Bilingual and multilingual language processing

Enhancement of phonemic verbal fluency in multilingual young adults by transcranial random noise stimulation

Several studies have analyzed the effects of transcranial direct current stimulation on verbal fluency tasks in non-clinical populations. Nevertheless, the reported effects on verbal fluency are inconsistent. In addition, the effect of other techniques such as transcranial random noise stimulation (tRNS) on verbal fluency enhancement has yet to be studied in healthy multilingual populations. This study aims to explore the effects of tRNS on verbal fluency in healthy multilingual individuals. Fifty healthy multilingual (Spanish, English and Basque) adults were randomly assigned to a tRNS or sham group. Electrodes were placed on the left dorsolateral prefrontal cortex and left inferior frontal gyrus. All participants performed phonemic and semantic verbal fluency tasks before, during (online assessment) and immediately after (offline assessment) stimulation in three different languages. The results showed significantly better performance by participants who received tRNS in the phonemic verbal fluency tasks in Spanish (in the online and offline assessment) and English (in the offline assessment). No differences between conditions were found in Basque nor semantic verbal fluency. These findings suggests that tRNS on the left prefrontal cortex could help improve phonemic, yet not semantic, fluency in healthy multilingual adults.

Application of a Standardized Treatment Paradigm as a Strategy to Achieve Optimal Onco-Functional Balance in Glioma Surgery

BACKGROUND

Gliomas, characterized by their invasive persistence and tendency to affect critical brain regions, pose a challenge in surgical resection due to the risk of neurological deficits. This study focuses on a personalized approach to achieving an optimal onco-functional balance in glioma resections, emphasizing maximal tumor removal while preserving the quality of life.

METHODS

A retrospective analysis of 57 awake surgical resections of gliomas at the National University Hospital, Singapore, was conducted. The inclusion criteria were based on diagnosis, functional boundaries determined by direct electrical stimulation, preoperative Karnofsky Performance Status score, and absence of multifocal disease on MRI. The treatment approach included comprehensive neuropsychological evaluation, determination of suitability for awake surgery, and standard asleep-awake-asleep anesthesia protocol. Tumor resection techniques and postoperative care were systematically followed.

RESULTS

The study included 53 patients (55.5% male, average age 39 years), predominantly right-handed. Over half reported seizures as their chief complaint. Tumors were mostly low-grade gliomas. Positive mapping of the primary motor cortex was conducted in all cases, with awake surgery completed in 77.2% of cases. New neurological deficits were observed in 26.3% of patients at 1 month after operation; most showed significant improvement at 6 months.

CONCLUSION

The standardized treatment paradigm effectively achieved an optimal onco-functional balance in glioma patients. While some patients experienced neurological deficits postoperatively, the majority recovered to their preoperative baseline within 3 months. The approach prioritizes patient empowerment and customized utilization of functional mapping techniques, considering the challenge of preserving diverse languages in a multilingual patient population.

SORL1 rs1699102 Moderates the Effect of Sex on Language Network

BACKGROUND

Language ability differs between the sexes. However, it is unclear how this sex difference is moderated by genetic factors and how the brain interacts with genetics to support this specific language capacity. Previous studies have demonstrated that the sorting protein-related receptor (SORL1) polymorphism influences cognitive function and brain structure differently in males and females and is associated with Alzheimer's disease risk.

OBJECTIVE

The aim of this study was to investigate the effects of sex and the SORL1 rs1699102 (CC versus T carriers) genotype on language.

METHODS

103 non-demented Chinese older adults from Beijing Aging Brain Rejuvenation Initiative (BABRI) database were included in this study. Participants completed language tests, T1-weighted structural magnetic resonance imaging (MRI) and resting-state functional MRI. Language test performance, gray matter volume, and network connections were compared between genotype and sex groups.

RESULTS

The rs1699102 polymorphism moderated the effects of sex on language performance, with the female having reversed language advantages in T carriers. The T allele carriers had lower gray matter volume in the left precentral gyrus. The effect of sex on language network connections was moderated by rs1699102; male CC homozygotes and female T carriers had higher internetwork connections, which were negatively correlated with language performance.

CONCLUSION

These results suggest that SORL1 moderates the effects of sex on language, with T being a risk allele, especially in females. Our findings underscore the importance of considering the influence of genetic factors when examining sex effects.

The influence of orthographic depth on multilinguals' neural networks

Orthographic depth, the consistency and complexity of grapheme-phoneme correspondence, influences brain activation in multilinguals’ first (L1) and second language (L2). The intrinsic functional connectivity of cross-language transfer was investigated between two groups of multilinguals, those whose L2 orthography is deeper than their L1 (S-to-D group) and those whose L2 orthography is shallower than their L1 (D-to-S group). Based on previous reports, we focused on two seed regions: the Visual Word Form Area (VWFA) and the left posterior supramarginal gyrus (pSMG). Group comparisons revealed stronger connectivity for the D-to-S group between the left pSMG and the right precuneus/cuneal cortex and the right SMG/angular gyrus. Moreover, we found that the greater the linguistic orthographic distance—the less similar in orthographic depth two languages are—the greater the negative connectivity between the left pSMG and the right pSMG, middle frontal gyrus (MFG) and frontal pole, and a cluster that included the inferior frontal gyrus (IFG) pars opercularis, frontal operculum, and insular cortex. When linguistic distance was greater, there was also greater negative connectivity between the VWFA and the left precuneus. Furthermore, stronger connectivity was found between the left pSMG and the right precuneus in multilinguals who spoke at least three languages (trilinguals) compared to those who only spoke two languages (bilinguals). Follow-up analyses revealed that this difference was driven by stronger intrinsic connectivity in D-to-S trilinguals compared to the S-to-D trilinguals. Taken together, the findings of this study suggest that multilinguals’ intrinsic functional connectivity is shaped by the orthographic depth of their L2 in relation to L1, as well as differences between bilingualism and trilingualism.

Intraoperative Seizure Detection During Active Resection of Glioblastoma Through a Novel Hollow Circular Electrocorticography Array

BACKGROUND AND IMPORTANCE

Data supporting the use of electrocorticography (ECoG) monitoring during electrical stimulation in awake craniotomies for resection of supratentorial neoplasms is robust, but its applicability during active resection is often limited by the inability to keep the array in place. Given the known survival benefit of gross total resection in glioma surgery, novel approaches to surgical monitoring are warranted to maximize safe resection and optimize surgical outcomes in patients with glioblastoma.

CLINICAL PRESENTATION

A 68-yr-old right-handed woman presented to the emergency department with confusion. Imaging studies revealed a bifrontal intra-axial brain lesion. She underwent a left-sided awake craniotomy procedure with cortical and subcortical mapping. During surgical resection, multiple electrographic seizures were detected on continuous ECoG monitoring with a customized 22-channel high-density hollow circular array. She remained without clinical evidence of seizures at 3 mo after surgery.

CONCLUSION

We report a unique case of serial electrographic seizures detected during continuous intraoperative ECoG monitoring during active surgical resection of a glioblastoma using a novel circular hollow array during an awake craniotomy. The use of continuous ECoG monitoring during active resection may provide additional data, with potential influence in outcomes for patients undergoing resection of high-grade glial neoplasms.

Potential differences between monolingual and bilingual patients in approach and outcome after awake brain surgery

INTRODUCTION

20.8% of the United States population and 67% of the European population speak two or more languages. Intraoperative different languages, mapping, and localization are crucial. This investigation aims to address three questions between BL and ML patients: (1) Are there differences in complications (i.e. seizures) and DECS techniques during intra-operative brain mapping? (2) Is EOR different? and (3) Are there differences in the recovery pattern post-surgery?

METHODS

Data from 56 patients that underwent left-sided awake craniotomy for tumors infiltrating possible dominant hemisphere language areas from September 2016 to June 2019 were identified and analyzed in this study; 14 BL and 42 ML control patients. Patient demographics, education level, and the age of language acquisition were documented and evaluated. fMRI was performed on all participants.

RESULTS

0 (0%) BL and 3 (7%) ML experienced intraoperative seizures (P = 0.73). BL patients received a higher direct DECS current in comparison to the ML patients (average = 4.7, 3.8, respectively, P = 0.03). The extent of resection was higher in ML patients in comparison to the BL patients (80.9 vs. 64.8, respectively, P = 0.04). The post-operative KPS scores were higher in BL patients in comparison to ML patients (84.3, 77.4, respectively, P = 0.03). BL showed lower drop in post-operative KPS in comparison to ML patients (- 4.3, - 8.7, respectively, P = 0.03).

CONCLUSION

We show that BL patients have a lower incidence of intra-operative seizures, lower EOR, higher post-operative KPS and tolerate higher DECS current, in comparison to ML patients.

Epilepsy and Bilingualism. A Systematic Review

Background: In patients with epilepsy, language abilities and neural language organization have been primarily investigated for the patient's mother tongue. However, in clinical practice, many patients use more than one language or use their second language more than their mother tongue. Yet, information about the linguistic profiles and brain organization of both languages in bilingual epilepsy patients is scarce. The purpose of this study was thus to systematically review the literature on language localization and language abilities in bilingual patients with epilepsy. Methods: An extensive literature search was performed using various electronic databases, including Embase and Medline. Key aspects of inclusion criteria were the assessment of language abilities and/or the investigation of neural language mapping in bilingual patients with epilepsy. Results: Our search strategy yielded 155 articles on language in bilingual epilepsy patients. Of these, 12 met final eligibility criteria. The majority of included articles focused on brain mapping of language using fMRI, Wada-test, or electrocortical stimulation in bilingual epilepsy patients, five studies investigated interictal language abilities in this patient group. Study results showed a pronounced heterogeneity of language abilities in bilingual patients, varying from intact language profiles to impairment in several language functions in both languages. However, the mother tongue was most often better perserved than the second language. Furthermore, studies on brain mapping of both languages again revealed heterogeneous findings ranging from identical brain regions for both languages to overlapping, but more distributed cortical areas for the non-native language. Conclusions: This review underlines the need to evaluate linguistic abilities in both languages, as well as the necessity to preoperatively map both languages in bilingual epilepsy patients. In contrast to the large scientific interest in language abilities and language localization in monolingual epilepsy patients, this review shows that in bilingual patients, the examination of language functions and the identification of brain regions associated with both languages so far played a minor role in epilepsy research. Our review thus emphasizes the need of future research activities in this field.

Structural neural predictors of Farsi-English bilingualism

The neurobiology of bilingualism is hotly debated. The present study examines whether normalized cortical measurements can be used to reliably classify monolinguals versus bilinguals in a structural MRI dataset of Farsi-English bilinguals and English monolinguals. A decision tree classifier classified bilinguals with an average correct classification rate of 85%, and monolinguals with a rate of 71.4%. The most relevant regions for classification were the right supramarginal gyrus, left inferior temporal gyrus and left inferior frontal gyrus. Larger studies with carefully matched monolingual and bilingual samples are needed to confirm that features of these regions can reliably categorize monolingual and bilingual brains. Nonetheless, the present findings suggest that a single structural MRI scan, analyzed with measures readily available using default procedures in a free open-access software (Freesurfer), can be used to reliably predict an individual's language experience using a decision tree classifier, and that Farsi-English bilingualism implicates regions identified in previous group-level studies of bilingualism in other languages.

Recently learned foreign abstract and concrete nouns are represented in distinct cortical networks similar to the native language

In the native language, abstract and concrete nouns are represented in distinct areas of the cerebral cortex. Currently, it is unknown whether this is also the case for abstract and concrete nouns of a foreign language. Here, we taught adult native speakers of German 45 abstract and 45 concrete nouns of a foreign language. After learning the nouns for 5 days, participants performed a vocabulary translation task during functional magnetic resonance imaging. Translating abstract nouns in contrast to concrete nouns elicited responses in regions that are also responsive to abstract nouns in the native language: the left inferior frontal gyrus and the left middle and superior temporal gyri. Concrete nouns elicited larger responses in the angular gyri bilaterally and the left parahippocampal gyrus than abstract nouns. The cluster in the left angular gyrus showed psychophysiological interaction (PPI) with the left lingual gyrus. The left parahippocampal gyrus showed PPI with the posterior cingulate cortex. Similar regions have been previously found for concrete nouns in the native language. The results reveal similarities in the cortical representation of foreign language nouns with the representation of native language nouns that already occur after 5 days of vocabulary learning. Furthermore, we showed that verbal and enriched learning methods were equally suitable to teach foreign abstract and concrete nouns. Hum Brain Mapp 38:4398-4412, 2017. © 2017 Wiley Periodicals, Inc.

Numbers and functional lateralization: A visual half-field and dichotic listening study in proficient bilinguals

Potential links between language and numbers and the laterality of symbolic number representations in the brain are still debated. Furthermore, reports on bilingual individuals indicate that the language-number interrelationships might be quite complex. Therefore, we carried out a visual half-field (VHF) and dichotic listening (DL) study with action words and different forms of symbolic numbers used as stimuli to test the laterality of word and number processing in single-, dual-language and mixed -task and language- contexts. Experiment 1 (VHF) showed a significant right visual field/left hemispheric advantage in response accuracy for action word, as compared to any form of symbolic number processing. Experiment 2 (DL) revealed a substantially reversed effect - a significant right ear/left hemisphere advantage for arithmetic operations as compared to action word processing, and in response times in single- and dual-language contexts for number vs. action words. All these effects were language independent. Notably, for within-task response accuracy compared across modalities significant differences were found in all studied contexts. Thus, our results go counter to findings showing that action-relevant concepts and words, as well as number words are represented/processed primarily in the left hemisphere. Instead, we found that in the auditory context, following substantial engagement of working memory (here: by arithmetic operations), there is a subsequent functional reorganization of processing single stimuli, whether verbs or numbers. This reorganization - their weakened laterality - at least for response accuracy is not exclusive to processing of numbers, but the number of items to be processed. For response times, except for unpredictable tasks in mixed contexts, the "number problem" is more apparent. These outcomes are highly relevant to difficulties that simultaneous translators encounter when dealing with lengthy auditory material in which single items such as number words (and possibly other types of key words) need to be emphasized. Our results may also shed a new light on the "mathematical savant problem".

Word meaning acquisition is reflected in brain potentials of isolated words

Learning a new concept and corresponding word typically involves repeated exposure to the word in the same or a similar context until the link crystallizes in long term memory. Although electrophysiological indices of the result of learning are well documented, there is currently no measure of the process of conceptually-mediated learning itself. Here, we recorded event-related brain potentials from participants who read unfamiliar words presented in isolation followed by a definition that either explained the meaning of the word or was a true, but uninformative statement. Self-reported word knowledge ratings increased for those words that were followed by meaningful definitions and were correlated with a decrease in ERP amplitude of a late frontal negativity (LFN) elicited by the isolated word. Importantly, the rate of LFN amplitude change predicted post-hoc learning outcome measures. Therefore, the LFN is real-time measure that is not under conscious control and which reflects conceptually-mediated learning. We propose that the LFN provides for the first time the opportunity to assess learning during study.

L1 and L2 processing in the bilingual brain: A meta-analysis of neuroimaging studies

Neuroimaging studies investigating bilingual processes have produced controversial results in determining similarities versus differences between L1 and L2 neural networks. The current meta-analytic study was conducted to examine what factors play a role in the similarities and differences between L1 and L2 networks with a focus on age of acquisition (AOA) and whether the orthographic transparency of L2 is more or less transparent than that of L1. Using activation likelihood estimation (ALE), we found L2 processing involved more additional regions than L1 for late bilinguals in comparison to early bilinguals, suggesting L2 processing is more demanding in late bilinguals. We also provide direct evidence that AOA of L2 influences L1 processing through the findings that early bilinguals had greater activation in the left fusiform gyrus than late bilinguals during L1 processing even when L1 languages were the same in the two groups, presumably due to greater co-activation of orthography in L1 and L2 in early bilinguals. In addition, we found that the same L2 languages evoked different brain activation patterns depending on whether it was more or less transparent than L1 in orthographic transparency. The bilateral auditory cortex and right precentral gyrus were more involved in shallower-than-L1 L2s, suggesting a "sound-out" strategy for a more regular language by involving the phonological regions and sensorimotor regions to a greater degree. In contrast, the left frontal cortex was more involved in the processing of deeper-than-L1 L2s, presumably due to the increased arbitrariness of mapping between orthography and phonology in L2.

Distinct activated cortical areas and volumes in Uygur-Chinese bilinguals

Objective

The aim of this study is to evaluate variations in cortical activation in early and late Uygur-Chinese bilinguals from the Xinjiang Uygur Autonomous Region of China. Methodology: During a semantic judgment task with visual stimulation by a single Chinese or Uygur word, functional magnetic resonance imaging (fMRI) was performed. The fMRI data regarding activated cortical areas and volumes by both languages were analyzed.

Results

The first language (L1) and second language (L2) activated language-related hemispheric regions, including the left inferior frontal and parietal cortices, and L1 specifically activated the left middle temporal gyrus. For both L1 and L2, cortical activation was greater in the left hemisphere, and there was no significant difference in the lateralization index (LI) between the two languages (p > 0.05). Although the total activated cortical areas were larger in early than late bilinguals, the activation volumes were not significantly different.

Conclusion

Activated brains areas in early and late fluent bilinguals largely overlapped. However, these areas were more scattered upon presentation of L2 than L1, and L1 had a more specific pattern of activation than L2. For both languages, the left hemisphere was dominant. We found that L2 proficiency level rather than age of acquisition had a greater influence on which brain areas were activated with semantic processing.

Co-lateralized bilingual mechanisms for reading in single and dual language contexts: evidence from visual half-field processing of action words in proficient bilinguals

When reading, proficient bilinguals seem to engage the same cognitive circuits regardless of the language in use. Yet, whether or not such “bilingual” mechanisms would be lateralized in the same way in distinct—single or dual—language contexts is a question for debate. To fill this gap, we tested 18 highly proficient Polish (L1) —English (L2) childhood bilinguals whose task was to read aloud one of the two laterally presented action verbs, one stimulus per visual half field. While in the single-language blocks only L1 or L2 words were shown, in the subsequent mixed-language blocks words from both languages were concurrently displayed. All stimuli were presented for 217 ms followed by masks in which letters were replaced with hash marks. Since in non-simultaneous bilinguals the control of language, skilled actions (including reading), and representations of action concepts are typically left lateralized, the vast majority of our participants showed the expected, significant right visual field advantage for L1 and L2, both for accuracy and response times. The observed effects were nevertheless associated with substantial variability in the strength of the lateralization of the mechanisms involved. Moreover, although it could be predicted that participants' performance should be better in a single-language context, accuracy was significantly higher and response times were significantly shorter in a dual-language context, irrespective of the language tested. Finally, for both accuracy and response times, there were significant positive correlations between the laterality indices (LIs) of both languages independent of the context, with a significantly greater left-sided advantage for L1 vs. L2 in the mixed-language blocks, based on LIs calculated for response times. Thus, despite similar representations of the two languages in the bilingual brain, these results also point to the functional separation of L1 and L2 in the dual-language context.

Human brain evolution: transcripts, metabolites and their regulators

What evolutionary events led to the emergence of human cognition? Although the genetic differences separating modern humans from both non-human primates (for example, chimpanzees) and archaic hominins (Neanderthals and Denisovans) are known, linking human-specific mutations to the cognitive phenotype remains a challenge. One strategy is to focus on human-specific changes at the level of intermediate phenotypes, such as gene expression and metabolism, in conjunction with evolutionary changes in gene regulation involving transcription factors, microRNA and proximal regulatory elements. In this Review we show how this strategy has yielded some of the first hints about the mechanisms of human cognition.

Once is Enough: N400 Indexes Semantic Integration of Novel Word Meanings from a Single Exposure in Context

We investigated the impact of contextual constraint on the integration of novel word meanings into semantic memory. Adults read strongly or weakly constraining sentences ending in known or unknown (novel) words as scalp-recorded electrical brain activity was recorded. Word knowledge was assessed via a lexical decision task in which recently seen known and unknown word sentence endings served as primes for semantically related, unrelated, and synonym/identical target words. As expected, N400 amplitudes to target words preceded by known word primes were reduced by prime-target relatedness. Critically, N400 amplitudes to targets preceded by novel primes also varied with prime-target relatedness, but only when they had initially appeared in highly constraining sentences. This demonstrates for the first time that fast-mapped word representations can develop strong associations with semantically related word meanings and reveals a rapid neural process that can integrate information about word meanings into the mental lexicon of young adults.

How long does it take to describe what one sees? The first step using picture description tasks

The study explored the dependences between quantifiable features of a picture and the time it takes to describe it. Six native English speakers and six bilinguals watched pictures presented on the monitor and described them "as quickly and accurately as possible". The bilingual participants performed the test twice, in English and in their native language. The pictures could contain one to six objects. There were four series of trials that differed in the number of characteristics of the objects the participants were instructed to describe. Reaction time showed a modest, close to linear scaling with the number of objects. Both reaction time and speech time were significantly longer for the bilingual participants performing in English as compared to their performance in the native language and to the English speaking participants. The difference in reaction time did not depend on the number of objects. Speech time showed a close to linear scaling with the number of objects within each of the four series. The linear regression coefficient in this relationship increased linearly with the number of characteristics of the objects across all series. The results are discussed in relation to speed-accuracy trade-off and different strategies of picture description.

Normal-hearing English-as-a-second-language listeners' recognition of English words in competing signals

English-as-a-second-language (ESL) listeners have difficulty perceiving English speech presented in background noise. The current study furthered this line of investigations by including participants who varied widely in their age of English acquisition and length of English learning: 24 native English monolingual (EML), 12 simultaneous bilingual (SBL), 10 early ESL (E-ESL), and 14 late ESL (L-ESL) listeners. Word recognition scores were obtained in quiet and in the presence of speech-weighted noise, multi-talker babble, forward-playing music, and time-reversed music. All words and competing signals were presented at 45 dB HL. EML and SBL listeners' performances were found to be similar across test conditions. ESL, especially L-ESL listeners, performed significantly more poorly in all conditions than EML and SBL listeners. Overall, speech-weighted noise and multi-talker babble showed greater masking effect than music; however, the difference in performance between L-ESL and EML listeners was the largest for the music maskers, indicating that L-ESL listeners are susceptible to weaker maskers. Age of acquisition and length of learning were both shown to be good indicators of SBL and ESL listeners' performance.

Is /h/ phonetically neutral?

Use of /h/ in the phrase, 'Say /hVC/ again' has been tacitly assumed to provide a neutral phonetic context in which to study the articulatory characteristics of speech either preceding or following /h/ articulation. Yet, assessment of the stability or neutrality of /h/ has gone untested. The current study sought to determine whether articulation of /h/ differs according to sex and language accent, as well as to examine its influence on subsequent vowel articulation. Selected acoustic features of /hVC/ were measured in 40 speakers of American English (AE) and 40 speakers of Mandarin-accented English (MAE). Results of an analysis of /h/ duration revealed no sex differences within each language group, however considerable variation was found according to accented vs unaccented English. Clear sex differences were found for the production of /h/, occurring more often among male speakers regardless of language variety. Considerable variation in production of /h/ was found between language groups. Analysis of vowel formant frequencies immediately following /h/ articulation indicated minimal coarticulatory effects for both AE and MAE speakers. The present results appear to support the suggestion that /h/ is not exclusively sex-linked and may indeed vary according to non-biological factors. In spite of these variations, /h/ articulation appears to have a negligible influence on neighbouring vowel articulation.

Evidence of a large-scale network underlying language switching: a brain stimulation study

This 47-year-old, right-handed bilingual (French and English) man underwent awake surgery for a glioma in the left dominant posterior temporal lobe. During intraoperative picture naming, direct electrostimulation of a discrete cortical area within the posterior part of the superior temporal sulcus elicited an involuntary language switching (French to English). Moreover, during tumor resection, subcortical electrical mapping again generated reproducible language switching (French to English) when stimulating the superior longitudinal fasciculus. After transient immediately postoperative worsening, the patient recovered normal language performance. Both 7 days and 2 months later, however, another language switching episode (French to English) was observed during a naming task. Thus, both intraoperative mapping and transient postsurgical disturbances support involvement of the left dominant posterior temporal area and the superior longitudinal fasciculus in language switching. Interestingly, this pathway is known to connect the posterosuperior temporal gyrus to the Broca center, a region the authors have described as inducing possible switching on stimulation. Therefore, the authors suggest the existence of a large-scale distributed network subserving language switching. Such knowledge may have important clinical implications for the surgical care of a bilingual patient harboring a lesion in the left hemisphere.

Normal and abnormal aging in bilinguals

Bilinguals use two different language systems to mediate not only social communication, but also cognitive processes. Potential differences between bilinguals and monolinguals in task-solving strategies and patterns of cognitive decline during normal and abnormal aging have been suggested.

Review of language organisation in bilingual patients: what can we learn from direct brain mapping?

Although the majority of people worldwide are bilingual, the brain representation of language in bilingual persons is still a matter of debate. Since the beginning of the studies conducted on bilinguals, most authors denied that learning a new language requires a new semantic processing or the involvement of new cortical areas. In this paper, we review neurosurgical studies using direct electrocortical or subcortical stimulation techniques for brain mapping in bilingual subjects and compare this data with that obtained from other brain mapping methods. The authors focused on the most controversial issue whether multiple languages are represented in common or distinct cerebral areas. Seven direct brain mapping studies from different teams focused on bilingualism and multilingualism. All these studies showed that even if cerebral representation of language in multilingual patients could be grossly located in the same cortical region, it was possible to individualise distinct language-specific areas by direct cortical stimulation in the dominant frontal and temporo-parietal regions. Task- and language-specific sites were also described, demonstrating an important specialisation of some cortical areas. Using subcortical stimulation, some authors were able to find specific white matter tracts for different languages. Finally, all authors recommend in bilingual patients who need brain mapping for neurosurgical purpose to test all languages in which the subjects are fluent.