Structure and function in acquired prosopagnosia: lessons from a series of 10 patients with brain damage

The neuropsychological evaluation of face identity recognition

Facial identity recognition (FIR) is arguably the ultimate form of recognition for the adult human brain. Even if the term prosopagnosia is reserved for exceptionally rare brain-damaged cases with a category-specific abrupt loss of FIR at adulthood, subjective and objective impairments or difficulties of FIR are common in the neuropsychological population. Here we provide a critical overview of the evaluation of FIR both for clinicians and researchers in neuropsychology. FIR impairments occur following many causes that should be identified objectively by both general and specific, behavioral and neural examinations. We refute the commonly used dissociation between perceptual and memory deficits/tests for FIR, since even a task involving the discrimination of unfamiliar face images presented side-by-side relies on cortical memories of faces in the right-lateralized ventral occipito-temporal cortex. Another frequently encountered confusion is between specific deficits of the FIR function and a more general impairment of semantic memory (of people), the latter being most often encountered following anterior temporal lobe damage. Many computerized tests aimed at evaluating FIR have appeared over the last two decades, as reviewed here. However, despite undeniable strengths, they often suffer from ecological limitations, difficulties of instruction, as well as a lack of consideration for processing speed and qualitative information. Taking into account these issues, a recently developed behavioral test with natural images manipulating face familiarity, stimulus inversion, and correct response times as a key variable appears promising. The measurement of electroencephalographic (EEG) activity in the frequency domain from fast periodic visual stimulation also appears as a particularly promising tool to complete and enhance the neuropsychological assessment of FIR.

Long-Term Bridge Training Induces Functional Plasticity Changes in the Brain of Early-Adult Individuals

The aim of this study was to investigate the impact of extended bridge expertise on rapid perceptual processing and brain functional plasticity in early adulthood, utilizing functional magnetic resonance imaging (fMRI). In this investigation, we compared 6 high-level college bridge players with 25 college students lacking bridge experience, assessing their intelligence and working memory. Additionally, we scrutinized behavioral performance and whole-brain activation patterns during an image perceptual judgment task. Findings indicated significant group and interaction effects at the behavioral level. Bridge players exhibited prolonged reaction times and enhanced accuracy on card tasks. At the neural level, the activation level of bridge players in the occipital lobe exceeded that of ordinary college students, with more pronounced group effects in the motor area and inferior parietal lobule during card tasks. This implies that bridge expertise in early adulthood induces functional plasticity changes in regions associated with visual processing and automated mathematical computation.

What is developmental about developmental prosopagnosia?

Developmental prosopagnosia (DP) is characterised by difficulties recognising face identities and is associated with diverse co-occurring object recognition difficulties. The high co-occurrence rate and heterogeneity of associated difficulties in DP is an intrinsic feature of developmental conditions, where co-occurrence of difficulties is the rule, rather than the exception. However, despite its name, cognitive and neural theories of DP rarely consider the developmental context in which these difficulties occur. This leaves a large gap in our understanding of how DP emerges in light of the developmental trajectory of face recognition. Here, we argue that progress in the field requires re-considering the developmental origins of differences in face recognition abilities, rather than studying the end-state alone. In practice, considering development in DP necessitates a re-evaluation of current approaches in recruitment, design, and analyses.

The anterior fusiform gyrus: The ghost in the cortical face machine

Face-selective regions in the human ventral occipito-temporal cortex (VOTC) have been defined for decades mainly with functional magnetic resonance imaging. This face-selective VOTC network is traditionally divided in a posterior 'core' system thought to subtend face perception, and regions of the anterior temporal lobe as a semantic memory component of an extended general system. In between these two putative systems lies the anterior fusiform gyrus and surrounding sulci, affected by magnetic susceptibility artifacts. Here we suggest that this methodological gap overlaps with and contributes to a conceptual gap between (visual) perception and semantic memory for faces. Filling this gap with intracerebral recordings and direct electrical stimulation reveals robust face-selectivity in the anterior fusiform gyrus and a crucial role of this region, especially in the right hemisphere, in identity recognition for both familiar and unfamiliar faces. Based on these observations, we propose an integrated theoretical framework for human face (identity) recognition according to which face-selective regions in the anterior fusiform gyrus join the dots between posterior and anterior cortical face memories.

Stability of face recognition abilities after left or right anterior temporal lobectomy

Patients with anterior temporal lobe (ATL) resection due to mesial temporal lobe epilepsy (MTLE) have difficulties at identifying familiar faces and explicitly remembering newly learned faces but their ability to individuate unfamiliar faces remains largely unknown. Moreover, the extent to which their difficulties with familiar face identity recognition and learning is truly due to the ATL resection remains unknown. Here, we report a study of 24 MTLE patients and matched healthy controls tested with an extensive set of seven face and visual object recognition tasks (including three tasks evaluating unfamiliar face individuation) before and about 6 months after unilateral (nine left, 15 right) ATL resection. We found that ATL resection has little or no effect on the patients' preserved pre-surgical ability to perform unfamiliar face individuation, both at the group and individual levels. More surprisingly, ATL resection also has little effect on the patients' performance at recognizing and naming famous faces as well as at learning new faces. A substantial proportion of right MTLE patients (33%) even improved their response times on several tasks, which may indicate a functional release of visuo-spatial processing after resection in the right ATL. Altogether this study shows that face recognition abilities are mainly unaffected by ATL resection in MTLE, either because the critical regions for face recognition are spared or because performance at some tasks is already lower than normal preoperatively. Overall, these findings urge caution when interpreting the causal effect of brain lesions on face recognition ability in patients with ATL resection due to MTLE. They also illustrate the complexity of predicting cognitive outcomes after epilepsy surgery because of the influence of many different intertwined factors.

Prosopagnosia: face blindness and its association with neurological disorders

Loss of facial recognition or prosopagnosia has been well-recognized for over a century. It has been categorized as developmental or acquired depending on whether the onset is in early childhood or beyond, and acquired cases can have degenerative or non-degenerative aetiologies. Prosopagnosia has been linked to involvement of the fusiform gyri, mainly in the right hemisphere. The literature on prosopagnosia comprises case reports and small case series. We aim to assess demographic, clinical and imaging characteristics and neurological and neuropathological disorders associated with a diagnosis of prosopagnosia in a large cohort. Patients were categorized as developmental versus acquired; those with acquired prosopagnosia were further subdivided into degenerative versus non-degenerative, based on neurological aetiology. We assessed regional involvement on [18F] fluorodeoxyglucose-PET and MRI of the right and left frontal, temporal, parietal and occipital lobes. The Intake and Referral Center at the Mayo Clinic identified 487 patients with possible prosopagnosia, of which 336 met study criteria for probable or definite prosopagnosia. Ten patients, 80.0% male, had developmental prosopagnosia including one with Niemann-Pick type C and another with a forkhead box G1 gene mutation. Of the 326 with acquired prosopagnosia, 235 (72.1%) were categorized as degenerative, 91 (27.9%) as non-degenerative. The most common degenerative diagnoses were posterior cortical atrophy, primary prosopagnosia syndrome, Alzheimer's disease dementia and semantic dementia, with each diagnosis accounting for >10% of this group. The most common non-degenerative diagnoses were infarcts (ischaemic and haemorrhagic), epilepsy-related and primary brain tumours, each accounting for >10%. We identified a group of patients with non-degenerative transient prosopagnosia in which facial recognition loss improved or resolved over time. These patients had migraine-related prosopagnosia, posterior reversible encephalopathy syndrome, delirium, hypoxic encephalopathy and ischaemic infarcts. On [18F] fluorodeoxyglucose-PET, the temporal lobes proved to be the most frequently affected regions in 117 patients with degenerative prosopagnosia, while in 82 patients with non-degenerative prosopagnosia, MRI revealed the right temporal and right occipital lobes as most affected by a focal lesion. The most common pathological findings in those with degenerative prosopagnosia were frontotemporal lobar degeneration with hippocampal sclerosis and mixed Alzheimer's and Lewy body disease pathology. In this large case series of patients diagnosed with prosopagnosia, we observed that facial recognition loss occurs across a wide range of acquired degenerative and non-degenerative neurological disorders, most commonly in males with developmental prosopagnosia. The right temporal and occipital lobes, and connecting fusiform gyrus, are key areas. Multiple different pathologies cause degenerative prosopagnosia.

Brain functional segregation, handedness and cognition in situs inversus totalis: A replication study

Situs inversus totalis (SIT) is a rare congenital anomaly in which the arrangement of the visceral organs is completely left-right mirrored. A previous study by our lab suggests that SIT (N = 15) correlated with more heterogeneous asymmetrical brain organization and increased left-handedness. In addition, visceral reversal correlated with poorer cognitive performance, especially when hemisphere organization was atypical. The current study sought to replicate these findings in a larger sample. We scanned 23 volunteers with SIT as well as an equal number of controls with usual organ arrangement, and used fMRI to determine their hemisphere dominance for two left hemisphere functions (language and manual praxis) and two right hemisphere functions (spatial attention and face recognition). Effects of SIT etiology were explored by pooling data from the original cohort with the replication sample. Our results reveal that each of those four cognitive functions demonstrated the expected population dominance in SIT, albeit they were less pronounced - but not significantly so - compared to controls. Unusual patterns of hemispheric crowding and mirror-reversal of functional brain organization was observed more often in SIT (48%) than in the controls (30%), but this difference also did not reach statistical significance. However, left-handedness was found to be significantly more common in SIT (26%) than in the overall population (10.6%). Finally, cognitive ability, as assessed by a neuropsychological test battery, was not associated with organ situs or hemisphere organization. Taken together, our data adds to the growing evidence that the determinants of visceral and neural asymmetries are largely independent from one another and that complete situs inversus does not co-occur with an obligatory transposition of the brain's functional architecture. There nevertheless might be instances in which (genetic) mechanisms could simultaneously cause complete visceral reversal and atypical brain laterality.

Null effect of anodal and cathodal transcranial direct current stimulation (tDCS) on own- and other-race face recognition

Successful face recognition is important for social interactions and public security. Although some preliminary evidence suggests that anodal and cathodal transcranial direct current stimulation (tDCS) might modulate own- and other-race face identification, respectively, the findings are largely inconsistent. Hence, we examined the effect of both anodal and cathodal tDCS on the recognition of own- and other-race faces. Ninety participants first completed own- and other-race Cambridge Face Memory Test (CFMT) as baseline measurements. Next, they received either anodal tDCS, cathodal tDCS or sham stimulation and finally they completed alternative versions of the own- and other-race CFMT. No difference in performance, in terms of accuracy and reaction time, for own- and other-race face recognition between anodal tDCS, cathodal tDCS and sham stimulation was found. Our findings cast doubt upon the efficacy of tDCS to modulate performance in face identification tasks.

Intracerebral electrical stimulation of the face-selective right lateral fusiform gyrus transiently impairs face identity recognition

Neuroimaging and intracranial electrophysiological studies have consistently shown the largest and most consistent face-selective neural activity in the middle portion of the human right lateral fusiform gyrus ('fusiform face area(s)', FFA). Yet, direct evidence for the critical role of this region in face identity recognition (FIR) is still lacking. Here we report the first evidence of transient behavioral impairment of FIR during focal electrical stimulation of the right FFA. Upon stimulation of an electrode contact within this region, subject CJ, who shows typical FIR ability outside of stimulation, was transiently unable to point to pictures of famous faces among strangers and to match pictures of famous or unfamiliar faces presented simultaneously for their identity. Her performance at comparable tasks with other visual materials (written names, pictures of buildings) remained unaffected by stimulation at the same location. During right FFA stimulation, CJ consistently reported that simultaneously presented faces appeared as being the same identity, with little or no distortion of the spatial face configuration. Independent electrophysiological recordings showed the largest neural face-selective and face identity activity at the critical electrode contacts. Altogether, this extensive multimodal case report supports the causal role of the right FFA in FIR.

Visual imagery deficits in posterior cortical atrophy

Visual imagery has a close overlapping relationship with visual perception. Posterior cortical atrophy (PCA) is a neurodegenerative syndrome marked by early impairments in visuospatial processing and visual object recognition. We asked whether PCA would therefore also be marked by deficits in visual imagery, tested using objective forced-choice questionnaires, and whether imagery deficits would be selective for certain properties. We recruited four patients with PCA and a patient with integrative visual agnosia due to bilateral occipitotemporal strokes for comparison. We administered a test battery probing imagery for object shape, size, colour lightness, hue, upper-case letters, lower-case letters, word shape, letter construction, and faces. All subjects showed significant impairments in visual imagery, with imagery for lower-case letters most likely to be spared. We conclude that PCA subjects can show severe deficits in visual imagery. Further work is needed to establish how frequently this occurs and how early it can be found.

The Neural Correlates of Developmental Prosopagnosia: Twenty-Five Years on

Faces play a crucial role in social interactions. Developmental prosopagnosia (DP) refers to the lifelong difficulty in recognizing faces despite the absence of obvious signs of brain lesions. In recent decades, the neural substrate of this condition has been extensively investigated. While early neuroimaging studies did not reveal significant functional and structural abnormalities in the brains of individuals with developmental prosopagnosia (DPs), recent evidence identifies abnormalities at multiple levels within DPs' face-processing networks. The current work aims to provide an overview of the convergent and contrasting findings by examining twenty-five years of neuroimaging literature on the anatomo-functional correlates of DP. We included 55 original papers, including 63 studies that compared the brain structure (MRI) and activity (fMRI, EEG, MEG) of healthy control participants and DPs. Despite variations in methods, procedures, outcomes, sample selection, and study design, this scoping review suggests that morphological, functional, and electrophysiological features characterize DPs' brains, primarily within the ventral visual stream. Particularly, the functional and anatomical connectivity between the Fusiform Face Area and the other face-sensitive regions seems strongly impaired. The cognitive and clinical implications as well as the limitations of these findings are discussed in light of the available knowledge and challenges in the context of DP.

Single neuron responses underlying face recognition in the human midfusiform face-selective cortex

Faces are critical for social interactions and their recognition constitutes one of the most important and challenging functions of the human brain. While neurons responding selectively to faces have been recorded for decades in the monkey brain, face-selective neural activations have been reported with neuroimaging primarily in the human midfusiform gyrus. Yet, the cellular mechanisms producing selective responses to faces in this hominoid neuroanatomical structure remain unknown. Here we report single neuron recordings performed in 5 human subjects (1 male, 4 females) implanted with intracerebral microelectrodes in the face-selective midfusiform gyrus, while they viewed pictures of familiar and unknown faces and places. We observed similar responses to faces and places at the single cell level, but a significantly higher number of neurons responding to faces, thus offering a mechanistic account for the face-selective activations observed in this region. Although individual neurons did not respond preferentially to familiar faces, a population level analysis could consistently determine whether or not the faces (but not the places) were familiar, only about 50 ms after the initial recognition of the stimuli as faces. These results provide insights into the neural mechanisms of face processing in the human brain.

Why can people with developmental prosopagnosia recognise some familiar faces? Insights from subjective experience

Developmental prosopagnosia is a relatively common visuo-cognitive condition, characterised by impaired facial identity recognition. Impairment severity appears to reside on a continuum, however, it is unknown whether instances of milder deficits reflect the successful use of spontaneous (typical) face recognition strategies, or the application of extraneous compensatory cues to recognition. Here, we explore this issue in two studies. First, 23 adults with developmental prosopagnosia were asked about their use of spontaneous versus compensatory face recognition techniques in everyday life, using a series of closed- and open-ended questions. Second, the same participants performed a computerised famous face recognition task where they were asked to provide reasons why they could make any successful identifications. Findings from both studies suggest that people with developmental prosopagnosia can successfully, and quite frequently, use compensatory strategies to recognition, and that these cues support the majority of instances of preserved familiar face recognition. In contrast, 16 of the 23 participants were able to spontaneously recognise familiar faces on at least some occasions, but there were vast individual differences in frequencies of success. These findings have important implications for our conceptualisation of the condition, as well as for diagnostic practice.

Recognition of animal faces is impaired in developmental prosopagnosia

An on-going debate in psychology and neuroscience concerns the way faces and objects are represented. Domain-specific theories suggest that faces are processed via a specialised mechanism, separate from objects. Developmental prosopagnosia (DP) is a neurodevelopmental disorder in which there is a deficit in the ability to recognize conspecific (human) faces. It is unclear, however, whether prosopagnosia also affects recognition of heterospecific (animal) faces. To address this question, we compared recognition performance with human and animal faces in neurotypical controls and participants with DP. We found that DPs showed deficits in the recognition of both human and animal faces compared to neurotypical controls. In contrast to, we found no group-level deficit in the recognition of animate or inanimate non-face objects in DPs. Using an individual-level approach, we demonstrate that in 60% of cases in which face recognition is impaired, there is a concurrent deficit with animal faces. Together, these results show that DPs have a general deficit in the recognition of faces that encompass a range of configural and morphological structures.

Provoked overt recognition in acquired prosopagnosia using multiple different images of famous faces

Provoked overt recognition refers to the fact that patients with acquired prosopagnosia can sometimes recognize faces when presented in arrays of individuals from the same category (e.g., actors or politicians). We ask whether a prosopagnosic patient might experience recognition when presented with multiple different images of the same face simultaneously. Over two sessions, patient Herschel, a 66-year-old British man with acquired prosopagnosia, viewed face images individually or in arrays. On several occasions he failed to recognize single photos of an individual but successfully identified that person when the same photos were presented together. For example, Herschel failed to recognize any individual images of King Charles or Paul McCartney but recognised both in arrays of the same photos. Like reports based on category membership, overt recognition was transient and inconsistent. These findings are discussed in terms of models of covert recognition, alongside more recent research on within-person variability for face perception.

Music perception in acquired prosopagnosia

BACKGROUND

Acquired prosopagnosia is often associated with other deficits such as dyschromatopsia and topographagnosia, from damage to adjacent perceptual networks. A recent study showed that some subjects with developmental prosopagnosia also have congenital amusia, but problems with music perception have not been described with the acquired variant.

OBJECTIVE

Our goal was to determine if music perception was also impaired in subjects with acquired prosopagnosia, and if so, its anatomic correlate.

METHOD

We studied eight subjects with acquired prosopagnosia, all of whom had extensive neuropsychological and neuroimaging testing. They performed a battery of tests evaluating pitch and rhythm processing, including the Montréal Battery for the Evaluation of Amusia.

RESULTS

At the group level, subjects with anterior temporal lesions were impaired in pitch perception relative to the control group, but not those with occipitotemporal lesions. Three of eight subjects with acquired prosopagnosia had impaired musical pitch perception while rhythm perception was spared. Two of the three also showed reduced musical memory. These three reported alterations in their emotional experience of music: one reported music anhedonia and aversion, while the remaining two had changes consistent with musicophilia. The lesions of these three subjects affected the right or bilateral temporal poles as well as the right amygdala and insula. None of the three prosopagnosic subjects with lesions limited to the inferior occipitotemporal cortex exhibited impaired pitch perception or musical memory, or reported changes in music appreciation.

CONCLUSION

Together with the results of our previous studies of voice recognition, these findings indicate an anterior ventral syndrome that can include the amnestic variant of prosopagnosia, phonagnosia, and various alterations in music perception, including acquired amusia, reduced musical memory, and subjective reports of altered emotional experience of music.

Persistent prosopagnosia following COVID-19

COVID-19 can cause psychological problems including loss of smell and taste, long-lasting memory, speech, and language impairments, and psychosis. Here, we provide the first report of prosopagnosia following symptoms consistent with COVID-19. Annie is a 28-year-old woman who had normal face recognition prior to contracting COVID-19 in March 2020. Two months later, she noticed face recognition difficulties while experiencing symptom relapses and her deficits with faces have persisted. On two tests of familiar face recognition and two tests of unfamiliar face recognition, Annie showed clear impairments. In contrast, she scored normally on tests assessing face detection, face identity perception, object recognition, scene recognition, and non-visual memory. Navigational deficits frequently co-occur with prosopagnosia, and Annie reports that her navigational abilities are substantially worse than before she became ill. Self-report survey data from 54 respondents with long COVID showed that a majority reported reductions in visual recognition and navigation abilities. In summary, Annie's results indicate that COVID-19 can produce severe and selective neuropsychological impairment similar to deficits seen following brain damage, and it appears that high-level visual impairments are not uncommon in people with long COVID.

Face recognition ability is manifest in early dynamic decoding of face-orientation selectivity-Evidence from multi-variate pattern analysis of the neural response

Although humans are considered to be face experts, there is a well-established reliable variation in the degree to which neurotypical individuals are able to learn and recognise faces. While many behavioural studies have characterised these differences, studies that seek to relate the neuronal response to standardised behavioural measures of ability remain relatively scarce, particularly so for the time-resolved approaches and the early response to face stimuli. In the present study we make use of a relatively recent methodological advance, multi-variate pattern analysis (MVPA), to decode the time course of the neural response to faces compared to other object categories (inverted faces, objects). Importantly, for the first time, we directly relate metrics of this decoding assessed at the individual level to gold-standard measures of behavioural face processing ability assessed in an independent task. Thirty-nine participants completed the behavioural Cambridge Face Memory Test (CFMT), then viewed images of faces and houses (presented upright and inverted) while their neural activity was measured via electroencephalography. Significant decoding of both face orientation and face category were observed in all individual participants. Decoding of face orientation, a marker of more advanced face processing, was earlier and stronger in participants with higher levels of face expertise, while decoding of face category information was earlier but not stronger for individuals with greater face expertise. Taken together these results provide a marker of significant differences in the early neuronal response to faces from around 100 ms post stimulus as a function of behavioural expertise with faces.

The impact of simulated hemianopia on visual search for faces, words, and cars

Tests of visual search can index the effects of perceptual load and compare the processing efficiency for different object types, particularly when one examines the set-size effect, the increase in search time for each additional stimulus in an array. Previous studies have shown that the set-size effect is increased by manoeuvres that impede object processing, and in patients with object processing impairments. In this study, we examine how the low-level visual impairment of hemianopia affects visual search for complex objects, using a virtual paradigm. Forty-two healthy subjects performed visual search for faces, words, or cars with full-viewing as well as gaze-contingent simulations of complete left or right hemianopia. Simulated hemianopia lowered accuracy and discriminative power and increased response times and set-size effects, similarly for faces, words and cars. A comparison of set-size effects between target absent and target present trials did not show a difference between full-view and simulated hemianopic conditions, and a model of decision-making suggested that simulated hemianopia reduced the rate of accumulation of perceptual data, but did not change decision thresholds. We conclude that simulated hemianopia reduces the efficiency of visual search for complex objects, and that such impairment should be considered when interpreting results from high-level object processing deficits.

Let's face it: The lateralization of the face perception network as measured with fMRI is not clearly right dominant

The neural face perception network is distributed across both hemispheres. However, the dominant role in humans is virtually unanimously attributed to the right hemisphere. Interestingly, there are, to our knowledge, no imaging studies that systematically describe the distribution of hemispheric lateralization in the core system of face perception across subjects in large cohorts so far. To address this, we determined the hemispheric lateralization of all core system regions (i.e., occipital face area (OFA), fusiform face area (FFA), posterior superior temporal sulcus (pSTS)) in 108 healthy subjects using functional magnetic resonance imaging (fMRI). We were particularly interested in the variability of hemispheric lateralization across subjects and explored how many subjects can be classified as right-dominant based on the fMRI activation pattern. We further assessed lateralization differences between different regions of the core system and analyzed the influence of handedness and sex on the lateralization with a generalized mixed effects regression model. As expected, brain activity was on average stronger in right-hemispheric brain regions than in their left-hemispheric homologues. This asymmetry was, however, only weakly pronounced in comparison to other lateralized brain functions (such as language and spatial attention) and strongly varied between individuals. Only half of the subjects in the present study could be classified as right-hemispheric dominant. Additionally, we did not detect significant lateralization differences between core system regions. Our data did also not support a general leftward shift of hemispheric lateralization in left-handers. Only the interaction of handedness and sex in the FFA revealed that specifically left-handed men were significantly more left-lateralized compared to right-handed males. In essence, our fMRI data did not support a clear right-hemispheric dominance of the face perception network. Our findings thus ultimately question the dogma that the face perception network - as measured with fMRI - can be characterized as "typically right lateralized".

Face specific inversion effects provide evidence for two subtypes of developmental prosopagnosia

Many studies have attempted to identify the perceptual underpinnings of developmental prosopagnosia (DP). The majority have focused on whether holistic and configural processing mechanisms are impaired in DP. However, previous work suggests that there is substantial heterogeneity in holistic and configural processing within the DP population; further, there is disagreement as to whether any deficits are face-specific or reflect a broader perceptual deficit. This study used a data-driven approach to examine whether there are systematic patterns of variability in DP that reflect different underpinning perceptual deficits. A group of individuals with DP (N = 37) completed a cognitive battery measuring holistic/configural and featural processing in faces and non-face objects. A two-stage cluster analysis on data from the Cambridge Face Perception Test identified two subgroups of DPs. Across several tasks, the first subgroup (N = 21) showed typical patterns of holistic/configural processing (measured via inversion effects); the second (N = 16) was characterised by reduced or abolished inversion effects compared to age-matched control participants (N = 91). The subgroups did not differ on tasks measuring upright face matching, object matching, non-face holistic processing, or composite effects. These findings indicate two separable pathways to face recognition impairment, one characterised by impaired configural processing and the other potentially by impaired featural processing. Comparisons to control participants provide some preliminary evidence that the deficit in featural processing may extend to some non-face stimuli. Our results demonstrate the utility of examining both the variability between and consistency across individuals with DP as a means of illuminating our understanding of face recognition in typical and atypical populations.

Twenty years of investigation with the case of prosopagnosia PS to understand human face identity recognition. Part II: Neural basis

Patient PS sustained her dramatic brain injury in 1992, the same year as the first report of a neuroimaging study of human face recognition. The present paper complements the review on the functional nature of PS's prosopagnosia (part I), illustrating how her case study directly, i.e., through neuroimaging investigations of her brain structure and activity, but also indirectly, through neural studies performed on other clinical cases and neurotypical individuals, inspired and constrained neural models of human face recognition. In the dominant right hemisphere for face recognition in humans, PS's main lesion concerns (inputs to) the inferior occipital gyrus (IOG), in a region where face-selective activity is typically found in normal individuals ('Occipital Face Area', OFA). Her case study initially supported the criticality of this region for face identity recognition (FIR) and provided the impetus for transcranial magnetic stimulation (TMS), intracerebral electrical stimulation, and cortical surgery studies that have generally supported this view. Despite PS's right IOG lesion, typical face-selectivity is found anteriorly in the middle portion of the fusiform gyrus, a hominoid structure (termed the right 'Fusiform Face Area', FFA) that is widely considered to be the most important region for human face recognition. This finding led to the original proposal of direct anatomico-functional connections from early visual cortices to the FFA, bypassing the IOG/OFA (lulu), a hypothesis supported by further neuroimaging studies of PS, other neurological cases and neuro-typical individuals with original visual stimulation paradigms, data recordings and analyses. The proposal of a lack of sensitivity to face identity in PS's right FFA due to defective reentrant inputs from the IOG/FFA has also been supported by other cases, functional connectivity and cortical surgery studies. Overall, neural studies of, and based on, the case of prosopagnosia PS strongly question the hierarchical organization of the human neural face recognition system, supporting a more flexible and dynamic view of this key social brain function.

The Intricate Web of Asymmetric Processing of Social Stimuli in Humans

Although the population-level preference for the use of the right hand is the clearest example of behavioral lateralization, it represents only the best-known instance of a variety of functional asymmetries observable in humans. What is interesting is that many of such asymmetries emerge during the processing of social stimuli, as often occurs in the case of human bodies, faces and voices. In the present paper, after reviewing previous literature about human functional asymmetries for social and emotional stimuli, we suggest some possible links among them and stress the necessity of a comprehensive account (in both ontogenetic and phylogenetic terms) for these not yet fully explained phenomena. In particular, we propose that the advantages of lateralization for emotion processing should be considered in light of previous suggestions that (i) functional hemispheric specialization enhances cognitive capacity and efficiency, and (ii) the alignment (at the population level) of the direction of behavioral asymmetries emerges, under social pressures, as an evolutionary stable strategy.

Higher-dimensional neural representations predict better episodic memory

Episodic memory enables humans to encode and later vividly retrieve information about our rich experiences, yet the neural representations that support this mental capacity are poorly understood. Using a large fMRI dataset (n = 468) of face-name associative memory tasks and principal component analysis to examine neural representational dimensionality (RD), we found that the human brain maintained a high-dimensional representation of faces through hierarchical representation within and beyond the face-selective regions. Critically, greater RD was associated with better subsequent memory performance both within and across participants, and this association was specific to episodic memory but not general cognitive abilities. Furthermore, the frontoparietal activities could suppress the shared low-dimensional fluctuations and reduce the correlations of local neural responses, resulting in greater RD. RD was not associated with the degree of item-specific pattern similarity, and it made complementary contributions to episodic memory. These results provide a mechanistic understanding of the role of RD in supporting accurate episodic memory.

Is It Just Face Blindness? Exploring Developmental Comorbidity in Individuals with Self-Reported Developmental Prosopagnosia

Developmental prosopagnosia (DP)—or ‘face blindness’—refers to life-long problems with facial recognition in the absence of brain injury. We know that neurodevelopmental disorders tend to co-occur, and this study aims to explore if individuals with self-reported DP also report indications of other neurodevelopmental disorders, deficits, or conditions (developmental comorbidity). In total, 115 individuals with self-reported DP participated in this online cross-sectional survey. Face recognition impairment was measured with a validated self-report instrument. Indications of difficulties with navigation, math, reading, or spelling were measured with a tailored questionnaire using items from published sources. Additional diagnoses were measured with direct questions. We also included open-ended questions about cognitive strengths and difficulties. Results: Overall, 57% reported at minimum one developmental comorbidity of interest, with most reflecting specific cognitive impairment (e.g., in memory or object recognition) rather than diagnostic categories (e.g., ADHD, dyslexia). Interestingly, many participants reported cognitive skills or strengths within the same domains that others reported impairment, indicating a diverse pattern of cognitive strengths and difficulties in this sample. The frequency and diversity of self-reported developmental comorbidity suggests that face recognition could be important to consider in future investigations of neurodevelopmental comorbidity patterns.

Face-Processing Performance is an Independent Predictor of Social Affect as Measured by the Autism Diagnostic Observation Schedule Across Large-Scale Datasets

Face-processing deficits, while not required for the diagnosis of autism spectrum disorder (ASD), have been associated with impaired social skills-a core feature of ASD; however, the strength and prevalence of this relationship remains unclear. Across 445 participants from the NIMH Data Archive, we examined the relationship between Benton Face Recognition Test (BFRT) performance and Autism Diagnostic Observation Schedule-Social Affect (ADOS-SA) scores. Lower BFRT scores (worse face-processing performance) were associated with higher ADOS-SA scores (higher ASD severity)-a relationship that held after controlling for other factors associated with face processing, i.e., age, sex, and IQ. These findings underscore the utility of face discrimination, not just recognition of facial emotion, as a key covariate for the severity of symptoms that characterize ASD.

Intracerebral electrical stimulation of the right anterior fusiform gyrus impairs human face identity recognition

Brain regions located between the right fusiform face area (FFA) in the middle fusiform gyrus and the temporal pole may play a critical role in human face identity recognition but their investigation is limited by a large signal drop-out in functional magnetic resonance imaging (fMRI). Here we report an original case who is suddenly unable to recognize the identity of faces when electrically stimulated on a focal location inside this intermediate region of the right anterior fusiform gyrus. The reliable transient identity recognition deficit occurs without any change of percept, even during nonverbal face tasks (i.e., pointing out the famous face picture among three options; matching pictures of unfamiliar or familiar faces for their identities), and without difficulty at recognizing visual objects or famous written names. The effective contact is associated with the largest frequency-tagged electrophysiological signals of face-selectivity and of familiar and unfamiliar face identity recognition. This extensive multimodal investigation points to the right anterior fusiform gyrus as a critical hub of the human cortical face network, between posterior ventral occipito-temporal face-selective regions directly connected to low-level visual cortex, the medial temporal lobe involved in generic memory encoding, and ventral anterior temporal lobe regions holding semantic associations to people's identity.

EXPRESS: Distinct abilities associated with matching same identity faces vs. discriminating different faces: Evidence from individual differences in prosopagnosics and controls

Previous face matching studies provide evidence that matching same identity faces (match trials) and discriminating different face identities (non-match trials) rely on distinct processes. For example, instructional studies geared towards improving face matching in applied settings have often found selective improvements in match or non-match trials only. Additionally, a small study found that developmental prosopagnosics (DPs) have specific deficits in making match but not non-match judgments. In the current study, we sought to replicate this finding in DPs and examine how individual differences across DPs and controls in match vs. non-match performance relate to featural vs. holistic processing abilities. 43 DPs and 27 controls matched face images shown from similar front views or with varied lighting or viewpoint. Participants also performed tasks measuring featural (eyes/mouth) and holistic processing (part-whole task). We found that DPs showed worse overall matching performance than controls and that their relative match vs. non-match deficit depended on image variation condition, indicating that DPs do not consistently show match- or non-match-specific deficits. When examining the association between holistic and featural processing abilities and match vs. non-match trials in the entire group of DPs and controls, we found a very clear dissociation: Match trials significantly correlated with eye processing ability (r=.48) but not holistic processing (r=.11), whereas non-match trials significantly correlated with holistic processing (r=.32) but not eye processing (r=.03). This suggests that matching same identity faces relies more on eye processing while discriminating different faces relies more on holistic processing.

Face processing in the temporal lobe

Face perception is a socially important but complex process with many stages and many facets. There is substantial evidence from many sources that it involves a large extent of the temporal lobe, from the ventral occipitotemporal cortex and superior temporal sulci to anterior temporal regions. While early human neuroimaging work suggested a core face network consisting of the occipital face area, fusiform face area, and posterior superior temporal sulcus, studies in both humans and monkeys show a system of face patches stretching from posterior to anterior in both the superior temporal sulcus and inferotemporal cortex. Sophisticated techniques such as fMRI adaptation have shown that these face-activated regions show responses that have many of the attributes of human face processing. Lesions of some of these regions in humans lead to variants of prosopagnosia, the inability to recognize the identity of a face. Lesion, imaging, and electrophysiologic data all suggest that there is a segregation between identity and expression processing, though some suggest this may be better characterized as a distinction between static and dynamic facial information.

OUP accepted manuscript

While there have been decades of clinical and theoretical interest in developmental and acquired face recognition difficulties, very little work has examined their remediation. Here, we report two studies that examined the efficacy of an existing face training programme in improving face-processing skills in adults and children with developmental face recognition impairments. The programme has only been trialled in typical children to date, where 2 weeks of perceptual training (modelled on an adapted version of the popular family game Guess Who?) resulted in face-specific improvements for memory but not perception after 2 weeks of training. In Study 1, we performed a randomized, parallel groups, placebo-controlled trial of the same programme in 20 adults with a pre-existing diagnosis of developmental prosopagnosia. Assessment tasks were administered immediately before and after training, and 2 weeks later. Face-specific gains in memory (but not perception) were observed in the experimental group and were greatest in those with the poorest face recognition skills at entry. These gains persisted 2 weeks after training ceased. In Study 2, a case-series approach was used to administer the experimental version of the training programme to four children who presented with difficulties in face recognition. Improvements in face memory were observed in three of the participants; while one also improved at face perception, there was mixed evidence for the face specificity of these gains. Together, these findings suggest plasticity in the human face recognition system through to at least mid-adulthood and also pave the way for longer-term implementations of the face training programme that will likely elicit greater gains in both adults and children.

An update of the Benton Facial Recognition Test

The Benton Facial Recognition Test (BFRT) is a paper-and-pen task that is traditionally used to assess face perception skills in neurological, clinical and psychiatric conditions. Despite criticisms of its stimuli, the task enjoys a simple procedure and is rapid to administer. Further, it has recently been computerised (BFRT-c), allowing reliable measurement of completion times and the need for online testing. Here, in response to calls for repeat screening for the accurate detection of face processing deficits, we present the BFRT-Revised (BFRT-r): a new version of the BFRT-c that maintains the task's basic paradigm, but employs new, higher-quality stimuli that reflect recent theoretical advances in the field. An initial validation study with typical participants indicated that the BFRT-r has good internal reliability and content validity. A second investigation indicated that while younger and older participants had comparable accuracy, completion times were longer in the latter, highlighting the need for age-matched norms. Administration of the BFRT-r and BFRT-c to 32 individuals with developmental prosopagnosia resulted in improved sensitivity in diagnostic screening for the BFRT-r compared to the BFRT-c. These findings are discussed in relation to current diagnostic screening protocols for face perception deficits. The BFRT-r is stored in an open repository and is freely available to other researchers.

When two fields collide: Identifying "super-recognisers" for neuropsychological and forensic face recognition research

In the last decade, a novel individual differences approach has emerged across the face recognition literature. While the field has long been concerned with prosopagnosia (the inability to recognise facial identity), it has more recently become clear that there are vast differences in face recognition ability within the typical population. "Super-recognisers" are those individuals purported to reside at the very top of this spectrum. On one hand, these people are of interest to cognitive neuropsychologists who are motivated to explore the commonality of the face recognition continuum, whereas on the other hand, researchers from the forensic face matching field evaluate the implementation of super-recognisers into real-world police and security settings. These two rather different approaches have led to discrepancies in the definition of super-recognisers, and perhaps more fundamentally, the approach to identifying them, resulting in a lack of consistency that prohibits theoretical progress. Here, we review the protocols used in published work to identify super-recognisers, and propose a common definition and screening recommendations that can be adhered to across fields.

Visual adaptation and 7T fMRI reveal facial identity processing in the human brain under shallow interocular suppression

Face identity is represented at a high level of the visual hierarchy. Whether the human brain can process facial identity information in the absence of visual awareness remains unclear. In this study, we investigated potential face identity representation through face-identity adaptation with the adapting faces interocularly suppressed by Continuous Flash Suppression (CFS) noise, a modified binocular rivalry paradigm. The strength of interocular suppression was manipulated by varying the contrast of CFS noise. While obeservers reported the face images subjectively unperceived and the face identity objectively unrecognizable, a significant face identity aftereffect was observed under low but not high contrast CFS noise. In addition, the identity of face images under shallow interocular suppression can be decoded from multi-voxel patterns in the right fusiform face area (FFA) obtained with high-resolution 7T fMRI. Thus the comined evidence from visual adaptation and 7T fMRI suggest that face identity can be represented in the human brain without explicit perceptual recognition. The processing of interocularly suppressed faces could occur at different levels depending on how "deep" the information is suppressed.

Psychiatric sequelae of stroke affecting the non-dominant cerebral hemisphere

There are a plethora of cognitive sequelae in addition to neglect and extinction that arise with unilateral right hemispheric stroke (RHS). Cognitive deficits following non-dominant (right) hemisphere stroke are common with unilateral neglect and extinction being the most recognized examples. The severity of RHS is usually underestimated by the National Institutes of Health Stroke Scale (NIHSS), which in terms of lateralized right hemisphere cognitive deficits, tests only for visual inattention/extinction. They account for 2 out of 42 total possible points. Additional neuropsychiatric sequelae include but are not limited to deficiencies in affective prosody comprehension and production (aprosodias), understanding and expressing facial emotions, empathy, recognition of familiar faces, anxiety, mania, apathy, and psychosis. These sequelae have a profound impact on patients' quality of life; affecting communication, interpersonal relationships, and the ability to fulfill social roles. They also pose additional challenges to recovery. There is presently a gap in the literature regarding a cohesive overview of the significant cognitive sequelae following RHS. This paper serves as a narrative survey of the current understanding of the subject, with particular emphasis on neuropsychiatric poststroke syndromes not predominantly associated with left hemisphere lesions (LHL), bilateral lesions, hemiplegia, or paralysis. A more comprehensive understanding of the neuropsychological consequences of RHS extending beyond the typical associations of unilateral neglect and extinction may have important implications for clinical practice, including the ways in which clinicians approach diagnostics, treatment, and rehabilitation.

Is human face recognition lateralized to the right hemisphere due to neural competition with left-lateralized visual word recognition? A critical review

The right hemispheric lateralization of face recognition, which is well documented and appears to be specific to the human species, remains a scientific mystery. According to a long-standing view, the evolution of language, which is typically substantiated in the left hemisphere, competes with the cortical space in that hemisphere available for visuospatial processes, including face recognition. Over the last decade, a specific hypothesis derived from this view according to which neural competition in the left ventral occipito-temporal cortex with selective representations of letter strings causes right hemispheric lateralization of face recognition, has generated considerable interest and research in the scientific community. Here, a systematic review of studies performed in various populations (infants, children, literate and illiterate adults, left-handed adults) and methodologies (behavior, lesion studies, (intra)electroencephalography, neuroimaging) offers little if any support for this reading lateralized neural competition hypothesis. Specifically, right-lateralized face-selective neural activity already emerges at a few months of age, well before reading acquisition. Moreover, consistent evidence of face recognition performance and its right hemispheric lateralization being modulated by literacy level during development or at adulthood is lacking. Given the absence of solid alternative hypotheses and the key role of neural competition in the sensory-motor cortices for selectivity of representations, learning, and plasticity, a revised language-related neural competition hypothesis for the right hemispheric lateralization of face recognition should be further explored in future research, albeit with substantial conceptual clarification and advances in methodological rigor.

Whole-object effects in visual word processing: Parallels with and differences from face recognition

Visual words and faces differ in their structural properties, but both are objects of high expertise. Holistic processing is said to characterize expert face recognition, but the extent to which whole-word processes contribute to word recognition is unclear, particularly as word recognition is thought to proceed by a component-based process. We review the evidence for experimental effects in word recognition that parallel those used to support holistic face processing, namely inversion effects, the part-whole task, and composite effects, as well as the status of whole-word processing in pure alexia and developmental dyslexia, contrasts between familiar and unfamiliar languages, and the differences between handwriting and typeset font. The observations support some parallels in whole-object influences between face and visual word recognition, but do not necessarily imply similar expert mechanisms. It remains to be determined whether and how the relative balance between part-based and whole-object processing differs for visual words and faces.

Local neuronal relational structures underlying the contents of human conscious experience

While most theories of consciousness posit some kind of dependence on global network activities, I consider here an alternative, localist perspective-in which localized cortical regions each underlie the emergence of a unique category of conscious experience. Under this perspective, the large-scale activation often found in the cortex is a consequence of the complexity of typical conscious experiences rather than an obligatory condition for the emergence of conscious awareness-which can flexibly shift, depending on the richness of its contents, from local to more global activation patterns. This perspective fits a massive body of human imaging, recordings, lesions and stimulation data but opens a fundamental problem: how can the information, defining each content, be derived locally in each cortical region. Here, I will discuss a solution echoing pioneering structuralist ideas in which the content of a conscious experience is defined by its relationship to all other contents within an experiential category. In neuronal terms, this relationship structure between contents is embodied by the local geometry of similarity distances between cortical activation patterns generated during each conscious experience, likely mediated via networks of local neuronal connections. Thus, in order for any conscious experience to appear in an individual's mind, two central conditions must be met. First, a specific configural pattern ("bar-code") of neuronal activity must appear within a local relational geometry, i.e. a cortical area. Second, the individual neurons underlying the activated pattern must be bound into a unified functional ensemble through a burst of recurrent neuronal firing: local "ignitions".

Oxytocin Modulates Neural Individuation/Categorization Processing of Faces in Early Face-Selective Areas

Oxytocin (OT) is known as a neuropeptide that promotes social adaptation. Individuating racial in-group members and viewing racial out-groups in categories is an adaptive strategy that evolved to aid effective social interaction. Nevertheless, whether OT modulates the neural individuation/categorization processing of racial in-group and out-group faces remain unknown. After intranasal OT or placebo administration, 46 male participants (OT: 24, placebo: 22) were presented with face pairs with the same or different identities or races in rapid succession. The neural repetition suppression (RS) effects to identity and race were measured using functional magnetic resonance imaging (fMRI) as indices of individuation/categorization face-processing. The results showed that while OT increased the RS effect to race, it decreased the RS effect to identity in the right fusiform face area. As for the left occipital face area, OT enlarged the differential RS effects to identities of in-group and out-group faces. Additionally, OT modulated the association of interdependence self-construal and the RS effects on identity and race. These findings bring to light preliminary evidence that OT can regulate neuronal specificity of identity and race in early face-selective regions and benefit adaptive individuation/categorization face-processing.

Reflections and New Perspectives on Face Cognition as a Specific Socio-Cognitive Ability

The study of socio-cognitive abilities emerged from intelligence research, and their specificity remains controversial until today. In recent years, the psychometric structure of face cognition (FC)—a basic facet of socio-cognitive abilities—was extensively studied. In this review, we summarize and discuss the divergent psychometric structures of FC in easy and difficult tasks. While accuracy in difficult tasks was consistently shown to be face-specific, the evidence for easy tasks was inconsistent. The structure of response speed in easy tasks was mostly—but not always—unitary across object categories, including faces. Here, we compare studies to identify characteristics leading to face specificity in easy tasks. The following pattern emerges: in easy tasks, face specificity is found when modeling speed in a single task; however, when modeling speed across multiple, different easy tasks, only a unitary factor structure is reported. In difficult tasks, however, face specificity occurs in both single task approaches and task batteries. This suggests different cognitive mechanisms behind face specificity in easy and difficult tasks. In easy tasks, face specificity relies on isolated cognitive sub-processes such as face identity recognition. In difficult tasks, face-specific and task-independent cognitive processes are employed. We propose a descriptive model and argue for FC to be integrated into common taxonomies of intelligence.

Visual mechanisms for voice-identity recognition flexibly adjust to auditory noise level

Recognising the identity of voices is a key ingredient of communication. Visual mechanisms support this ability: recognition is better for voices previously learned with their corresponding face (compared to a control condition). This so‐called ‘face‐benefit’ is supported by the fusiform face area (FFA), a region sensitive to facial form and identity. Behavioural findings indicate that the face‐benefit increases in noisy listening conditions. The neural mechanisms for this increase are unknown. Here, using functional magnetic resonance imaging, we examined responses in face‐sensitive regions while participants recognised the identity of auditory‐only speakers (previously learned by face) in high (SNR −4 dB) and low (SNR +4 dB) levels of auditory noise. We observed a face‐benefit in both noise levels, for most participants (16 of 21). In high‐noise, the recognition of face‐learned speakers engaged the right posterior superior temporal sulcus motion‐sensitive face area (pSTS‐mFA), a region implicated in the processing of dynamic facial cues. The face‐benefit in high‐noise also correlated positively with increased functional connectivity between this region and voice‐sensitive regions in the temporal lobe in the group of 16 participants with a behavioural face‐benefit. In low‐noise, the face‐benefit was robustly associated with increased responses in the FFA and to a lesser extent the right pSTS‐mFA. The findings highlight the remarkably adaptive nature of the visual network supporting voice‐identity recognition in auditory‐only listening conditions.

Separated and overlapping neural coding of face and body identity

Recognising a person's identity often relies on face and body information, and is tolerant to changes in low‐level visual input (e.g., viewpoint changes). Previous studies have suggested that face identity is disentangled from low‐level visual input in the anterior face‐responsive regions. It remains unclear which regions disentangle body identity from variations in viewpoint, and whether face and body identity are encoded separately or combined into a coherent person identity representation. We trained participants to recognise three identities, and then recorded their brain activity using fMRI while they viewed face and body images of these three identities from different viewpoints. Participants' task was to respond to either the stimulus identity or viewpoint. We found consistent decoding of body identity across viewpoint in the fusiform body area, right anterior temporal cortex, middle frontal gyrus and right insula. This finding demonstrates a similar function of fusiform and anterior temporal cortex for bodies as has previously been shown for faces, suggesting these regions may play a general role in extracting high‐level identity information. Moreover, we could decode identity across fMRI activity evoked by faces and bodies in the early visual cortex, right inferior occipital cortex, right parahippocampal cortex and right superior parietal cortex, revealing a distributed network that encodes person identity abstractly. Lastly, identity decoding was consistently better when participants attended to identity, indicating that attention to identity enhances its neural representation. These results offer new insights into how the brain develops an abstract neural coding of person identity, shared by faces and bodies.

Intracerebral electrical stimulation to understand the neural basis of human face identity recognition

Recognizing people's identity by their faces is a key function in the human species, supported by regions of the ventral occipito-temporal cortex (VOTC). In the last decade, there have been several reports of perceptual face distortion during direct electrical stimulation (DES) with subdural electrodes positioned over a well-known face-selective VOTC region of the right lateral middle fusiform gyrus (LatMidFG; i.e., the "Fusiform Face Area", FFA). However, transient impairments of face identity recognition (FIR) have been extremely rare and only behaviorally quantified during DES with intracerebral (i.e., depth) electrodes in stereo-electroencephalography (SEEG). The three detailed cases reported so far, summarized here, were specifically impaired at FIR during DES inside different anatomical VOTC regions of the right hemisphere: the inferior occipital gyrus (IOG) and the LatMidFG, as well as a region that lies at the heart of a large magnetic susceptibility artifact in functional magnetic resonance imaging (fMRI): the anterior fusiform gyrus (AntFG). In the first two regions, the eloquent electrode contacts were systematically associated with the highest face-selective and (unfamiliar) face individuation responses as measured with intracerebral electrophysiology. Stimulation in the right AntFG did not lead to perceptual changes but also caused an inability to remember having been presented face pictures, as if the episode was never recorded in memory. These observations support the view of an extensive network of face-selective VOTC regions subtending human FIR, with at least three critical nodes in the right hemisphere associated with differential intrinsic and extrinsic patterns of reentrant connectivity.

Multi-modal Mapping of the Face Selective Ventral Temporal Cortex-A Group Study With Clinical Implications for ECS, ECoG, and fMRI

Face recognition is impaired in patients with prosopagnosia, which may occur as a side effect of neurosurgical procedures. Face selective regions on the ventral temporal cortex have been localized with electrical cortical stimulation (ECS), electrocorticography (ECoG), and functional magnetic resonance imagining (fMRI). This is the first group study using within-patient comparisons to validate face selective regions mapping, utilizing the aforementioned modalities. Five patients underwent surgical treatment of intractable epilepsy and joined the study. Subdural grid electrodes were implanted on their ventral temporal cortices to localize seizure foci and face selective regions as part of the functional mapping protocol. Face selective regions were identified in all patients with fMRI, four patients with ECoG, and two patients with ECS. From 177 tested electrode locations in the region of interest (ROI), which is defined by the fusiform gyrus and the inferior temporal gyrus, 54 face locations were identified by at least one modality in all patients. fMRI mapping showed the highest detection rate, revealing 70.4% for face selective locations, whereas ECoG and ECS identified 64.8 and 31.5%, respectively. Thus, 28 face locations were co-localized by at least two modalities, with detection rates of 89.3% for fMRI, 85.7% for ECoG and 53.6 % for ECS. All five patients had no face recognition deficits after surgery, even though five of the face selective locations, one obtained by ECoG and the other four by fMRI, were within 10 mm to the resected volumes. Moreover, fMRI included a quite large volume artifact on the ventral temporal cortex in the ROI from the anatomical structures of the temporal base. In conclusion, ECS was not sensitive in several patients, whereas ECoG and fMRI even showed activation within 10 mm to the resected volumes. Considering the potential signal drop-out in fMRI makes ECoG the most reliable tool to identify face selective locations in this study. A multimodal approach can improve the specificity of ECoG and fMRI, while simultaneously minimizing the number of required ECS sessions. Hence, all modalities should be considered in a clinical mapping protocol entailing combined results of co-localized face selective locations.