Brain organization for language from the perspective of electrical stimulation mapping

Using Biosensors to Detect and Map Language Areas in the Brain for Individuals with Traumatic Brain Injury

The application of biosensors in neurolinguistics has significantly advanced the detection and mapping of language areas in the brain, particularly for individuals with brain trauma. This study explores the role of biosensors in this domain and proposes a conceptual model to guide their use in research and clinical practice. The researchers explored the integration of biosensors in language and brain function studies, identified trends in research, and developed a conceptual model based on cluster and thematic analyses. Using a mixed-methods approach, we conducted cluster and thematic analyses on data curated from Web of Science, Scopus, and SciSpace, encompassing 392 articles. This dual analysis facilitated the identification of research trends and thematic insights within the field. The cluster analysis highlighted Functional Magnetic Resonance Imaging (fMRI) dominance and the importance of neuroplasticity in language recovery. Biosensors such as the Magnes 2500 watt-hour (WH) neuromagnetometer and microwire-based sensors are reliable for real-time monitoring, despite methodological challenges. The proposed model synthesizes these findings, emphasizing biosensors' potential in preoperative assessments and therapeutic customization. Biosensors are vital for non-invasive, precise mapping of language areas, with fMRI and repetitive Transcranial Magnetic Stimulation (rTMS) playing pivotal roles. The conceptual model serves as a strategic framework for employing biosensors and improving neurolinguistic interventions. This research may enhance surgical planning, optimize recovery therapies, and encourage technological advancements in biosensor precision and application protocols.

An electroencephalogram microdisplay to visualize neuronal activity on the brain surface

Functional mapping during brain surgery is applied to define brain areas that control critical functions and cannot be removed. Currently, these procedures rely on verbal interactions between the neurosurgeon and electrophysiologist, which can be time-consuming. In addition, the electrode grids that are used to measure brain activity and to identify the boundaries of pathological versus functional brain regions have low resolution and limited conformity to the brain surface. Here, we present the development of an intracranial electroencephalogram (iEEG)-microdisplay that consists of freestanding arrays of 2048 GaN light-emitting diodes laminated on the back of micro-electrocorticography electrode grids. With a series of proof-of-concept experiments in rats and pigs, we demonstrate that these iEEG-microdisplays allowed us to perform real-time iEEG recordings and display cortical activities by spatially corresponding light patterns on the surface of the brain in the surgical field. Furthermore, iEEG-microdisplays allowed us to identify and display cortical landmarks and pathological activities from rat and pig models. Using a dual-color iEEG-microdisplay, we demonstrated coregistration of the functional cortical boundaries with one color and displayed the evolution of electrical potentials associated with epileptiform activity with another color. The iEEG-microdisplay holds promise to facilitate monitoring of pathological brain activity in clinical settings.

The Brain Electroencephalogram Microdisplay for Precision Neurosurgery

Brain surgeries are among the most delicate clinical procedures and must be performed with the most technologically robust and advanced tools. When such surgical procedures are performed in functionally critical regions of the brain, functional mapping is applied as a standard practice that involves direct coordinated interactions between the neurosurgeon and the clinical neurology electrophysiology team. However, information flow during these interactions is commonly verbal as well as time consuming which in turn increases the duration and cost of the surgery, possibly compromising the patient outcomes. Additionally, the grids that measure brain activity and identify the boundaries of pathological versus functional brain regions suffer from low resolution (3-10 mm contact to contact spacing) with limited conformity to the brain surface. Here, we introduce a brain intracranial electroencephalogram microdisplay (Brain-iEEG-microdisplay) which conforms to the brain to measure the brain activity and display changes in near real-time (40 Hz refresh rate) on the surface of the brain in the surgical field. We used scalable engineered gallium nitride (GaN) substrates with 6" diameter to fabricate, encapsulate, and release free-standing arrays of up to 2048 GaN light emitting diodes (μLEDs) in polyimide substrates. We then laminated the μLED arrays on the back of micro-electrocorticography (μECoG) platinum nanorod grids (PtNRGrids) and developed hardware and software to perform near real-time intracranial EEG analysis and activation of light patterns that correspond to specific cortical activities. Using the Brain-iEEG-microdisplay, we precisely ideFSntified and displayed important cortical landmarks and pharmacologically induced pathological activities. In the rat model, we identified and displayed individual cortical columns corresponding to individual whiskers and the near real-time evolution of epileptic discharges. In the pig animal model, we demonstrated near real-time mapping and display of cortical functional boundaries using somatosensory evoked potentials (SSEP) and display of responses to direct electrical stimulation (DES) from the surface or within the brain tissue. Using a dual-color Brain-iEEG-microdisplay, we demonstrated co-registration of the functional cortical boundaries with one color and displayed the evolution of electrical potentials associated with epileptiform activity with another color. The Brain-iEEG-microdisplay holds the promise of increasing the efficiency of diagnosis and possibly surgical treatment, thereby reducing the cost and improving patient outcomes which would mark a major advancement in neurosurgery. These advances can also be translated to broader applications in neuro-oncology and neurophysiology.

Localization patterns of speech and language errors during awake brain surgery: a systematic review

Awake craniotomy with direct electrical stimulation (DES) is the standard treatment for patients with eloquent area gliomas. DES detects speech and language errors, which indicate functional boundaries that must be maintained to preserve quality of life. During DES, traditional object naming or other linguistic tasks such as tasks from the Dutch Linguistic Intraoperative Protocol (DuLIP) can be used. It is not fully clear which speech and language errors occur in which brain locations. To provide an overview and to update DuLIP, a systematic review was conducted in which 102 studies were included, reporting on speech and language errors and the corresponding brain locations during awake craniotomy with DES in adult glioma patients up until 6 July 2020. The current findings provide a crude overview on language localization. Even though subcortical areas are in general less often investigated intraoperatively, still 40% out of all errors was reported at the subcortical level and almost 60% at the cortical level. Rudimentary localization patterns for different error types were observed and compared to the dual-stream model of language processing and the DuLIP model. While most patterns were similar compared to the models, additional locations were identified for articulation/motor speech, phonology, reading, and writing. Based on these patterns, we propose an updated DuLIP model. This model can be applied for a more adequate "location-to-function" language task selection to assess different linguistic functions during awake craniotomy, to possibly improve intraoperative language monitoring. This could result in a better postoperative language outcome in the future.

The role of the anterior insular cortex in self-monitoring: A novel study protocol with electrical stimulation mapping and functional magnetic resonance imaging

Becoming aware of one's own states is a fundamental aspect for self-monitoring, allowing us to adjust our beliefs of the world to the changing context. Previous evidence points out to the key role of the anterior insular cortex (aIC) in evaluating the consequences of our own actions, especially whenever an error has occurred. In the present study, we propose a new multimodal protocol combining electrical stimulation mapping (ESM) and functional magnetic resonance imaging (fMRI) to explore the functional role of the aIC for self-monitoring in patients undergoing awake brain surgery. Our results using a modified version of the Stroop task tackling metacognitive abilities revealed new direct evidence of the involvement of the aIC in monitoring our performance, showing increased difficulties in detecting action-outcome mismatches when stimulating a cortical site located at the most posterior part of the aIC as well as significant BOLD activations at this region during outcome incongruences for self-made actions. Based on these preliminary results, we highlight the importance of assessing the aIC's functioning during tumor resection involving this region to evaluate metacognitive awareness of the self in patients undergoing awake brain surgery. In a similar vein, a better understanding of the aIC's role during self-monitoring may help shed light on action/outcome processing abnormalities reported in several neuropsychiatric disorders such as schizophrenia, anosognosia for hemiplegia or major depression.

Accurate Preoperative Identification of Motor Speech Area as Termination of Arcuate Fasciculus Depicted by Q-ball Imaging Tractography

BACKGROUND

Tractography is one way to predict the distribution of cortical functional domains preoperatively. Diffusion tensor tractography (DTT) is commonly used in clinical practice but is known to have limitations in delineating crossed fibers, which can be overcome by q-ball imaging tractography (QBT). In this study, we aimed to compare the reliability of these two methods, based on the spatial correlation between the arcuate fasciculus depicted by tractography and direct cortical stimulation (DCS) during awake surgery.

METHODS

Fifteen patients with glioma underwent awake surgery with DCS. Tractography was depicted in a 3D computer graphic model preoperatively, which was integrated with the photograph of the actual brain cortex using our novel mixed-reality technology. The termination of the arcuate fasciculus depicted by either DTT or QBT and the results of DCS were compared, and sensitivity and specificity were calculated in speech-associated brain gyri: pars triangularis, pars opercularis, ventral precentral gyrus, and middle frontal gyrus.

RESULTS

QBT had significantly better sensitivity and lower false positive rate than DTT in the pars orpercularis. The same trend was noted for the other gyri.

CONCLUSIONS

QBT is more reliable than DTT in identification of the motor speech area and may be clinically useful in brain tumor surgery.

Intraoperative Brain Mapping in Multilingual Patients: What Do We Know and Where Are We Going?

In this review, we evaluate the knowledge gained so far about the neural bases of multilingual language processing obtained mainly through imaging and electrical stimulation mapping (ESM). We attempt to answer some key questions about multilingualism in the light of recent literature evidence, such as the degree of anatomical–functional integration of two or more languages in a multilingual brain, how the age of L2-acquisition affects language organization in the human brain, or how the brain controls more than one language. Finally, we highlight the future trends in multilingual language mapping.

The dual stream model of speech and language processing

The Wernicke-Lichtheim-Geschwind model of the neurology of language has served the field well despite its limited scope. More recent work has updated the basic architecture of the classical model and expanded its scope. This chapter briefly reviews the Wernicke-Lichtheim-Geschwind model and points out its shortcomings, then describes and motivates the dual stream model and how it solves several empirical shortcomings of the classical model. The chapter also (i) underscores how the dual stream model relates to the organization of nonlinguistic cortical networks, integrating language systems with the broader functional-anatomical landscape, (ii) describes recent work that further specifies the computational architecture and neural correlates of the dorsal speech production system, and (iii) summarizes recent extensions of the architectural framework to include syntax.

The noun-verb distinction

The comparison between nouns and verbs has been a topic of interest for many researchers over the last 50 years. This comparison, and subsequent behavioral and (partly) anatomic dissociation, has allowed researchers to delve into many topics including the behavioral architecture of the language system and its neural correlates, the underlying nature of the linguistic impairment in individuals with different neurologic disorders, the assessment of language treatment protocols, and the proposal of new protocols aimed to protect the language system of individuals undergoing surgery for brain tumors and epilepsy. Specific to the left temporal lobe, classic accounts have shown its relevance for the processing of nouns and less for the processing of verbs. Nonetheless, more recent accounts indicate that different areas in the left temporal lobe can subserve different functions for the processing of both nouns and verbs. In this chapter, we outlined an overview of key findings of the study of nouns and verbs, with a particular focus on the left temporal lobe. This chapter contextualizes the literature on category-specific impairments and neural correlates of nouns and verbs with linguistic and psycholinguistic theories, and provides new ways to investigate and understand the intricacies of this comparison.

Language Mapping Using Stereo Electroencephalography: A Review and Expert Opinion

Stereo-electroencephalography (sEEG) is a method that uses stereotactically implanted depth electrodes for extra-operative mapping of epileptogenic and functional networks. sEEG derived functional mapping is achieved using electrical cortical stimulations (ECS) that are currently the gold standard for delineating eloquent cortex. As this stands true especially for primary cortices (e.g., visual, sensitive, motor, etc.), ECS applied to higher order brain areas determine more subtle behavioral responses. While anterior and posterior language areas in the dorsal language stream seem to share characteristics with primary cortices, basal temporal language area (BTLA) in the ventral temporal cortex (VTC) behaves as a highly associative cortex. After a short introduction and considerations about methodological aspects of ECS using sEEG, we review the sEEG language mapping literature in this perspective. We first establish the validity of this technique to map indispensable language cortices in the dorsal language stream. Second, we highlight the contrast between the growing empirical ECS experience and the lack of understanding regarding the fundamental mechanisms underlying ECS behavioral effects, especially concerning the dispensable language cortex in the VTC. Evidences for considering network architecture as determinant for ECS behavioral response complexities are discussed. Further, we address the importance of designing new research in network organization of language as this could enhance ECS ability to map interindividual variability, pathology driven reorganization, and ultimately identify network resilience markers in order to better predict post-operative language deficit. Finally, based on a whole body of available studies, we believe there is strong evidence to consider sEEG as a valid, safe and reliable method for defining eloquent language cortices although there have been no proper comparisons between surgical resections with or without extra-operative or intra-operative language mapping.

Focal Cortical Surface Cooling is a Novel and Safe Method for Intraoperative Functional Brain Mapping

OBJECTIVE

Electric cortical stimulation (ECS) has been the gold standard for intraoperative functional mapping in neurosurgery, yet it carries the risk of induced seizures. We assess the safety of focal cortical cooling (CC) as a potential alternative to ECS.

METHODS

We reviewed 40 patients (13 with tumor and 27 with mesial temporal lobe epilepsy) who underwent intraoperative CC at the University of Iowa Hospital and Clinics (CC group), of whom 38 underwent ECS preceding CC. Intraoperative and postoperative seizure incidence, postoperative neurologic deficits, and new postoperative radiographic findings were collected to assess CC safety. Fifty-five patients who underwent ECS mapping without CC (ECS-alone group) were reviewed as a control cohort. Another 25 patients who underwent anterior temporal lobectomy (ATL) without CC or ECS (no ECS/no CC-ATL group) were also reviewed to evaluate long-term effects of CC.

RESULTS

Seventy-nine brain sites in the CC group were cooled, comprising inferior frontal gyrus (44%), precentral gyrus (39%), postcentral gyrus (6%), subcentral gyrus (4%), and superior temporal gyrus (6%). The incidence of intraoperative seizure(s) was 0% (CC group) and 3.6% (ECS-alone group). The incidence of seizure(s) within the first postoperative week did not significantly differ among CC (7.9%), ECS-alone (9.0%), and no ECS/no CC-ATL groups (12%). There was no significant difference in the incidence of postoperative radiographic change between CC (7.5%) and ECS-alone groups (5.5%). Long-term seizure outcome (Engel I+II) for mesial temporal epilepsy did not differ among CC (80%), ECS-alone (83.3%), and no ECS/no CC-ATL groups (83.3%).

CONCLUSIONS

CC when used as an intraoperative mapping technique is safe and may complement ECS.

Towards linking diffusion MRI based macro- and microstructure measures with cortico-cortical transmission in brain tumor patients

We aimed to link macro- and microstructure measures of brain white matter obtained from diffusion MRI with effective connectivity measures based on a propagation of cortico-cortical evoked potentials induced with intrasurgical direct electrical stimulation. For this, we compared streamline lengths and log-transformed ratios of streamlines computed from presurgical diffusion-weighted images, and the delays and amplitudes of N1 peaks recorded intrasurgically with electrocorticography electrodes in a pilot study of 9 brain tumor patients. Our results showed positive correlation between these two modalities in the vicinity of the stimulation sites (Pearson coefficient 0.54±0.13 for N1 delays, and 0.47±0.23 for N1 amplitudes), which could correspond to the neural propagation via U-fibers. In addition, we reached high sensitivities (0.78±0.07) and very high specificities (0.93±0.03) in a binary variant of our comparison. Finally, we used the structural connectivity measures to predict the effective connectivity using a multiple linear regression model, and showed a significant role of brain microstructure-related indices in this relation.

History of awake mapping and speech and language localization: from modules to networks

Lesion-symptom correlations shaped the early understanding of cortical localization. The classic Broca-Wernicke model of cortical speech and language organization underwent a paradigm shift in large part due to advances in brain mapping techniques. This initially started by demonstrating that the cortex was excitable. Later, advancements in neuroanesthesia led to awake surgery for epilepsy focus and tumor resection, providing neurosurgeons with a means of studying cortical and subcortical pathways to understand neural architecture and obtain maximal resection while avoiding so-called critical structures. The aim of this historical review is to highlight the essential role of direct electrical stimulation and cortical-subcortical mapping and the advancements it has made to our understanding of speech and language cortical organization. Specifically, using cortical and subcortical mapping, neurosurgeons shifted from a localist view in which the brain is composed of rigid functional modules to one of dynamic and integrative large-scale networks consisting of interconnected cortical subregions.

Modulation of Human Memory by Deep Brain Stimulation of the Entorhinal-Hippocampal Circuitry

Neurological disorders affecting human memory present a major scientific, medical, and societal challenge. Direct or indirect deep brain stimulation (DBS) of the entorhinal-hippocampal system, the brain's major memory hub, has been studied in people with epilepsy or Alzheimer's disease, intending to enhance memory performance or slow memory decline. Variability in the spatiotemporal parameters of stimulation employed to date notwithstanding, it is likely that future DBS for memory will employ closed-loop, nuanced approaches that are synergistic with native physiological processes. The potential for editing human memory-decoding, enhancing, incepting, or deleting specific memories-suggests exciting therapeutic possibilities but also raises considerable ethical concerns.

Probabilistic mapping of language networks from high frequency activity induced by direct electrical stimulation

Direct electrical stimulation (DES) at 50 Hz is used as a gold standard to map cognitive functions but little is known about its ability to map large‐scale networks and specific subnetwork. In the present study, we aim to propose a new methodological approach to evaluate the specific hypothesis suggesting that language errors/dysfunction induced by DES are the result of large‐scale network modification rather than of a single cortical region, which explains that similar language symptoms may be observed after stimulation of different cortical regions belonging to this network. We retrospectively examined 29 patients suffering from focal drug‐resistant epilepsy who benefitted from stereo‐electroencephalographic (SEEG) exploration and exhibited language symptoms during a naming task following 50 Hz DES. We assessed the large‐scale language network correlated with behavioral DES‐induced responses (naming errors) by quantifying DES‐induced changes in high frequency activity (HFA, 70–150 Hz) outside the stimulated cortical region. We developed a probabilistic approach to report the spatial pattern of HFA modulations during DES‐induced language errors. Similarly, we mapped the pattern of after‐discharges (3–35 Hz) occurring after DES. HFA modulations concurrent to language symptoms revealed a brain network similar to our current knowledge of language gathered from standard brain mapping. In addition, specific subnetworks could be identified within the global language network, related to different language processes, generally described in relation to the classical language regions. Spatial patterns of after‐discharges were similar to HFA induced during DES. Our results suggest that this new methodological DES‐HFA mapping is a relevant approach to map functional networks during SEEG explorations, which would allow to shift from “local” to “network” perspectives.

Virtual Cortical Stimulation Mapping of Epilepsy Networks to Localize the Epileptogenic Zone

Cortical stimulation mapping (CSM) is a common clinical procedure for mapping eloquent cortex in epilepsy patients. Electrical responses to the stimulation, or after-discharges (ADs), that occur in response to stimulation can point to unstable regions of cortex that are more prone to spontaneous seizures. Clinicians are interested in identifying regions that start seizures, i.e., the epileptogenic zone (EZ), so that they can target treatment. However, during CSM, not all regions are stimulated, as it would be time-consuming and potentially harmful to the patient. This limits the clinician's ability to fully explore ADs to reliably localize the EZ. In this paper, we develop a virtual CSM procedure that processes pre-seizure intracranial EEG recordings obtained from epilepsy patients being treated at three different epilepsy centers. First, we identify a linear time varying network (LTVN) model from electrocorticography (ECoG) and stereo-EEG (SEEG) data using sparse least squares estimation for each patient. We then construct an virtual CSM by applying impulse perturbations to each electrode contact in the LTVN model and then measuring the ADs of the network. We summarize the l2-norm of the responses in the form of a heatmap that shows the spatio-temporal evolution of the ADs before, during, and after seizures. Finally we compute an impulse response ratio (IRR) metric from each heatmap, that measures the ratio between the mean norm of ADs of clinically annotated EZ contacts and the mean norm of ADs of the remaining contacts. We find that the IRR is higher in maps derived from patients with successful surgical outcomes and lower in failed surgical outcomes. This suggests that virtual CSM may provide valuable information to clinicians regarding EZ location.

fMRI-Targeted High-Angular Resolution Diffusion MR Tractography to Identify Functional Language Tracts in Healthy Controls and Glioma Patients

BACKGROUND

MR Tractography enables non-invasive preoperative depiction of language subcortical tracts, which is crucial for the presurgical work-up of brain tumors; however, it cannot evaluate the exact function of the fibers.

PURPOSE

A systematic pipeline was developed to combine tractography reconstruction of language fiber bundles, based on anatomical landmarks (Anatomical-T), with language fMRI cortical activations. A fMRI-targeted Tractography (fMRI-T) was thus obtained, depicting the subsets of the anatomical tracts whose endpoints are located inside a fMRI activation. We hypothesized that fMRI-T could provide additional functional information regarding the subcortical structures, better reflecting the eloquent white matter structures identified intraoperatively.

METHODS

Both Anatomical-T and fMRI-T of language fiber tracts were performed on 16 controls and preoperatively on 16 patients with left-hemisphere brain tumors, using a q-ball residual bootstrap algorithm based on High Angular Resolution Diffusion Imaging (HARDI) datasets (b = 3000 s/mm2; 60 directions); fMRI ROIs were obtained using picture naming, verbal fluency, and auditory verb generation tasks. In healthy controls, normalized MNI atlases of fMRI-T and Anatomical-T were obtained. In patients, the surgical resection of the tumor was pursued by identifying eloquent structures with intraoperative direct electrical stimulation mapping and extending surgery to the functional boundaries. Post-surgical MRI allowed to identify Anatomical-T and fMRI-T non-eloquent portions removed during the procedure.

RESULTS

MNI Atlases showed that fMRI-T is a subset of Anatomical-T, and that different task-specific fMRI-T involve both shared subsets and task-specific subsets - e.g., verbal fluency fMRI-T strongly involves dorsal frontal tracts, consistently with the phonogical-articulatory features of this task. A quantitative analysis in patients revealed that Anatomical-T removed portions of AF-SLF and IFOF were significantly greater than verbal fluency fMRI-T ones, suggesting that fMRI-T is a more specific approach. In addition, qualitative analyses showed that fMRI-T AF-SLF and IFOF predict the exact functional limits of resection with increased specificity when compared to Anatomical-T counterparts, especially the superior frontal portion of IFOF, in a subcohort of patients.

CONCLUSION

These results suggest that performing fMRI-T in addition to the 'classic' Anatomical-T may be useful in a preoperative setting to identify the 'high-risk subsets' that should be spared during the surgical procedure.

The role of diffusion tractography in refining glial tumor resection

Primary brain tumors are notoriously hard to resect surgically. Due to their infiltrative nature, finding the optimal resection boundary without damaging healthy tissue can be challenging. One potential tool to help make this decision is diffusion-weighted magnetic resonance imaging (dMRI) tractography. dMRI exploits the diffusion of water molecule along axons to generate a 3D modelization of the white matter bundles in the brain. This feature is particularly useful to visualize how a tumor affects its surrounding white matter and plan a surgical path. This paper reviews the different ways in which dMRI can be used to improve brain tumor resection, its benefits and also its limitations. We expose surgical tools that can be paired with dMRI to improve its impact on surgical outcome, such as loading the 3D tractography in the neuronavigation system and direct electrical stimulation to validate the position of the white matter bundles of interest. We also review articles validating dMRI findings using other anatomical investigation techniques, such as postmortem dissections, manganese-enhanced MRI, electrophysiological stimulations, and phantom studies with known ground truth. We will be discussing the areas of the brain where dMRI performs well and where the future challenges are. We will conclude this review with suggestions and take home messages for neurosurgeons, tractographers, and vendors for advancing the field and on how to benefit from tractography's use in clinical practice.

Direct electrical stimulation mapping of cognitive functions in the human brain

Direct electrical stimulation (DES) is a well-established clinical tool for mapping cognitive functions while patients are undergoing awake neurosurgery or invasive long-term monitoring to identify epileptogenic tissue. Despite the proliferation of a range of invasive and noninvasive methods for mapping sensory, motor and cognitive processes in the human brain, DES remains the clinical gold standard for establishing the margins of brain tissue that can be safely removed while avoiding long-term neurological deficits. In parallel, and principally over the last two decades, DES has emerged as a powerful scientific tool for testing hypotheses of brain organization and mechanistic hypotheses of cognitive function. DES can cause transient "lesions" and thus can support causal inferences about the necessity of stimulated brain regions for specific functions, as well as the separability of sensory, motor and cognitive processes. This Special Issue of Cognitive Neuropsychology emphasizes the use of DES as a research tool to advance understanding of normal brain organization and function.

Inhibition of Manual Movements at Speech Arrest Sites in the Posterior Inferior Frontal Lobe

BACKGROUND

Intraoperative stimulation of the posterior inferior frontal lobe (IFL) induces speech arrest, which is often interpreted as demonstration of essential language function. However, prior reports have described “negative motor areas” in the IFL, sites where stimulation halts ongoing limb motor activity.

OBJECTIVE

To investigate the spatial and functional relationship between IFL speech arrest areas and negative motor areas (NMAs).

METHODS

In this retrospective cohort study, intraoperative stimulation mapping was performed to localize speech and motor function, as well as arrest of hand movement, hand posture, and guitar playing in a set of patients undergoing awake craniotomy for dominant hemisphere pathologies. The incidence and localization of speech arrest and motor inhibition was analyzed.

RESULTS

Eleven patients underwent intraoperative localization of speech arrest sites and inhibitory motor areas. A total of 17 speech arrest sites were identified in the dominant frontal lobe, and, of these, 5 sites (29.4%) were also identified as NMAs. Speech arrest and arrest of guitar playing was also evoked by a single IFL site in 1 subject.

CONCLUSION

Inferior frontal gyrus speech arrest sites do not function solely in speech production. These findings provide further evidence for the complexity of language organization, and suggest the need for refined mapping strategies that discern between language-specific sites and inhibitory motor areas.

Language processing from the perspective of electrical stimulation mapping

Electrical Stimulation (ES) is a neurostimulation technique that is used to localize language functions in the brain of people with intractable epilepsy and/or brain tumors. We reviewed 25 ES articles published between 1984 and 2018 and interpreted them from a cognitive neuropsychological perspective. Our aim was to highlight ES as a tool to further our understanding of cognitive models of language. We focused on associations and dissociations between cognitive functions within the framework of two non-neuroanatomically specified models of language. Also, we discussed parallels between the ES and the stroke literatures and showed how ES data can help us to generate hypotheses regarding how language is processed. A good understanding of cognitive models of language is essential to motivate task selection and to tailor surgical procedures, for example, by avoiding testing the same cognitive functions and understanding which functions may be more or less relevant to be tested during surgery.

Speech and language adverse effects after thalamotomy and deep brain stimulation in patients with movement disorders: A meta-analysis

BACKGROUND

The thalamus has been a surgical target for the treatment of various movement disorders. Commonly used therapeutic modalities include ablative and nonablative procedures. A major clinical side effect of thalamic surgery is the appearance of speech problems.

OBJECTIVE

This review summarizes the data on the development of speech problems after thalamic surgery.

METHODS

A systematic review and meta-analysis was performed using nine databases, including Medline, Web of Science, and Cochrane Library. We also checked for articles by searching citing and cited articles. We retrieved studies between 1960 and September 2014.

RESULTS

Of a total of 2,320 patients, 19.8% (confidence interval: 14.8-25.9) had speech difficulty after thalamotomy. Speech difficulty occurred in 15% (confidence interval: 9.8-22.2) of those treated with a unilaterally and 40.6% (confidence interval: 29.5-52.8) of those treated bilaterally. Speech impairment was noticed 2- to 3-fold more commonly after left-sided procedures (40.7% vs. 15.2%). Of the 572 patients that underwent DBS, 19.4% (confidence interval: 13.1-27.8) experienced speech difficulty. Subgroup analysis revealed that this complication occurs in 10.2% (confidence interval: 7.4-13.9) of patients treated unilaterally and 34.6% (confidence interval: 21.6-50.4) treated bilaterally. After thalamotomy, the risk was higher in Parkinson's patients compared to patients with essential tremor: 19.8% versus 4.5% in the unilateral group and 42.5% versus 13.9% in the bilateral group. After DBS, this rate was higher in essential tremor patients.

CONCLUSION

Both lesioning and stimulation thalamic surgery produce adverse effects on speech. Left-sided and bilateral procedures are approximately 3-fold more likely to cause speech difficulty. This effect was higher after thalamotomy compared to DBS. In the thalamotomy group, the risk was higher in Parkinson's patients, whereas in the DBS group it was higher in patients with essential tremor. Understanding the pathophysiology of speech disturbance after thalamic procedures is a priority. © 2017 International Parkinson and Movement Disorder Society.

Selective Interference with Syntactic Encoding during Sentence Production by Direct Electrocortical Stimulation of the Inferior Frontal Gyrus

Cortical stimulation mapping (CSM) has provided important insights into the neuroanatomy of language because of its high spatial and temporal resolution, and the causal relationships that can be inferred from transient disruption of specific functions. Almost all CSM studies to date have focused on word-level processes such as naming, comprehension, and repetition. In this study, we used CSM to identify sites where stimulation interfered selectively with syntactic encoding during sentence production. Fourteen patients undergoing left-hemisphere neurosurgery participated in the study. In 7 of the 14 patients, we identified nine sites where cortical stimulation interfered with syntactic encoding but did not interfere with single word processing. All nine sites were localized to the inferior frontal gyrus, mostly to the pars triangularis and opercularis. Interference with syntactic encoding took several different forms, including misassignment of arguments to grammatical roles, misassignment of nouns to verb slots, omission of function words and inflectional morphology, and various paragrammatic constructions. Our findings suggest that the left inferior frontal gyrus plays an important role in the encoding of syntactic structure during sentence production.

The contribution of surgical brain mapping to the understanding of the anatomo-functional basis of syntax: A critical review

A wide range of studies on language assessment during awake brain surgery is nowadays available. Yet, a consensus on a standardized protocol for intraoperative language mapping is still lacking. More specifically, very limited information is offered about intraoperative assessment of a crucial component of language such as syntax. This review aims at critically analyzing the intraoperative studies investigating the cerebral basis of syntactic processing. A comprehensive query was performed on the literature, returning a total of 18 studies. These papers were analyzed according to two complementary criteria, based on the distinction between morphosyntax and syntax. The first criterion focused on the tasks and stimuli employed intraoperatively. Studies were divided into three different groups: group 1 included those studies that overtly aimed at investigating morphosyntactic processes; group 2 included studies that did not explicitly focus on syntax, yet employed stimuli requiring morphosyntactic processing; and group 3 included studies reporting some generic form of syntactic deficit, although not further investigated. The second criterion focused on the syntactic structures of the sentences assessed intraoperatively, analyzing the canonicity of sentence structure (i.e., canonical versus non-canonical word order). The global picture emerging from our analysis indicates that what was investigated in the intraoperative literature is morphosyntactic processing, rather than pure syntax. The study of the neurobiology of syntax during awake surgery seems thus to be still at an early stage, in need of systematic, linguistically grounded investigations.

The hearing ear is always found close to the speaking tongue: Review of the role of the motor system in speech perception

Does "the motor system" play "a role" in speech perception? If so, where, how, and when? We conducted a systematic review that addresses these questions using both qualitative and quantitative methods. The qualitative review of behavioural, computational modelling, non-human animal, brain damage/disorder, electrical stimulation/recording, and neuroimaging research suggests that distributed brain regions involved in producing speech play specific, dynamic, and contextually determined roles in speech perception. The quantitative review employed region and network based neuroimaging meta-analyses and a novel text mining method to describe relative contributions of nodes in distributed brain networks. Supporting the qualitative review, results show a specific functional correspondence between regions involved in non-linguistic movement of the articulators, covertly and overtly producing speech, and the perception of both nonword and word sounds. This distributed set of cortical and subcortical speech production regions are ubiquitously active and form multiple networks whose topologies dynamically change with listening context. Results are inconsistent with motor and acoustic only models of speech perception and classical and contemporary dual-stream models of the organization of language and the brain. Instead, results are more consistent with complex network models in which multiple speech production related networks and subnetworks dynamically self-organize to constrain interpretation of indeterminant acoustic patterns as listening context requires.

Stereotactic probability and variability of speech arrest and anomia sites during stimulation mapping of the language dominant hemisphere

OBJECTIVE

Functional mapping using direct cortical stimulation is the gold standard for the prevention of postoperative morbidity during resective surgery in dominant-hemisphere perisylvian regions. Its role is necessitated by the significant interindividual variability that has been observed for essential language sites. The aim in this study was to determine the statistical probability distribution of eliciting aphasic errors for any given stereotactically based cortical position in a patient cohort and to quantify the variability at each cortical site.

METHODS

Patients undergoing awake craniotomy for dominant-hemisphere primary brain tumor resection between 1999 and 2014 at the authors' institution were included in this study, which included counting and picture-naming tasks during dense speech mapping via cortical stimulation. Positive and negative stimulation sites were collected using an intraoperative frameless stereotactic neuronavigation system and were converted to Montreal Neurological Institute coordinates. Data were iteratively resampled to create mean and standard deviation probability maps for speech arrest and anomia. Patients were divided into groups with a “classic” or an “atypical” location of speech function, based on the resultant probability maps. Patient and clinical factors were then assessed for their association with an atypical location of speech sites by univariate and multivariate analysis.

RESULTS

Across 102 patients undergoing speech mapping, the overall probabilities of speech arrest and anomia were 0.51 and 0.33, respectively. Speech arrest was most likely to occur with stimulation of the posterior inferior frontal gyrus (maximum probability from individual bin = 0.025), and variance was highest in the dorsal premotor cortex and the posterior superior temporal gyrus. In contrast, stimulation within the posterior perisylvian cortex resulted in the maximum mean probability of anomia (maximum probability = 0.012), with large variance in the regions surrounding the posterior superior temporal gyrus, including the posterior middle temporal, angular, and supramarginal gyri. Patients with atypical speech localization were far more likely to have tumors in canonical Broca's or Wernicke's areas (OR 7.21, 95% CI 1.67–31.09, p < 0.01) or to have multilobar tumors (OR 12.58, 95% CI 2.22–71.42, p < 0.01), than were patients with classic speech localization.

CONCLUSIONS

This study provides statistical probability distribution maps for aphasic errors during cortical stimulation mapping in a patient cohort. Thus, the authors provide an expected probability of inducing speech arrest and anomia from specific 10-mm2 cortical bins in an individual patient. In addition, they highlight key regions of interindividual mapping variability that should be considered preoperatively. They believe these results will aid surgeons in their preoperative planning of eloquent cortex resection.

From Mimicry to Language: A Neuroanatomically Based Evolutionary Model of the Emergence of Vocal Language

The auditory cortex communicates with the frontal lobe via the middle temporal gyrus (auditory ventral stream; AVS) or the inferior parietal lobule (auditory dorsal stream; ADS). Whereas the AVS is ascribed only with sound recognition, the ADS is ascribed with sound localization, voice detection, prosodic perception/production, lip-speech integration, phoneme discrimination, articulation, repetition, phonological long-term memory and working memory. Previously, I interpreted the juxtaposition of sound localization, voice detection, audio-visual integration and prosodic analysis, as evidence that the behavioral precursor to human speech is the exchange of contact calls in non-human primates. Herein, I interpret the remaining ADS functions as evidence of additional stages in language evolution. According to this model, the role of the ADS in vocal control enabled early Homo (Hominans) to name objects using monosyllabic calls, and allowed children to learn their parents' calls by imitating their lip movements. Initially, the calls were forgotten quickly but gradually were remembered for longer periods. Once the representations of the calls became permanent, mimicry was limited to infancy, and older individuals encoded in the ADS a lexicon for the names of objects (phonological lexicon). Consequently, sound recognition in the AVS was sufficient for activating the phonological representations in the ADS and mimicry became independent of lip-reading. Later, by developing inhibitory connections between acoustic-syllabic representations in the AVS and phonological representations of subsequent syllables in the ADS, Hominans became capable of concatenating the monosyllabic calls for repeating polysyllabic words (i.e., developed working memory). Finally, due to strengthening of connections between phonological representations in the ADS, Hominans became capable of encoding several syllables as a single representation (chunking). Consequently, Hominans began vocalizing and mimicking/rehearsing lists of words (sentences).

Verbal-Spatial and Visuospatial Coding of the SNARC Effect: A Comparative Study in Cultures With Different Reading Directions

Using the magnitude comparison task, the current study tested verbal-spatial and visuospatial coding accounts by comparing the spatial-numerical association of response codes effect in 30 Chinese-speaking and 60 bilingual Uighur Chinese participants. The experimental tasks were presented using Chinese words for 30 Chinese-speaking and 30 bilingual Uighur Chinese participants, while only Uighur words were presented to the remaining 30 bilingual Uighur Chinese participants. Overall, the results of the current study showed that verbal-spatial coding could be applied to the experimental task when presented using Chinese words, but visuospatial coding could be applied to the experimental task when presented using Uighur words. The findings demonstrated that spatial coding was flexible and depended upon the language context in which the experimental task was presented.

The Wernicke conundrum and the anatomy of language comprehension in primary progressive aphasia

Wernicke's aphasia is characterized by severe word and sentence comprehension impairments. The location of the underlying lesion site, known as Wernicke's area, remains controversial. Questions related to this controversy were addressed in 72 patients with primary progressive aphasia who collectively displayed a wide spectrum of cortical atrophy sites and language impairment patterns. Clinico-anatomical correlations were explored at the individual and group levels. These analyses showed that neuronal loss in temporoparietal areas, traditionally included within Wernicke's area, leave single word comprehension intact and cause inconsistent impairments of sentence comprehension. The most severe sentence comprehension impairments were associated with a heterogeneous set of cortical atrophy sites variably encompassing temporoparietal components of Wernicke's area, Broca's area, and dorsal premotor cortex. Severe comprehension impairments for single words, on the other hand, were invariably associated with peak atrophy sites in the left temporal pole and adjacent anterior temporal cortex, a pattern of atrophy that left sentence comprehension intact. These results show that the neural substrates of word and sentence comprehension are dissociable and that a circumscribed cortical area equally critical for word and sentence comprehension is unlikely to exist anywhere in the cerebral cortex. Reports of combined word and sentence comprehension impairments in Wernicke's aphasia come almost exclusively from patients with cerebrovascular accidents where brain damage extends into subcortical white matter. The syndrome of Wernicke's aphasia is thus likely to reflect damage not only to the cerebral cortex but also to underlying axonal pathways, leading to strategic cortico-cortical disconnections within the language network. The results of this investigation further reinforce the conclusion that the left anterior temporal lobe, a region ignored by classic aphasiology, needs to be inserted into the language network with a critical role in the multisynaptic hierarchy underlying word comprehension and object naming.

From where to what: a neuroanatomically based evolutionary model of the emergence of speech in humans

In the brain of primates, the auditory cortex connects with the frontal lobe via the temporal pole (auditory ventral stream; AVS) and via the inferior parietal lobule (auditory dorsal stream; ADS). The AVS is responsible for sound recognition, and the ADS for sound-localization, voice detection and audio-visual integration. I propose that the primary role of the ADS in monkeys/apes is the perception and response to contact calls. These calls are exchanged between tribe members (e.g., mother-offspring) and are used for monitoring location. Perception of contact calls occurs by the ADS detecting a voice, localizing it, and verifying that the corresponding face is out of sight. The auditory cortex then projects to parieto-frontal visuospatial regions (visual dorsal stream) for searching the caller, and via a series of frontal lobe-brainstem connections, a contact call is produced in return. Because the human ADS processes also speech production and repetition, I further describe a course for the development of speech in humans. I propose that, due to duplication of a parietal region and its frontal projections, and strengthening of direct frontal-brainstem connections, the ADS converted auditory input directly to vocal regions in the frontal lobe, which endowed early Hominans with partial vocal control. This enabled offspring to modify their contact calls with intonations for signaling different distress levels to their mother. Vocal control could then enable question-answer conversations, by offspring emitting a low-level distress call for inquiring about the safety of objects, and mothers responding with high- or low-level distress calls. Gradually, the ADS and the direct frontal-brainstem connections became more robust and vocal control became more volitional. Eventually, individuals were capable of inventing new words and offspring were capable of inquiring about objects in their environment and learning their names via mimicry.

Apraxic agraphia following bithalamic damage

OBJECTIVES

Apraxic agraphia (AA) is a peripheral writing disorder generally considered to result from a causative lesion in the parietal and/or prefrontal lobe of the language dominant hemisphere (De Smet, Engelborghs, Paquier, De Deyn, & Mariën, 2011). De Smet et al. (2011), however, confirmed that AA might be associated with lesions outside the typical language areas such as the cerebellum or the thalamus. We report a 32-year-old ambidextrous patient with a left frontal lobectomy who following bilateral thalamic damage developed AA.

METHOD

Detailed neurolinguistic and neurocognitive test results were obtained after resection of an extensive left frontal lobe tumour by means of a set of standardised tests. Repeated investigations were performed after a bithalamic stroke. Functional imaging was performed by means of quantified SPECT.

RESULTS

Normal neurolinguistic test results were obtained after tumour resection. Neurocognitive test results, however, showed a dysexecutive syndrome and frontal behavioural deficits, including response inhibition. AA occurred after a bithalamic stroke while non-handwriting written language skills, such as typing, were normal. Quantified SPECT showed a significant bifrontal hypoperfusion.

CONCLUSION

Neurolinguistic follow-up findings and SPECT evidence in this unique patient with bithalamic damage for the first time indicate that AA in the alphabetic script may result from diaschisis affecting the frontal writing centre. The findings suggest that the thalamus is critically implicated in the neural network subserving graphomotor processing.

Determination of the posterior boundary of Wernicke's area based on multimodal connectivity profiles

Wernicke's area is one of the most important language regions and has been widely studied in both basic research and clinical neurology. However, its exact anatomy has been controversial. In this study, we proposed to address the anatomy of Wernicke's area by investigating different connectivity profiles. First, the posterior superior temporal gyrus (STG), traditionally called "Wernicke's area", was parcellated into three component subregions with diffusion MRI. Then, whole-brain anatomical connectivity, resting-state functional connectivity (RSFC) and meta-analytic connectivity modeling (MACM) analyses were used to establish the anatomical, resting-state and task-related coactivation network of each subregion to identify which subregions participated in the language network. In addition, behavioral domain analysis, meta-analyses of semantics, execution speech, and phonology and intraoperative electrical stimulation were used to determine which subregions were involved in language processing. Anatomical connectivity, RSFC and MACM analyses consistently identified that the two anterior subregions in the posterior STG primarily participated in the language network, whereas the most posterior subregion in the temporoparietal junction area primarily participated in the default mode network. Moreover, the behavioral domain analyses, meta-analyses of semantics, execution speech and phonology and intraoperative electrical stimulation mapping also confirmed that only the two anterior subregions were involved in language processing, whereas the most posterior subregion primarily participated in social cognition. Our findings revealed a convergent posterior anatomical border for Wernicke's area and indicated that the brain's functional subregions can be identified on the basis of its specific structural and functional connectivity patterns.

Primary progressive aphasia and the evolving neurology of the language network

Primary progressive aphasia (PPA) is caused by selective neurodegeneration of the language-dominant cerebral hemisphere; a language deficit initially arises as the only consequential impairment and remains predominant throughout most of the course of the disease. Agrammatic, logopenic and semantic subtypes, each reflecting a characteristic pattern of language impairment and corresponding anatomical distribution of cortical atrophy, represent the most frequent presentations of PPA. Such associations between clinical features and the sites of atrophy have provided new insights into the neurology of fluency, grammar, word retrieval, and word comprehension, and have necessitated modification of concepts related to the functions of the anterior temporal lobe and Wernicke's area. The underlying neuropathology of PPA is, most commonly, frontotemporal lobar degeneration in the agrammatic and semantic forms, and Alzheimer disease (AD) pathology in the logopenic form; the AD pathology often displays atypical and asymmetrical anatomical features consistent with the aphasic phenotype. The PPA syndrome reflects complex interactions between disease-specific neuropathological features and patient-specific vulnerability. A better understanding of these interactions might help us to elucidate the biology of the language network and the principles of selective vulnerability in neurodegenerative diseases. We review these aspects of PPA, focusing on advances in our understanding of the clinical features and neuropathology of PPA and what they have taught us about the neural substrates of the language network.

Asymmetric connectivity between the anterior temporal lobe and the language network

The anterior temporal lobe (ATL) sits at the confluence of auditory, visual, olfactory, transmodal, and limbic processing hierarchies. In keeping with this anatomical heterogeneity, the ATL has been implicated in numerous functional domains, including language, semantic memory, social cognition, and facial identification. One question that has attracted considerable discussion is whether the ATL contains a mosaic of differentially specialized areas or whether it provides a domain-independent amodal hub. In the current study, based on task-free fMRI in right-handed neurologically intact participants, we found that the left lateral ATL is interconnected with hubs of the temporosylvian language network, including the inferior frontal gyrus and middle temporal gyrus of the ipsilateral hemisphere and, to a lesser extent, with homotopic areas of the contralateral hemisphere. In contrast, the right lateral ATL had much weaker functional connectivity with these regions in either hemisphere. Together with evidence that has been gathered in lesion-mapping and event-related neuroimaging studies, this asymmetry of functional connectivity supports the inclusion of the left ATL within the language network, a relationship that had been overlooked by classic aphasiology. The asymmetric domain selectivity for language of the left ATL, together with the absence of such an affiliation in the right ATL, is inconsistent with a strict definition of domain-independent amodal functionality in this region of the brain.

Transcranial direct current stimulation (tDCS) and language

Transcranial direct current stimulation (tDCS), a non-invasive neuromodulation technique inducing prolonged brain excitability changes and promoting cerebral plasticity, is a promising option for neurorehabilitation. Here, we review progress in research on tDCS and language functions and on the potential role of tDCS in the treatment of post-stroke aphasia. Currently available data suggest that tDCS over language-related brain areas can modulate linguistic abilities in healthy individuals and can improve language performance in patients with aphasia. Whether the results obtained in experimental conditions are functionally important for the quality of life of patients and their caregivers remains unclear. Despite the fact that important variables are yet to be determined, tDCS combined with rehabilitation techniques seems a promising therapeutic option for aphasia.

The thalamus and language revisited

Regionalization of language function within the left thalamus has been established with language and verbal memory effects of thalamic stimulation during surgery for movement disorders. Three distinct language effects of thalamic stimulation were established: anomia from posterior ventrolateral (VL) and pulvinar regions; perseveration from mid-VL regions; and, a memory and acceleratory effect from anterior VL, described as a "specific alerting response" (SAR). These studies are reviewed in context of pertinent contemporary and recent literature on the thalamic role in memory and language. An explicit mechanistic model for the anomia and SAR effect is proposed. The suggested model for the SAR effect involves secondary switching in the striatum by the activation of thalamostriatal projections, whereas the anomia effect implicates the disruption of the cortical synchronization action of pulvinar via the cortico-pulvinar-cortical projection system. Further experimental data is required to firmly establish these mechanisms.

Human Temporal Cortical Single Neuron Activity during Language: A Review

Findings from recordings of human temporal cortical single neuron activity during several measures of language, including object naming and word reading are reviewed and related to changes in activity in the same neurons during recent verbal memory and verbal associative learning measures, in studies conducted during awake neurosurgery for the treatment of epilepsy. The proportion of neurons changing activity with language tasks was similar in either hemisphere. Dominant hemisphere activity was characterized by relative inhibition, some of which occurred during overt speech, possibly to block perception of one’s own voice. However, the majority seems to represent a dynamic network becoming active with verbal memory encoding and especially verbal learning, but inhibited during performance of overlearned language tasks. Individual neurons are involved in different networks for different aspects of language, including naming or reading and naming in different languages. The majority of the changes in activity were tonic sustained shifts in firing. Patterned phasic activity for specific language items was very infrequently recorded. Human single neuron recordings provide a unique perspective on the biologic substrate for language, for these findings are in contrast to many of the findings from other techniques for investigating this.

Accuracy of diffusion tensor magnetic resonance imaging-based tractography for surgery of gliomas near the pyramidal tract: a significant correlation between subcortical electrical stimulation and postoperative tractography

BACKGROUND

Diffusion tensor (DT) imaging-based fiber tracking is a noninvasive magnetic resonance technique that can delineate the course of white matter fibers.

OBJECTIVE

To evaluate the accuracy and usefulness of this DT imaging-based fiber tracking for surgery in patients with gliomas near the pyramidal tract (PT).

METHODS

Subjects comprised 32 patients with gliomas near the PT. DT imaging-based fiber tracks of the PT were generated before and within 3 days after surgery in all patients. A tractography-integrated navigation system was used during the operation. Cortical and subcortical motor-evoked potentials (MEPs) were also monitored during resection to maximize the preservation of motor function. The threshold intensity for subcortical MEPs was examined by searching the stimulus points and changing the stimulus intensity. Minimum distance between the resection border and the illustrated PT was measured on postoperative tractography.

RESULTS

In all subjects, DT imaging-based tractography of the PT was successfully performed, preoperatively demonstrating the relationship between tumors and the PT. With the use of the tractography-integrated navigation system and intraoperative MEPs, motor function was preserved postoperatively in all patients. A significant correlation was seen between threshold intensity for subcortical MEPs and the distance between the resection border and PT on postoperative DT imaging.

CONCLUSION

DT imaging-based fiber tracking is a reliable and accurate method for mapping the course of subcortical PTs. Fiber tracking and intraoperative MEPs were useful for preserving motor function in patients with gliomas near the PT.

Reproducibility of single-subject fMRI language mapping with AMPLE normalization

PURPOSE

To evaluate the reproducibility of presurgical functional MRI (fMRI) language mapping based on test-retest scans, comparing traditional activation t-maps to relative activation maps normalized by activation mapping as percentage of local excitation (AMPLE).

MATERIALS AND METHODS

Language fMRI scans were performed by 12 healthy volunteer subjects undergoing a standard clinical presurgical mapping protocol in multiple independent scan sessions. Objective relative AMPLE activation maps were generated automatically by normalizing statistical t-value maps to the local peak activation amplitude within each functional brain region. The spatial distribution of activation was quantified and compared across mapping algorithms, subjects, scanners, and pulse sequences.

RESULTS

The spatial distribution of traditional blood oxygen level-dependent (BOLD) t-value statistical activation maps was highly variable in test-retest scans of single subjects, whereas AMPLE normalized maps were highly reproducible in terms of the location, hemispheric laterality, and spatial extent of relative activation. AMPLE map reproducibility was good regardless of scanner, field strength, or pulse sequence used, but reproducibility was best for scans acquired on the same scanner using the same pulse sequence.

CONCLUSION

Reproducibility of the spatial pattern of BOLD activation makes relative amplitude fMRI mapping a useful normalization tool for clinical imaging of language function, where reproducibility and quantitative measurements are critical concerns.

Risk of seizures during intraoperative electrocortical stimulation of brain motor areas: a retrospective study on 50 patients

Tumours close to cerebral cortices involved in motor and language functions represent a major challenge for neurosurgeons. Intraoperative neurophysiologic monitoring is useful to gain insight into the anatomy of and the relationship between pathological and normal tissues. In this study we report on the experience of electrocortical stimulation in the surgery of tumours adjacent to the motor cortex in 50 patients under general anaesthesia (26 under propofol, 24 under sevoflurane), and on EMG responses from contralateral muscles. In 18 patients stimulation evoked seizures, which were controlled only with antiepileptic drugs (36%). No difference was found in the incidence of intra-operative seizures between the patients with (10 out of 27) or without (8 out of 23) pre-operative epilepsy (p = 0.8685). The majority of the patients (13 out of 18) with intraoperative seizures were under sevoflurane (p = 0.01) and there was a statistically significant difference in the mean electrical intensity used between the two groups, sevoflurane and propofol, respectively 5.3 ± 1.3 mA and 3.6 ± 2 mA (p = 0.03). Regarding pre-operative anti-epileptic drugs, the use of levitiracetam was associated with a high incidence of intraoperative seizure (5 out of 6 patients). 4 patients developed new, unwanted, permanent neurological deficits, of which 2 had intraoperative seizures controlled only with antiepileptic drugs. Electrocortical stimulation is a powerful tool to understand the functional organization of patients' eloquent areas. Intraoperative epileptic seizures may represent an unwanted complication preventing further stimulation and possibly worsening neurological results. The choice of anaesthetics according to the patients' characteristics, pre-op symptoms and medical therapy is pivotal.

Relationships between spike-free local field potentials and spike timing in human temporal cortex

Intracortical recordings comprise both fast events, action potentials (APs), and slower events, known as local field potentials (LFPs). Although it is believed that LFPs mostly reflect local synaptic activity, it is unclear which of their signal components are most closely related to synaptic potentials and would therefore be causally related to the occurrence of individual APs. This issue is complicated by the significant contribution from AP waveforms, especially at higher LFP frequencies. In recordings of single-cell activity and LFPs from the human temporal cortex, we computed quantitative, nonlinear, causal dynamic models for the prediction of AP timing from LFPs, at millisecond resolution, before and after removing AP contributions to the LFP. In many cases, the timing of a significant number of single APs could be predicted from spike-free LFPs at different frequencies. Not surprisingly, model performance was superior when spikes were not removed. Cells whose activity was predicted by the spike-free LFP models generally fell into one of two groups: in the first group, neuronal spike activity was associated with specific phases of low LFP frequencies, lower spike activity at high LFP frequencies, and a stronger linear component in the spike-LFP model; in the second group, neuronal spike activity was associated with larger amplitude of high LFP frequencies, less frequent phase locking, and a stronger nonlinear model component. Spike timing in the first group was better predicted by the sign and level of the LFP preceding the spike, whereas spike timing in the second group was better predicted by LFP power during a certain time window before the spike.