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Veljanoski D, Ng XY, Hill CS, Jamjoom AAB. Theory and evidence-base for a digital platform for the delivery of language tests during awake craniotomy and collaborative brain mapping. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2024; 6:e000234. [PMID: 38756704 PMCID: PMC11097893 DOI: 10.1136/bmjsit-2023-000234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 03/20/2024] [Indexed: 05/18/2024] Open
Abstract
Objectives Build the theoretical and evidence-base for a digital platform (map-OR) which delivers intraoperative language tests during awake craniotomy and facilitates collaborative sharing of brain mapping data. Design Mixed methodology study including two scoping reviews, international survey, synthesis of development guiding principles and a risk assessment using failure modes and effects analysis. Setting The two scoping reviews examined the literature published in the English language. International survey was completed by members of awake craniotomy teams from 14 countries. Main outcome measures Scoping review 1: number of technologies described for language mapping during awake craniotomy. Scoping review 2: barriers and facilitators to adopting novel technology in surgery. International survey: degree of language mapping technology penetration into clinical practice. Results A total of 12 research articles describing 6 technologies were included. The technologies required a range of hardware components including portable devices, virtual reality headsets and large integrated multiscreen stacks. The facilitators and barriers of technology adoption in surgery were extracted from 11 studies and mapped onto the 4 Unified Theory of Acceptance and Use of Technology constructs. A total of 37 awake craniotomy teams from 14 countries completed the survey. Of the responses, 20 (54.1%) delivered their language tests digitally, 10 (27.0%) delivered tests using cards and 7 (18.9%) used a combination of both. The most commonly used devices were tablet computers (67.7%; n=21) and the most common software used was Microsoft PowerPoint (60.6%; n=20). Four key risks for the proposed digital platform were identified, the highest risk being a software and internet connectivity failure during surgery. Conclusions This work represents a rigorous and structured approach to the development of a digital platform for standardized intraoperative language testing during awake craniotomy and for collaborative sharing of brain mapping data. Trial registration number Scoping review protocol registrations in OSF registries (scoping review 1: osf.io/su9xm; scoping review 2: osf.io/x4wsc).
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Affiliation(s)
| | - Xin Yi Ng
- Department of Medicine, Arrowe Park Hospital, Wirral, UK
| | - Ciaran Scott Hill
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Aimun A B Jamjoom
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Department of Neurosurgery, Barking Havering and Redbridge Hospitals NHS Trust, Romford, UK
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Strongyli E, Evangelidis P, Sakellari I, Gavriilaki M, Gavriilaki E. Change in Neurocognitive Function in Patients Who Receive CAR-T Cell Therapies: A Steep Hill to Climb. Pharmaceuticals (Basel) 2024; 17:591. [PMID: 38794161 PMCID: PMC11123727 DOI: 10.3390/ph17050591] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
Immunotherapy with chimeric antigen receptor T (CAR-T) cell therapies has brought substantial improvement in clinical outcomes in patients with relapsed/refractory B cell neoplasms. However, complications such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) limit the therapeutic efficacy of this treatment approach. ICANS can have a broad range of clinical manifestations, while various scoring systems have been developed for its grading. Cognitive decline is prevalent in CAR-T therapy recipients including impaired attention, difficulty in item naming, and writing, agraphia, and executive dysfunction. In this review, we aim to present the diagnostic methods and tests that have been used for the recognition of cognitive impairment in these patients. Moreover, up-to-date data about the duration of cognitive impairment symptoms after the infusion are presented. More research on the risk factors, pathogenesis, preventive measures, and therapy of neurocognitive impairment is crucial for better outcomes for our patients.
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Affiliation(s)
- Evlampia Strongyli
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (E.S.); (I.S.)
| | - Paschalis Evangelidis
- Second Propedeutic Department of Internal Medicine, Hippocration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
| | - Ioanna Sakellari
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (E.S.); (I.S.)
| | - Maria Gavriilaki
- 1st Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Eleni Gavriilaki
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (E.S.); (I.S.)
- Second Propedeutic Department of Internal Medicine, Hippocration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
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3
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Noll KR, Asman P, Tasnim I, Hall M, Connelly K, Swamy C, Ene C, Tummala S, Grasu RM, Liu HL, Kumar VA, Muir M, Prinsloo S, Michener H, Wefel JS, Ince NF, Prabhu SS. Intraoperative language mapping guided by real-time visualization of gamma band modulation electrocorticograms: Case report and proof of concept. Neurooncol Pract 2024; 11:92-100. [PMID: 38222047 PMCID: PMC10785572 DOI: 10.1093/nop/npad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Background Electrocorticography (ECoG) language mapping is often performed extraoperatively, frequently involves offline processing, and relationships with direct cortical stimulation (DCS) remain variable. We sought to determine the feasibility and preliminary utility of an intraoperative language mapping approach guided by real-time visualization of electrocorticograms. Methods A patient with astrocytoma underwent awake craniotomy with intraoperative language mapping, utilizing a dual iPad stimulus presentation system coupled to a real-time neural signal processing platform capable of both ECoG recording and delivery of DCS. Gamma band modulations in response to 4 language tasks at each electrode were visualized in real-time. Next, DCS was conducted for each neighboring electrode pair during language tasks. Results All language tasks resulted in strongest heat map activation at an electrode pair in the anterior to mid superior temporal gyrus. Consistent speech arrest during DCS was observed for Object and Action naming tasks at these same electrodes, indicating good correspondence with ECoG heat map recordings. This region corresponded well with posterior language representation via preoperative functional MRI. Conclusions Intraoperative real-time visualization of language task-based ECoG gamma band modulation is feasible and may help identify targets for DCS. If validated, this may improve the efficiency and accuracy of intraoperative language mapping.
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Affiliation(s)
- Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Priscella Asman
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Israt Tasnim
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Matthew Hall
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Katherine Connelly
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chandra Swamy
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Chibawanye Ene
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sudhakar Tummala
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Roxana M Grasu
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ho-Ling Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vinodh A Kumar
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Matthew Muir
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarah Prinsloo
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hayley Michener
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nuri F Ince
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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4
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Molinaro N, Nara S, Carreiras M. Early language dissociation in bilingual minds: magnetoencephalography evidence through a machine learning approach. Cereb Cortex 2024; 34:bhae053. [PMID: 38367613 DOI: 10.1093/cercor/bhae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/26/2024] [Accepted: 01/27/2024] [Indexed: 02/19/2024] Open
Abstract
Does neural activity reveal how balanced bilinguals choose languages? Despite using diverse neuroimaging techniques, prior studies haven't provided a definitive solution to this problem. Nonetheless, studies involving direct brain stimulation in bilinguals have identified distinct brain regions associated with language production in different languages. In this magnetoencephalography study with 45 proficient Spanish-Basque bilinguals, we investigated language selection during covert picture naming and word reading tasks. Participants were prompted to name line drawings or read words if the color of the stimulus changed to green, in 10% of trials. The task was performed either in Spanish or Basque. Despite similar sensor-level evoked activity for both languages in both tasks, decoding analyses revealed language-specific classification ~100 ms post-stimulus onset. During picture naming, right occipital-temporal sensors predominantly contributed to language decoding, while left occipital-temporal sensors were crucial for decoding during word reading. Cross-task decoding analysis unveiled robust generalization effects from picture naming to word reading. Our methodology involved a fine-grained examination of neural responses using magnetoencephalography, offering insights into the dynamics of language processing in bilinguals. This study refines our understanding of the neural underpinnings of language selection and bridges the gap between non-invasive and invasive experimental evidence in bilingual language production.
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Affiliation(s)
- Nicola Molinaro
- Basque Center on Cognition, Brain and Language, Paseo Mikeletegi, 69, 20009, Donostia/San Sebastian, Spain
- Ikerbasque, Basque Foundation for Science, 48009, Bilbao, Spain
| | - Sanjeev Nara
- Basque Center on Cognition, Brain and Language, Paseo Mikeletegi, 69, 20009, Donostia/San Sebastian, Spain
- Mathematical Institute, Department of Mathematics and Computer Science, Physics, Geography, Justus-Liebig-Universität Gießen (University of Giessen), 35392, Gießen, Germany
| | - Manuel Carreiras
- Basque Center on Cognition, Brain and Language, Paseo Mikeletegi, 69, 20009, Donostia/San Sebastian, Spain
- Ikerbasque, Basque Foundation for Science, 48009, Bilbao, Spain
- University of the Basque Country. UPV/EHU, 48940, Leioa, Spain
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5
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García AM, de Leon J, Tee BL, Blasi DE, Gorno-Tempini ML. Speech and language markers of neurodegeneration: a call for global equity. Brain 2023; 146:4870-4879. [PMID: 37497623 PMCID: PMC10690018 DOI: 10.1093/brain/awad253] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/29/2023] [Accepted: 07/15/2023] [Indexed: 07/28/2023] Open
Abstract
In the field of neurodegeneration, speech and language assessments are useful for diagnosing aphasic syndromes and for characterizing other disorders. As a complement to classic tests, scalable and low-cost digital tools can capture relevant anomalies automatically, potentially supporting the quest for globally equitable markers of brain health. However, this promise remains unfulfilled due to limited linguistic diversity in scientific works and clinical instruments. Here we argue for cross-linguistic research as a core strategy to counter this problem. First, we survey the contributions of linguistic assessments in the study of primary progressive aphasia and the three most prevalent neurodegenerative disorders worldwide-Alzheimer's disease, Parkinson's disease, and behavioural variant frontotemporal dementia. Second, we address two forms of linguistic unfairness in the literature: the neglect of most of the world's 7000 languages and the preponderance of English-speaking cohorts. Third, we review studies showing that linguistic dysfunctions in a given disorder may vary depending on the patient's language and that English speakers offer a suboptimal benchmark for other language groups. Finally, we highlight different approaches, tools and initiatives for cross-linguistic research, identifying core challenges for their deployment. Overall, we seek to inspire timely actions to counter a looming source of inequity in behavioural neurology.
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Affiliation(s)
- Adolfo M García
- Global Brain Health Institute, University of California, San Francisco, CA 94143, USA
- Cognitive Neuroscience Center, Universidad de San Andrés, Buenos Aires B1644BID, Argentina
- Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago 9160000, Chile
- Latin American Brain Health (BrainLat) Institute, Universidad Adolfo Ibáñez, Avenida Diagonal Las Torres 2640 (7941169), Santiago, Peñalolén, Región Metropolitana, Chile
| | - Jessica de Leon
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94143, USA
| | - Boon Lead Tee
- Global Brain Health Institute, University of California, San Francisco, CA 94143, USA
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94143, USA
| | - Damián E Blasi
- Data Science Initiative, Harvard University, Cambridge, MA 02138, USA
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
- Department of Linguistic and Cultural Evolution, Max Planck Institute for the Science of Human History, Jena 07745, Germany
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94143, USA
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Goldman E, Bou-Dargham S, Lai M, Guda A, Fallon J, Hauptman M, Reinoso A, Phillips S, Abrams E, Parrish A, Pylkkänen L. MEG correlates of speech planning in simple vs. interactive picture naming in children and adults. PLoS One 2023; 18:e0292316. [PMID: 37847686 PMCID: PMC10581494 DOI: 10.1371/journal.pone.0292316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/18/2023] [Indexed: 10/19/2023] Open
Abstract
The picture naming task is common both as a clinical task and as a method to study the neural bases of speech production in the healthy brain. However, this task is not reflective of most naturally occurring productions, which tend to happen within a context, typically in dialogue in response to someone else's production. How the brain basis of the classic "confrontation picture naming" task compares to the planning of utterances in dialogue is not known. Here we used magnetoencephalography (MEG) to measure neural activity associated with language production using the classic picture naming task as well as a minimal variant of the task, intended as more interactive or dialogue-like. We assessed how neural activity is affected by the interactive context in children, teenagers, and adults. The general pattern was that in adults, the interactive task elicited a robust sustained increase of activity in frontal and temporal cortices bilaterally, as compared to simple picture naming. This increase was present only in the left hemisphere in teenagers and was absent in children, who, in fact, showed the reverse effect. Thus our findings suggest a robustly bilateral neural basis for the coordination of interaction and a very slow developmental timeline for this network.
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Affiliation(s)
- Ebony Goldman
- Department of Psychology, New York University, New York, NY, United States of America
| | | | - Marco Lai
- Department of Psychology, New York University, New York, NY, United States of America
| | - Anvita Guda
- Department of Linguistics, New York University, New York, NY, United States of America
| | - Jacqui Fallon
- Department of Psychology, New York University, New York, NY, United States of America
| | - Miriam Hauptman
- Department of Psychology, Johns Hopkins University, Baltimore, MD, United States of America
| | - Alejandra Reinoso
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States of America
| | - Sarah Phillips
- Department of Linguistics, New York University, New York, NY, United States of America
- Center for Brain Plasticity and Recovery, Georgetown University, Washington, DC, United States of America
| | - Ellie Abrams
- Department of Psychology, New York University, New York, NY, United States of America
| | - Alicia Parrish
- Department of Linguistics, New York University, New York, NY, United States of America
| | - Liina Pylkkänen
- Department of Psychology, New York University, New York, NY, United States of America
- NYUAD Research Institute, New York University Abu Dhabi, Abu Dhabi, UAE
- Department of Linguistics, New York University, New York, NY, United States of America
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7
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Bermúdez G, Quiñones I, Carrasco A, Gil-Robles S, Amoruso L, Mandonnet E, Carreiras M, Catalán G, Pomposo I. A novel cognitive neurosurgery approach for supramaximal resection of non-dominant precuneal gliomas: a case report. Acta Neurochir (Wien) 2023; 165:2747-2754. [PMID: 37597007 PMCID: PMC10541831 DOI: 10.1007/s00701-023-05755-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/26/2023] [Indexed: 08/21/2023]
Abstract
Despite mounting evidence pointing to the contrary, classical neurosurgery presumes many cerebral regions are non-eloquent, and therefore, their excision is possible and safe. This is the case of the precuneus and posterior cingulate, two interacting hubs engaged during various cognitive functions, including reflective self-awareness; visuospatial and sensorimotor processing; and processing social cues. This inseparable duo ensures the cortico-subcortical connectivity that underlies these processes. An adult presenting a right precuneal low-grade glioma invading the posterior cingulum underwent awake craniotomy with direct electrical stimulation (DES). A supramaximal resection was achieved after locating the superior longitudinal fasciculus II. During surgery, we found sites of positive stimulation for line bisection and mentalizing tests that enabled the identification of surgical corridors and boundaries for lesion resection. When post-processing the intraoperative recordings, we further identified areas that positively responded to DES during the trail-making and mentalizing tests. In addition, a clear worsening of the patient's self-assessment ability was observed throughout the surgery. An awake cognitive neurosurgery approach allowed supramaximal resection by reaching the cortico-subcortical functional limits. The mapping of complex functions such as social cognition and self-awareness is key to preserving patients' postoperative cognitive health by maximizing the ability to resect the lesion and surrounding areas.
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Affiliation(s)
- Garazi Bermúdez
- Neurosurgery Service, Cruces Universitary Hospital, Barakaldo, Spain
- Health Research Institute Biocruces Bizkaia, Barakaldo, Spain
- University of the Basque Country, UPV/EHU, Bilbao, Spain
| | - Ileana Quiñones
- Neurobiology of Language, Basque Center On Cognition, Brain and Language, BCBL, Donostia-San Sebastian, Spain.
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain.
| | - Alejandro Carrasco
- Neurosurgery Service, Cruces Universitary Hospital, Barakaldo, Spain
- Health Research Institute Biocruces Bizkaia, Barakaldo, Spain
- University of the Basque Country, UPV/EHU, Bilbao, Spain
| | - Santiago Gil-Robles
- Health Research Institute Biocruces Bizkaia, Barakaldo, Spain
- Neurosurgery Service, Quironsalud Madrid Universitary Hospital, Madrid, Spain
| | - Lucia Amoruso
- Neurobiology of Language, Basque Center On Cognition, Brain and Language, BCBL, Donostia-San Sebastian, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
| | - Emmanel Mandonnet
- Lariboisière Hospital, Université Paris 7 Diderot, Paris, France
- Frontlab, CNRS UMR 7225, INSERM U1127, Paris, France
| | - Manuel Carreiras
- University of the Basque Country, UPV/EHU, Bilbao, Spain
- Neurobiology of Language, Basque Center On Cognition, Brain and Language, BCBL, Donostia-San Sebastian, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
| | - Gregorio Catalán
- Neurosurgery Service, Cruces Universitary Hospital, Barakaldo, Spain
- Health Research Institute Biocruces Bizkaia, Barakaldo, Spain
- University of the Basque Country, UPV/EHU, Bilbao, Spain
| | - Iñigo Pomposo
- Neurosurgery Service, Cruces Universitary Hospital, Barakaldo, Spain
- Health Research Institute Biocruces Bizkaia, Barakaldo, Spain
- University of the Basque Country, UPV/EHU, Bilbao, Spain
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Boerner C, Schroeder A, Meyer B, Krieg SM, Ille S. Cortical Location of Language Function May Differ between Languages While White Matter Pathways Are Similar in Brain Lesion Patients. Brain Sci 2023; 13:1141. [PMID: 37626496 PMCID: PMC10452579 DOI: 10.3390/brainsci13081141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
The neural representation of language can be identified cortically using navigated repetitive transcranial magnetic stimulation and subcortically using the fiber tracking of diffusion tensor imaging. We investigated how cortical locations of language and language-eloquent white matter pathways differ in 40 brain lesion patients speaking various languages. Error rates related to stimulations at single sites in the frontal and parietal lobe differed significantly between Balto-Slavic and Indo-European languages. Error rates related to stimulations at single sites in the temporal lobe differed significantly between bilingual individuals. No differences were found in the white matter language pathway volumes between Balto-Slavic and Indo-European languages nor between bilingual patients. These original and exploratory data indicate that the underlying subcortical structure might be similar across languages, with initially observed differences in the cortical location of language depending on the semantic processing, but these could not be confirmed using detailed statistical analyses pointing at a similar cortical and subcortical network.
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Affiliation(s)
- Corinna Boerner
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University Munich, 81675 Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University Munich, 81675 Munich, Germany
| | - Axel Schroeder
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University Munich, 81675 Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University Munich, 81675 Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University Munich, 81675 Munich, Germany
| | - Sandro M. Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University Munich, 81675 Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University Munich, 81675 Munich, Germany
| | - Sebastian Ille
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University Munich, 81675 Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University Munich, 81675 Munich, Germany
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9
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"Neural dynamics supporting longitudinal plasticity of action naming across languages: MEG evidence from bilingual brain tumor patients". Neuropsychologia 2023; 181:108494. [PMID: 36708918 DOI: 10.1016/j.neuropsychologia.2023.108494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 01/27/2023]
Abstract
Previous evidence suggests that distinct ventral and dorsal streams respectively underpin the semantic processing of object and action knowledge. Recently, we found that brain tumor patients with dorsal gliomas in frontoparietal hubs show a selective longitudinal compensation (post-vs. pre-surgery) during the retrieval of lexico-semantic information about actions (but not objects), indexed by power increases in beta rhythms (13-28 Hz). Here, we move one-step further and ask whether a similar organizational principle also stands across the different languages a bilingual speaks. To test this hypothesis, we combined a picture-naming task with MEG recordings and evaluated highly proficient Spanish-Basque bilinguals undergoing surgery for tumor resection in left frontoparietal regions. We assessed patients before and three months after surgery. At the behavioral level, we observed a similar performance across sessions irrespectively of the language at use, suggesting overall successful function preservation. At the oscillatory level, we found longitudinal selective power increases in beta for action naming in Spanish and Basque. Nevertheless, tumor resection triggered a differential reorganization of the L1 and the L2, with the latter one additionally recruiting the right hemisphere. Overall, our results provide evidence for (i) the specific involvement of frontoparietal regions in the semantic retrieval/representation of action knowledge across languages; (ii) a key role of beta oscillations as a signature of language compensation and (iii) the existence of divergent plasticity trajectories in L1 and L2 after surgery. By doing so, they provide new insights into the spectro-temporal dynamics supporting postoperative recovery in the bilingual brain.
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10
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Pascual JSG, Khu KJO, Starreveld YP. Cortical mapping in multilinguals undergoing awake brain surgery for brain tumors: Illustrative cases and systematic review. Neuropsychologia 2023; 179:108450. [PMID: 36529263 DOI: 10.1016/j.neuropsychologia.2022.108450] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Awake brain mapping in multilingual patients with brain tumors presents unique challenges to the neurosurgeon. Knowledge of potential eloquent sites is vital to preserve language function. METHODS We present two cases of pars opercularis glioma and perform a systematic review in accordance with PRISMA guidelines. RESULTS Our review yielded 7 studies, with a total of 25 multilingual brain tumor patients who underwent awake brain mapping. The age ranged from 25 to 62 years. Majority were female (56.5%). Most (52%) were trilingual, while 20% were quadrilingual and 28% were pentalingual. All tumors were left-sided, mostly in the frontal lobe. These were predominantly gliomas. Extent of resection was gross total in 61%. The brain mapping findings were heterogeneous. Some authors reported a greater number of cortical sites for the first language compared to others. Others found that the first and second languages shared cortical sites whereas the third and subsequent languages were located in distant sites. The peri-Sylvian area was also found to be involved in language that was learned at an earlier age. Subsequent languages thus involved more distant sites. A larger number of cortical areas were also activated for languages that were learned later in life. In terms of language disturbance and recovery, there were mixed results. CONCLUSION Cortical mapping in multilingual brain tumor patients showed heterogeneity in terms of the location and number of language areas in the face of pathology. These findings may influence neurosurgical and oncological management of tumors in the speech area but emphasize the need to tailor surgical approaches and intraoperative testing to the patient.
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Affiliation(s)
- Juan Silvestre G Pascual
- Division of Neurosurgery, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
| | - Kathleen Joy O Khu
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
| | - Yves P Starreveld
- Division of Neurosurgery, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Collée E, Vincent A, Visch-Brink E, De Witte E, Dirven C, Satoer D. Localization patterns of speech and language errors during awake brain surgery: a systematic review. Neurosurg Rev 2023; 46:38. [PMID: 36662312 PMCID: PMC9859901 DOI: 10.1007/s10143-022-01943-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/22/2022] [Accepted: 12/31/2022] [Indexed: 01/21/2023]
Abstract
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.
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Affiliation(s)
- Ellen Collée
- Department of Neurosurgery, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, NA2118, 3015, GD, Rotterdam, the Netherlands.
| | - Arnaud Vincent
- Department of Neurosurgery, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, NA2118, 3015, GD, Rotterdam, the Netherlands
| | - Evy Visch-Brink
- Department of Neurosurgery, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, NA2118, 3015, GD, Rotterdam, the Netherlands
| | - Elke De Witte
- Department of Neurosurgery, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, NA2118, 3015, GD, Rotterdam, the Netherlands
| | - Clemens Dirven
- Department of Neurosurgery, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, NA2118, 3015, GD, Rotterdam, the Netherlands
| | - Djaina Satoer
- Department of Neurosurgery, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, NA2118, 3015, GD, Rotterdam, the Netherlands
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12
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Geng S, Molinaro N, Timofeeva P, Quiñones I, Carreiras M, Amoruso L. Oscillatory dynamics underlying noun and verb production in highly proficient bilinguals. Sci Rep 2022; 12:764. [PMID: 35031665 PMCID: PMC8760282 DOI: 10.1038/s41598-021-04737-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/30/2021] [Indexed: 11/09/2022] Open
Abstract
Words representing objects (nouns) and words representing actions (verbs) are essential components of speech across languages. While there is evidence regarding the organizational principles governing neural representation of nouns and verbs in monolingual speakers, little is known about how this knowledge is represented in the bilingual brain. To address this gap, we recorded neuromagnetic signals while highly proficient Spanish-Basque bilinguals performed a picture-naming task and tracked the brain oscillatory dynamics underlying this process. We found theta (4-8 Hz) power increases and alpha-beta (8-25 Hz) power decreases irrespectively of the category and language at use in a time window classically associated to the controlled retrieval of lexico-semantic information. When comparing nouns and verbs within each language, we found theta power increases for verbs as compared to nouns in bilateral visual cortices and cognitive control areas including the left SMA and right middle temporal gyrus. In addition, stronger alpha-beta power decreases were observed for nouns as compared to verbs in visual cortices and semantic-related regions such as the left anterior temporal lobe and right premotor cortex. No differences were observed between categories across languages. Overall, our results suggest that noun and verb processing recruit partially different networks during speech production but that these category-based representations are similarly processed in the bilingual brain.
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Affiliation(s)
- Shuang Geng
- grid.423986.20000 0004 0536 1366Basque Center on Cognition, Brain and Language (BCBL), 20009 San Sebastian, Spain ,grid.11480.3c0000000121671098University of the Basque Country, UPV/EHU, 48940 Bilbao, Spain
| | - Nicola Molinaro
- grid.423986.20000 0004 0536 1366Basque Center on Cognition, Brain and Language (BCBL), 20009 San Sebastian, Spain ,grid.424810.b0000 0004 0467 2314IKERBASQUE, Basque Foundation for Science, 48009 Bilbao, Spain
| | - Polina Timofeeva
- grid.423986.20000 0004 0536 1366Basque Center on Cognition, Brain and Language (BCBL), 20009 San Sebastian, Spain ,grid.11480.3c0000000121671098University of the Basque Country, UPV/EHU, 48940 Bilbao, Spain
| | - Ileana Quiñones
- grid.423986.20000 0004 0536 1366Basque Center on Cognition, Brain and Language (BCBL), 20009 San Sebastian, Spain
| | - Manuel Carreiras
- grid.423986.20000 0004 0536 1366Basque Center on Cognition, Brain and Language (BCBL), 20009 San Sebastian, Spain ,grid.424810.b0000 0004 0467 2314IKERBASQUE, Basque Foundation for Science, 48009 Bilbao, Spain ,grid.11480.3c0000000121671098University of the Basque Country, UPV/EHU, 48940 Bilbao, Spain
| | - Lucia Amoruso
- Basque Center on Cognition, Brain and Language (BCBL), 20009, San Sebastian, Spain. .,IKERBASQUE, Basque Foundation for Science, 48009, Bilbao, Spain.
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13
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De Martino M, Talacchi A, Capasso R, Mazzotta A, Miceli G. Language Assessment in Multilingualism and Awake Neurosurgery. Front Hum Neurosci 2021; 15:750013. [PMID: 34899217 PMCID: PMC8660632 DOI: 10.3389/fnhum.2021.750013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/28/2021] [Indexed: 11/28/2022] Open
Abstract
Multilingualism has become a worldwide phenomenon that poses critical issues about the language assessment in patients undergoing awake neurosurgery in eloquent brain areas. The accuracy and sensitivity of multilingual perioperative language assessment procedures is crucial for a number of reasons: they should be appropriate to detect deficits in each of the languages spoken by the patient; they should be suitable to identify language-specific cortical regions; they should ensure that each of the languages of a multilingual patient is tested at an adequate and comparable level of difficulty. In clinical practice, a patient-tailored approach is generally preferred. This is a necessary compromise since it is impossible to predict all the possible language combinations spoken by individuals and thus the availability of standardized testing batteries is a potentially unattainable goal. On the other hand, this leads to high inconsistency in how different neurosurgical teams manage the linguistic features that determine similarity or distance between the languages spoken by the patient and that may constrain the neuroanatomical substrate of each language. The manuscript reviews the perioperative language assessment methodologies adopted in awake surgery studies on multilingual patients with brain tumor published from 1991 to 2021 and addresses the following issues: (1) The language selected for the general neuropsychological assessment of the patient. (2) The procedures adopted to assess the dimensions that may constrain language organization in multilingual speakers: age and type of acquisition, exposure, proficiency, and use of the different languages. (3) The type of preoperative language assessment used for all the languages spoken by the patient. (4) The linguistic tasks selected in the intraoperative setting. The reviewed data show a great heterogeneity in the perioperative clinical workup with multilingual patients. The only exception is the task used during language mapping, as the picture naming task is highly preferred. The review highlights that an objective and accurate description of both the linguistic profile of multilingual patients and the specific properties of the languages under scrutiny can profitably support clinical management and decision making in multilingual awake neurosurgery settings.
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Affiliation(s)
- Maria De Martino
- Department of Political and Communication Sciences (POLICOM), University of Salerno, Fisciano, Italy
| | | | | | - Annapina Mazzotta
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Gabriele Miceli
- Center for Mind/Brain Sciences, University of Trento, Trento, Italy
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14
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Roger E, Torlay L, Banjac S, Mosca C, Minotti L, Kahane P, Baciu M. Prediction of the clinical and naming status after anterior temporal lobe resection in patients with epilepsy. Epilepsy Behav 2021; 124:108357. [PMID: 34717247 DOI: 10.1016/j.yebeh.2021.108357] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/15/2021] [Accepted: 09/25/2021] [Indexed: 01/20/2023]
Abstract
By assessing the cognitive capital, neuropsychological evaluation (NPE) plays a vital role in the perioperative workup of patients with refractory focal epilepsy. In this retrospective study, we used cutting-edge statistical approaches to examine a group of 47 patients with refractory temporal lobe epilepsy (TLE), who underwent standard anterior temporal lobectomy (ATL). Our objective was to determine whether NPE may represent a robust predictor of the postoperative status, two years after surgery. Specifically, based on pre- and postsurgical neuropsychological data, we estimated the sensitivity of cognitive indicators to predict and to disentangle phenotypes associated with more or less favorable outcomes. Engel (ENG) scores were used to assess clinical outcome, and picture naming (NAM) performance to estimate naming status. Two methods were applied: (a) machine learning (ML) to explore cognitive sensitivity to postoperative outcomes; and (b) graph theory (GT) to assess network properties reflecting favorable vs. less favorable phenotypes after surgery. Specific neuropsychological indices assessing language, memory, and executive functions can globally predict outcomes. Interestingly, preoperative cognitive networks associated with poor postsurgical outcome already exhibit an atypical, highly modular and less densely interconnected configuration. We provide statistical and clinical tools to anticipate the condition after surgery and achieve a more personalized clinical management. Our results also shed light on possible mechanisms put in place for cognitive adaptation after acute injury of central nervous system in relation with surgery.
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Affiliation(s)
- Elise Roger
- Univ. Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France.
| | - Laurent Torlay
- Univ. Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France
| | - Sonja Banjac
- Univ. Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France
| | - Chrystèle Mosca
- Univ. Grenoble Alpes, Grenoble Institute of Neuroscience, Synchronisation et modulation des réseaux neuronaux dans l'épilepsie' & Neurology Department, 38000 Grenoble, France
| | - Lorella Minotti
- Univ. Grenoble Alpes, Grenoble Institute of Neuroscience, Synchronisation et modulation des réseaux neuronaux dans l'épilepsie' & Neurology Department, 38000 Grenoble, France
| | - Philippe Kahane
- Univ. Grenoble Alpes, Grenoble Institute of Neuroscience, Synchronisation et modulation des réseaux neuronaux dans l'épilepsie' & Neurology Department, 38000 Grenoble, France
| | - Monica Baciu
- Univ. Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France
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15
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Quiñones I, Amoruso L, Pomposo Gastelu IC, Gil-Robles S, Carreiras M. What Can Glioma Patients Teach Us about Language (Re)Organization in the Bilingual Brain: Evidence from fMRI and MEG. Cancers (Basel) 2021; 13:2593. [PMID: 34070619 PMCID: PMC8198785 DOI: 10.3390/cancers13112593] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 12/15/2022] Open
Abstract
Recent evidence suggests that the presence of brain tumors (e.g., low-grade gliomas) triggers language reorganization. Neuroplasticity mechanisms called into play can transfer linguistic functions from damaged to healthy areas unaffected by the tumor. This phenomenon has been reported in monolingual patients, but much less is known about the neuroplasticity of language in the bilingual brain. A central question is whether processing a first or second language involves the same or different cortical territories and whether damage results in diverse recovery patterns depending on the language involved. This question becomes critical for preserving language areas in bilingual brain-tumor patients to prevent involuntary pathological symptoms following resection. While most studies have focused on intraoperative mapping, here, we go further, reporting clinical cases for five bilingual patients tested before and after tumor resection, using a novel multimethod approach merging neuroimaging information from fMRI and MEG to map the longitudinal reshaping of the language system. Here, we present four main findings. First, all patients preserved linguistic function in both languages after surgery, suggesting that the surgical intervention with intraoperative language mapping was successful in preserving cortical and subcortical structures necessary for brain plasticity at the functional level. Second, we found reorganization of the language network after tumor resection in both languages, mainly reflected by a shift of activity to right hemisphere nodes and the recruitment of ipsilesional left nodes. Third, we found that this reorganization varied according to the language involved, indicating that L1 and L2 follow different reshaping patterns after surgery. Fourth, oscillatory longitudinal effects were correlated with BOLD laterality changes in superior parietal and middle frontal areas. These findings may reflect that neuroplasticity impacts on the compensatory involvement of executive control regions, supporting the allocation of cognitive resources as a consequence of increased attentional demands. Furthermore, these results hint at the complementary role of this neuroimaging approach in language mapping, with fMRI offering excellent spatial localization and MEG providing optimal spectrotemporal resolution.
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Affiliation(s)
- Ileana Quiñones
- Neurobiology of Language Group, Basque Center on Cognition, Brain and Language (BCBL), 20009 Donostia-San Sebastián, Spain; (L.A.); (M.C.)
| | - Lucia Amoruso
- Neurobiology of Language Group, Basque Center on Cognition, Brain and Language (BCBL), 20009 Donostia-San Sebastián, Spain; (L.A.); (M.C.)
- IKERBASQUE, Basque Foundation for Science, 48009 Bilbao, Spain
| | | | - Santiago Gil-Robles
- BioCruces Research Institute, 48015 Bilbao, Spain;
- Department of Neurosurgery, Hospital Quironsalud, 28223 Madrid, Spain
| | - Manuel Carreiras
- Neurobiology of Language Group, Basque Center on Cognition, Brain and Language (BCBL), 20009 Donostia-San Sebastián, Spain; (L.A.); (M.C.)
- IKERBASQUE, Basque Foundation for Science, 48009 Bilbao, Spain
- Department of Basque Language and Communication, University of the Basque Country, UPV/EHU, 48940 Bilbao, Spain
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