Determination Of Hemispheric Language Dominance Research Articles

Determination of hemispheric language dominance using functional magnetic resonance imaging and the Shiritori (Japanese word chain) task in patients with epilepsy: Comparison with the Wada test

PurposeThe Wada test has been the gold standard for determining hemispheric language dominance (HLD) in the presurgical evaluation of patients scheduled for neurosurgical procedures. As it poses inherent risks associated with intra-arterial catheter techniques and as it occasionally fails to indicate language dominance, an alternative reliable test is needed. We quantitatively assessed the results of functional magnetic resonance imaging (fMRI) using the Shiritori task, a Japanese word chain, to identify the threshold for correctly predicting HLD. MethodsThe subjects were 28 patients with intractable epilepsy scheduled to undergo the Wada test and focus resection. We set the region of interest (ROI) on the bilateral Brodmann areas 44 and 45 (BA 44 and 45). To compare the functional activity at both ROIs we calculated the language laterality index (LI) using the formula: [VL−VR]/[VL+VR]×100, where VL and VR indicated the number of activated voxels in the left and right ROIs, respectively. ResultsAs 2 patients were excluded due to the lack of activation in either ROI, the final study population consisted of 26 patients. By the Wada test, HLD was left in 20, right in 3, and equivocal in 3. At a cut-off of LI+50, the predictive sensitivity and specificity for left HLD were 85% (17/20) and 100%; right HLD was predicted in a single patient (sensitivity 33.3%, specificity 100%). ConclusionThe fMRI using the Shiritori task showed good activation in ROI of BA 44 and 45. At a cut-off of LI+50, LI of BA 44 and 45 predicted HLD identified by the Wada test with high specificity.

Determination of Hemispheric Language Dominance in the Surgical Epilepsy Patient

Presurgical evaluation for refractory epilepsy typically includes assessment of cognitive and language functions. The reference standard for determination of hemispheric language dominance has been the intracarotid amobarbital test (IAT) but functional magnetic resonance imaging (fMRI) is increasingly used. To critically assess current evidence regarding the diagnostic properties of fMRI in comparison with the IAT for determination of hemispheric language dominance. The objective was addressed through the development of a structured critically appraised topic. This included a clinical scenario, structured question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and content experts in the fields of epilepsy and neurosurgery. A systematic review and meta-analysis that compared the sensitivity and specificity of fMRI to IAT-determined language lateralization was selected for critical appraisal. The review included data from 23 articles (n=442); study methodology varied widely. fMRI was 83.5% sensitive and 88.1% specific for detection of hemispheric language dominance. There are insufficient data to support routine use of fMRI for the purpose of determining hemispheric language dominance in patients with intractable epilepsy. Larger, well-designed studies of fMRI for language and other cognitive outcomes as part of the presurgical and postsurgical evaluation of epilepsy patients are necessary.

Language Lateralization Represented by Spatiotemporal Mapping of Magnetoencephalography

Determination of hemispheric language dominance is critical for planning epilepsy surgery. We assess the usefulness of spatiotemporal source analysis of magnetoencephalography for determining language laterality. Thirty-five patients with epilepsy were studied. The patients performed a semantic word-processing task during MEG recording. Epochs containing language-related neuromagnetic activity were averaged after preprocessing. The averaged data between 250 and 550 ms after stimulus were analyzed by using dynamic statistical parametric mapping. ROIs were obtained in the opercular and triangular parts of the inferior frontal gyrus, superior temporal gyrus, and supramarginal gyrus in both hemispheres. We calculated laterality indices according to 1) dSPM-amplitude method, based on the amplitude of activation in the ROIs, and 2) dSPM-counting method, based on the number of unit dipoles with activation over a threshold in the ROIs. The threshold was determined as half of the maximum value in all ROIs for each patient. A LI ≥0.10 or ≤-0.10 was considered left- or right-hemisphere dominance, respectively; a LI between -0.10 and 0.10 was considered bilateral. All patients underwent an intracarotid amobarbital procedure as part of presurgical evaluation. The dSPM-counting method demonstrated laterality consistent with the IAP in 32 of 35 patients (91.4%), the remaining 3 (8.6%) demonstrated bilateral language representation, whereas the dSPM-amplitude method showed 18 (51.4%) concordant and 17 (48.6%) bilateral. No laterality opposite to the IAP was found. Spatiotemporal mapping of language lateralization with the dSPM-counting method may reduce the necessity for an IAP in as many as 90% of patients.

Pediatric Language Mapping: Sensitivity of Neurostimulation and Wada Testing in Epilepsy Surgery

Functional mapping of eloquent cortex with electrical neurostimulation is used both intra- and extraoperatively to tailor resections. In pediatric patients, however, functional mapping studies frequently fail to localize language. Wada testing has also been reported to be less sensitive in children. Thirty children (4.7 - 14.9 years) and 18 adult controls (18-59 years) who underwent extraoperative language mapping via implanted subdural electrodes at the NYU Comprehensive Epilepsy Center were included in the study. Ten children and 14 adults underwent preoperative Wada testing. Success of the procedures was defined as the identification of at least one language site by neurostimulation mapping and determination of hemispheric language dominance on the Wada test. In children younger than 10.2 years, cortical stimulation identified language cortex at a lower rate than was seen in children older than 10.2 years and in adults (p<0.05). This threshold, demonstrated by survival and chi2 analysis, was sharply defined in our data set. Additionally, Wada testing was more likely to be successful than was extraoperative mapping in this younger age group (p<0.05). Analysis of our series demonstrates that language cortex is less likely to be identified in children younger than 10 years, suggesting that alternatives to the current methods of cortical electrical stimulation, particularly the use of preoperative language lateralization, may be required in this age group.

Putting the brain in Jeopardy: a novel comprehensive and expressive language task?

To develop and test a novel fMRI compatible comprehensive and expressive language task that reliably and predictably activates both Wernicke's and Broca's cortical brain regions, respectively, and has utility for the determination of hemispheric language dominance. Ten healthy men (seven) and women (three) were administered a task based on the television game Jeopardy that was adapted for fMRI presentation. The task was programmed using E-PRIME software and designed to run as an event-related experiment. The study was conducted on 3 T MRI Phillips Intera scanner, and data was anlysed using Brain Voyager QX. All subjects provided written informed consent. The Jeopardy task produced robust left hemisphere activation in regions corresponding to Wernicke's and Broca's areas. This novel fMRI compatible task (Jeopardy) reliably maps both Broca's and Wernicke's areas with robust hemispheric lateralization. It is potentially useful in language localization studies as it offers advantages over conventional procedures and other fMRI tasks by virtue of being non-invasive and mapping both language areas in one experiment.

Comparison between visual half-field performance and cerebral blood flow changes as indicators of language dominance

The determination of hemispheric language dominance (HLD) can be accomplished in two ways. One approach relies on hemispheric differences in cerebral blood flow velocity (CBFV) changes during language activity, while the other approach makes use of performance differences between the left and right visual field when verbal stimuli are presented in a tachistoscopic visual field paradigm. Since both methodologically different approaches claim to assess functional HLD, it seems plausible to expect that the respective laterality indices (LI) would correspond. To test this expectation we measured language lateralisation in 58 healthy right-handed, left-handed, and ambidextrous subjects with both approaches. CBFV changes were recorded with functional transcranial Doppler sonography (fTCD). We applied a lexical decision task with bilateral visual field presentation of abstract nouns and, in addition, a task of mental word generation. In the lexical decision task, a highly significant right visual field advantage was observed for number of correct responses and reaction times, while at the same time and contrary to expectation the increase of CBFV was significantly higher in the right than left hemisphere. During mental word generation, the acceleration of CBF was significantly higher in the left hemisphere. A comparison between individual LI derived from CBF measurement during mental word generation and from visual field performances in the lexical decision task showed a moderate correspondence in classifying the subjects' HLD. However, the correlation between the corresponding individual LI was surprisingly low and not significant. The results are discussed with regard to the issue of a limited reliability of behavioural LI on the one hand and the possibility of a fundamental difference between the behavioural and the physiological indicators of laterality on the other hand.

Determination of Hemispheric Language Dominance Using Functional MRI: Comparison of Visual and Auditory Stimuli

Purpose : To assess the difference between auditory and visual stimuli when determining hemispheric lan-guage dominance by using functional MRI. Materials and Methods : In ten healthy adult volunteers (8 right-handed, 1 left-handed, 1 ambidextrous), motor language activation in axial slices of frontal lobe was mapped on a Simens 1.5T Vision Plus system using single-shot EPI. Series of 120 consecutive images per section were acquired during three cycles of task activation and rest. During each activation, a series of four syllables was delivered by means of both a visual and auditory method, and the volunteers were asked to mentally generate words starting with each syllable. In both in-ferior frontal gyri and whole frontal lobes, lateralization indices were calculated from the activated pixels. We determined the language dominant hemisphere, and compared the results of the visual method and the auditory method. Results : Seven right-handed persons were left-hemisphere dominant, and one left-handed and one ambidex-trous person were right-hemisphere dominant. Five of nine persons demonstrated larger lateralization indices with the auditory method than the visual method, while the remaining four showed larger lateralization in-dices with the visual method. No statistically significant difference was noted when comparing the results of the two methods(p>0.05). Conclusion : When determining hemispheric language dominance using functional MRI, the two methods are equally appropriate.

Localization of Language-Related Cortex with15O-Labeled Water PET in Patients with Gliomas

Measurement of relative cerebral blood flow (CBF) with15O-labeled water PET has been widely used for brain mapping experiments on language functions in normal volunteers and patients with epilepsy. We focused on the question of whether PET during speech activation is an appropriate method for noninvasive determination of language-related cortex in patients with brain tumors. Furthermore, the suitability of the method for determination of hemispheric language dominance was examined and compared to the results of the Edinburgh Handedness Inventory. Ten right-handed and six left-handed patients with gliomas were examined prior to surgery while repeatedly performing word repetition and verb generation tasks. A set of volumes of interest (VOIs) was drawn on coregistered MRI in order to account for anatomic variability as well as anatomical alterations due to tumor mass effect. Repetition of nouns did not produce significant hemispheric differences. During stimulation by verb generation, reliable lateralized activations of Broca's area and supplementary motor area were detected in all right-handed patients. Of the left-handed patients, two showed clear right lateralization, two activated Broca's area bilaterally, and two had a pattern similar to that of right-handers. Patients with bilateral activations showed the strongest tendency toward bihandedness according to the handedness inventory. Lateralization of supplementary motor area in left-handers corresponded to lateralized activity in Broca's area. Tumors in the vicinity of language-related regions did not alter activation responses. In conclusion, measurement of CBF changes during verb generation permits identification of language-related areas in patients with gliomas with strong lateralization related to hemispheric dominance. These findings may be of particular clinical interest for left-handed patients.

Determination of hemispheric language dominance by imaging event-related brain potentials

Determination of hemispheric language dominance by imaging event-related brain potentials

Rapid-rate transcranial magnetic stimulation and hemispheric language dominance: usefulness and safety in epilepsy.

We performed rapid-rate transcranial magnetic stimulation (r-TMS) in 14 epileptic patients, using a coil centered over nine different positions on each side of the scalp and while the subjects counted aloud. We obtained lateralized speech arrest, concordant with the site of manual preference, in only seven patients. There was transitory homonymous hemianopia (one patient), brief jerking of one arm (two patients), and affective (crying) reaction (three patients) after the end of a train of stimuli. In our experience, r-TMS is not as sensitive as previously reported for determination of hemispheric language dominance and may have undesirable side effects.

Induction of speech arrest and counting errors with rapid‐rate transcranial magnetic stimulation

Six adult epileptic patients underwent rapid-rate transcranial magnetic stimulation (rTMS) at stimulation rates of up to 25 Hz with an 11-cm water-cooled round coil held flat on the scalp, centered over 15 different positions on each side of the scalp. The trains of stimuli were for 10 seconds while the patients counted aloud. rTMS centered over D5 or D7 induced reproducible speech arrest in all patients and counting errors in three when applied at lower intensities. There were no such speech disturbances by rTMS centered over the different positions on the right side. Intracarotid amobarbital test (IAT) demonstrated left hemispheric language dominance in all patients. Lateralization of speech arrest induced by rTMS correlated with the IAT results and may be helpful for noninvasive determination of hemispheric language dominance.