center, Utrecht, The Netherlands
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria.,Center for Cognitive Neuroscience, Salzburg, Austria
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Sever RW, Vivas AC, Vale FL, Schoenberg MR. Wada asymmetry in patients with drug-resistant mesial temporal lobe epilepsy: Implications for postoperative neuropsychological outcomes. Epilepsia Open 2018; 3:399-408. [PMID: 30187011 PMCID: PMC6119753 DOI: 10.1002/epi4.12250] [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] [Accepted: 06/20/2018] [Indexed: 11/09/2022] Open
Abstract
Objective This study reports neuropsychological outcomes based on preoperative Wada testing in patients with drug‐resistant mesial temporal lobe epilepsy (mTLE). Methods Patient records were retrospectively reviewed as part of a larger database. Patients with a diagnosis of TLE based on seizure semiology and long‐term surface video–electroencephalography (EEG) were identified. These patients underwent preoperative and postoperative testing including advanced imaging (magnetic resonance imaging [MRI]), Wada testing, and neuropsychological assessment. Decrements in neuropsychological function were noted in comparison of pre‐ and postoperative studies. Patients had regular follow‐up in the multidisciplinary epilepsy clinic to assess seizure outcomes. All participants had Engel class I/II outcome following selective amygdalohippocampectomy (AH) via the inferior temporal gyrus (ITG) approach. Results Forty‐eight patients with electrographic and clinical semiology consistent with unilateral mTLE were identified. Left mTLE was identified in 28 patients (58.3%), whereas 20 patients (41.7%) had right mTLE. Language‐dominant hemisphere resections were performed on 23 patients (47.9%) (all left‐sided surgery), whereas 25 (52.1%) had language nondominant resection (all right‐sided and five left‐sided surgery). Twenty‐two participants (45.8%) showed no Wada memory asymmetry (No‐WMA), whereas 26 (54.2%) exhibited Wada memory asymmetry (WMA). Postoperatively, analysis of variance (ANOVA) found that the No‐WMA group exhibited a decline in verbal memory, but average scores on measures of nonverbal reasoning, general intelligence, and mood improved. Alternatively, patients with WMA did not show declines in memory postoperatively, and also exhibited improved nonverbal reasoning and general intelligence. Neither group exhibited reliable decline in verbal fluency or visual confrontation naming. Significance Wada procedures for predicting surgical outcome from elective temporal surgery have been criticized and remain an area of active debate. However, decades of data across multiple epilepsy centers have demonstrated the value of Wada for reducing unanticipated neuropsychological adverse effects of surgical treatment. These data show that no Wada memory asymmetry increases the risk for neuropsychological decline following ITG approach for selective AH for drug‐resistant mTLE.
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Affiliation(s)
- Ryan W Sever
- Department of Neurosurgery and Brain Repair Morsani College of Medicine University of South Florida Tampa Florida U.S.A.,Florida School of Professional Psychology Argosy University Tampa Florida U.S.A
| | - Andrew C Vivas
- Department of Neurosurgery and Brain Repair Morsani College of Medicine University of South Florida Tampa Florida U.S.A
| | - Fernando L Vale
- Department of Neurosurgery and Brain Repair Morsani College of Medicine University of South Florida Tampa Florida U.S.A
| | - Mike R Schoenberg
- Department of Neurosurgery and Brain Repair Morsani College of Medicine University of South Florida Tampa Florida U.S.A.,Department of Neurology Morsani College of Medicine University of South Florida Tampa Florida U.S.A
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Benjamin CFA, Dhingra I, Li AX, Blumenfeld H, Alkawadri R, Bickel S, Helmstaedter C, Meletti S, Bronen RA, Warfield SK, Peters JM, Reutens D, Połczyńska MM, Hirsch LJ, Spencer DD. Presurgical language fMRI: Technical practices in epilepsy surgical planning. Hum Brain Mapp 2018; 39:4032-4042. [PMID: 29962111 PMCID: PMC6175127 DOI: 10.1002/hbm.24229] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/10/2018] [Accepted: 05/14/2018] [Indexed: 11/24/2022] Open
Abstract
Little is known about how language functional MRI (fMRI) is executed in clinical practice in spite of its widespread use. Here we comprehensively documented its execution in surgical planning in epilepsy. A questionnaire focusing on cognitive design, image acquisition, analysis and interpretation, and practical considerations was developed. Individuals responsible for collecting, analyzing, and interpreting clinical language fMRI data at 63 epilepsy surgical programs responded. The central finding was of marked heterogeneity in all aspects of fMRI. Most programs use multiple tasks, with a fifth routinely using 2, 3, 4, or 5 tasks with a modal run duration of 5 min. Variants of over 15 protocols are in routine use with forms of noun–verb generation, verbal fluency, and semantic decision‐making used most often. Nearly all aspects of data acquisition and analysis vary markedly. Neither of the two best‐validated protocols was used by more than 10% of respondents. Preprocessing steps are broadly consistent across sites, language‐related blood flow is most often identified using general linear modeling (76% of respondents), and statistical thresholding typically varies by patient (79%). The software SPM is most often used. fMRI programs inconsistently include input from experts with all required skills (imaging, cognitive assessment, MR physics, statistical analysis, and brain–behavior relationships). These data highlight marked gaps between the evidence supporting fMRI and its clinical application. Teams performing language fMRI may benefit from evaluating practice with reference to the best‐validated protocols to date and ensuring individuals trained in all aspects of fMRI are involved to optimize patient care.
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Affiliation(s)
| | - Isha Dhingra
- Yale Comprehensive Epilepsy Center, New Haven, Connecticut, USA
| | - Alexa X Li
- Quinnipiac University School of Medicine, North Haven, Connecticut, USA
| | - Hal Blumenfeld
- Yale Comprehensive Epilepsy Center, New Haven, Connecticut, USA
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Visualization of subcortical language pathways by diffusion tensor imaging fiber tracking based on rTMS language mapping. Brain Imaging Behav 2018; 11:899-914. [PMID: 27323766 DOI: 10.1007/s11682-016-9563-0] [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] [Indexed: 02/07/2023]
Abstract
Diffusion tensor imaging fiber tracking (DTI FT) is used to visualize subcortical fiber tracts. Yet, there is no standard at hand to visualize language-involved subcortical fibers reliably. Thus, this study investigates the feasibility of using language-related cortical areas identified via repetitive navigated transcranial magnetic stimulation (rTMS) to seed DTI FT of subcortical language tracts. From 2011 to 2014, 37 patients with left-hemispheric perisylvian lesions were examined. Language-positive rTMS stimulation spots were integrated in the deterministic tractography software (BrainLAB, iPlanNet 3.0) as objects and used as seed regions for DTI FT. Tractography was then performed in each patient with 77 different combinations of fiber lengths (40 - 100 mm) and fractional anisotropy (FA; 0.01 - 0.5). The rTMS-based DTI FT identified all commonly known subcortical language tracts, such as the corticonuclear tract, arcuate fascicle, uncinate fascicle, superior longitudinal fascicle, inferior longitudinal fascicle, arcuate fibers, commissural fibers, corticothalamic fibers, and the fronto-occipital fascicle. In 32 patients (86.5 %), each above-named tract could be visualized, while at least 6 out of these 9 tracts were identified in each patient. A fiber length of 100 mm and an FA of 0.1 or 0.15 provided optimal visualization by revealing 125 and 61 individually tracked fibers per visualized language tract and 90 % and 73 % of all language-related tracts, respectively. This study proves the feasibility of rTMS-based DTI FT for subcortical language tracts, provides suitable settings, and shows its easy and standardizable application for the visualization of every language tract in 86.5 % of patients.
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