Reliability and validity of functional neuroimaging techniques for identifying language-critical areas in children and adults

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

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

Magnetoencephalography Language Mapping Using Auditory Memory Retrieval and Silent Repeating Task

PURPOSE

The study aims to (1) examine the spatiotemporal map of magnetoencephalography-evoked responses during an Auditory Memory Retrieval and Silent Repeating (AMRSR) task, and determine the hemispheric dominance for language, and (2) evaluate the accuracy of the AMRSR task in Wernicke and Broca area localization.

METHODS

In 30 patients with brain tumors and/or epilepsies, the AMRSR task was used to evoke magnetoencephalography responses. We applied Fast VEctor-based Spatial-Temporal Analyses with minimum L1-norm source imaging method to the magnetoencephalography responses for localizing the brain areas evoked by the AMRSR task.

RESULTS

The Fast-VEctor-based Spatial-Temporal Analysis found consistent activation in the posterior superior temporal gyrus around 300 to 500 ms, and another activation in the frontal cortex (pars opercularis and/or pars triangularis) around 600 to 900 ms, which were localized to the Wernicke area (BA 22) and Broca area (BA 44 and BA 45), respectively. The language-dominant hemispheric laterization elicited by the AMRSR task was comparable with the result from an Auditory Dichotic task result given to the same patient, with the exception that AMRSR is more sensitive on bilateral language laterization cases on finding the Wernicke and Broca areas.

CONCLUSIONS

For all patients who successfully finished the AMRSR task, Fast-VEctor-based Spatial-Temporal Analysis could establish accurate and robust localizations of Broca and Wernicke area and determine hemispheric dominance. For subjects with normal auditory functionality, the AMRSR paradigm evaluation showed significant promise in providing reliable assessments of cerebral language dominance and language network localization.

"Anatomical mechanism of ideation, association and attention" [1895] and "Certain points in neurological histophysiology" [1896]: Cajal's conjectures, then and now

The purpose of this article is two-fold: first, to preserve, in updated English translations, two theoretical papers written by Santiago Ramón y Cajal (1852-1934) in 1895 and 1896 under the titles, "Conjectures on the anatomical mechanism of ideation, association and attention" and "Conjectural interpretations of certain points in neurological histophysiology"; and second, to set some of the ideas proposed by Cajal in a modern perspective. In his "Conjectures," Cajal ventured to explain the mechanisms of perception, association and attention in cellular terms. He introduced the term "impression unit," which would propagate, leading to conscious act via an "avalanche of conduction." Additionally, he attributed mental repose and sleep to morphological variations of neuroglia; at times of relaxation, astrocytes would grow appendices that penetrated among nerve cell connections and blocked the conduction of the "nervous current"; in energetic contraction, such glial "pseudopodia" would shrink, allowing neuronal processes to come into contact again. In the sequel to the "Conjectures," Cajal presented strong arguments defending the neuron theory against the reticular theory. Moreover, he discussed the functional differentiation of spinal motor neurons and cortical pyramidal cells, which respectively subserve movement and consciousness, despite their morphological similarity.

An adaptive semantic matching paradigm for reliable and valid language mapping in individuals with aphasia

Research on neuroplasticity in recovery from aphasia depends on the ability to identify language areas of the brain in individuals with aphasia. However, tasks commonly used to engage language processing in people with aphasia, such as narrative comprehension and picture naming, are limited in terms of reliability (test-retest reproducibility) and validity (identification of language regions, and not other regions). On the other hand, paradigms such as semantic decision that are effective in identifying language regions in people without aphasia can be prohibitively challenging for people with aphasia. This paper describes a new semantic matching paradigm that uses an adaptive staircase procedure to present individuals with stimuli that are challenging yet within their competence, so that language processing can be fully engaged in people with and without language impairments. The feasibility, reliability and validity of the adaptive semantic matching paradigm were investigated in sixteen individuals with chronic post-stroke aphasia and fourteen neurologically normal participants, in comparison to narrative comprehension and picture naming paradigms. All participants succeeded in learning and performing the semantic paradigm. Test-retest reproducibility of the semantic paradigm in people with aphasia was good (Dice coefficient = 0.66), and was superior to the other two paradigms. The semantic paradigm revealed known features of typical language organization (lateralization; frontal and temporal regions) more consistently in neurologically normal individuals than the other two paradigms, constituting evidence for validity. In sum, the adaptive semantic matching paradigm is a feasible, reliable and valid method for mapping language regions in people with aphasia.

Short- and long-term reliability of language fMRI

When using functional magnetic resonance imaging (fMRI) for mapping important language functions, a high test-retest reliability is mandatory, both in basic scientific research and for clinical applications. We, therefore, systematically tested the short- and long-term reliability of fMRI in a group of healthy subjects using a picture naming task and a sparse-sampling fMRI protocol. We hypothesized that test-retest reliability might be higher for (i) speech-related motor areas than for other language areas and for (ii) the short as compared to the long intersession interval. 16 right-handed subjects (mean age: 29 years) participated in three sessions separated by 2-6 (session 1 and 2, short-term) and 21-34 days (session 1 and 3, long-term). Subjects were asked to perform the same overt picture naming task in each fMRI session (50 black-white images per session). Reliability was tested using the following measures: (i) Euclidean distances (ED) between local activation maxima and Centers of Gravity (CoGs), (ii) overlap volumes and (iii) voxel-wise intraclass correlation coefficients (ICCs). Analyses were performed for three regions of interest which were chosen based on whole-brain group data: primary motor cortex (M1), superior temporal gyrus (STG) and inferior frontal gyrus (IFG). Our results revealed that the activation centers were highly reliable, independent of the time interval, ROI or hemisphere with significantly smaller ED for the local activation maxima (6.45 ± 1.36 mm) as compared to the CoGs (8.03 ± 2.01 mm). In contrast, the extent of activation revealed rather low reliability values with overlaps ranging from 24% (IFG) to 56% (STG). Here, the left hemisphere showed significantly higher overlap volumes than the right hemisphere. Although mean ICCs ranged between poor (ICC<0.5) and moderate (ICC 0.5-0.74) reliability, highly reliable voxels (ICC>0.75) were found for all ROIs. Voxel-wise reliability of the different ROIs was influenced by the intersession interval. Taken together, we could show that, despite of considerable ROI-dependent variations of the extent of activation over time, highly reliable centers of activation can be identified using an overt picture naming paradigm.

MRI in the evaluation of localization-related epilepsy

This article covers the MRI evaluation of patients with epilepsy, with a focus on neuroimaging in those with localization-related epilepsy who may be potential epilepsy surgery candidates. The article includes structural MRI to identify a lesion, functional MRI to identify the eloquent cortex and diffusion tensor imaging to identify the eloquent white matter tracts. We consider the equipment, protocol or procedures, and reporting of MRI in patients with epilepsy. Recommendations for both adult and pediatric patients are described for protocols and procedures. The authors hope that this article will provide a standardized approach for clinical imaging of patients with suspected localization-related epilepsy who may be evaluated for epilepsy surgery. J. Magn. Reson. Imaging 2016.

Validity and reliability of four language mapping paradigms

Language areas of the brain can be mapped in individual participants with functional MRI. We investigated the validity and reliability of four language mapping paradigms that may be appropriate for individuals with acquired aphasia: sentence completion, picture naming, naturalistic comprehension, and narrative comprehension. Five neurologically normal older adults were scanned on each of the four paradigms on four separate occasions. Validity was assessed in terms of whether activation patterns reflected the known typical organization of language regions, that is, lateralization to the left hemisphere, and involvement of the left inferior frontal gyrus and the left middle and/or superior temporal gyri. Reliability (test-retest reproducibility) was quantified in terms of the Dice coefficient of similarity, which measures overlap of activations across time points. We explored the impact of different absolute and relative voxelwise thresholds, a range of cluster size cutoffs, and limitation of analyses to a priori potential language regions. We found that the narrative comprehension and sentence completion paradigms offered the best balance of validity and reliability. However, even with optimal combinations of analysis parameters, there were many scans on which known features of typical language organization were not demonstrated, and test-retest reproducibility was only moderate for realistic parameter choices. These limitations in terms of validity and reliability may constitute significant limitations for many clinical or research applications that depend on identifying language regions in individual participants.

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Validity and reliability were investigated for four language mapping paradigms.

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Narrative comprehension and sentence completion paradigms performed best.

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Lateralization to the left hemisphere was not always apparent.

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Test-retest reproducibility was only moderate.

Pediatric awake craniotomy and intra-operative stimulation mapping

The indications for operating on lesions in or near areas of cortical eloquence balance the benefit of resection with the risk of permanent neurological deficit. In adults, awake craniotomy has become a versatile tool in tumor, epilepsy and functional neurosurgery, permitting intra-operative stimulation mapping particularly for language, sensory and motor cortical pathways. This allows for maximal tumor resection with considerable reduction in the risk of post-operative speech and motor deficits. We report our experience of awake craniotomy and cortical stimulation for epilepsy and supratentorial tumors located in and around eloquent areas in a pediatric population (n=10, five females). The presenting symptom was mainly seizures and all children had normal neurological examinations. Neuroimaging showed lesions in the left opercular (n=4) and precentral or peri-sylvian regions (n=6). Three right-sided and seven left-sided awake craniotomies were performed. Two patients had a history of prior craniotomy. All patients had intra-operative mapping for either speech or motor or both using cortical stimulation. The surgical goal for tumor patients was gross total resection, while for all epilepsy procedures, focal cortical resections were completed without any difficulty. None of the patients had permanent post-operative neurologic deficits. The patient with an epileptic focus over the speech area in the left frontal lobe had a mild word finding difficulty post-operatively but this improved progressively. Follow-up ranged from 6 to 27 months. Pediatric awake craniotomy with intra-operative mapping is a precise, safe and reliable method allowing for resection of lesions in eloquent areas. Further validations on larger number of patients will be needed to verify the utility of this technique in the pediatric population.

Signal space separation algorithm and its application on suppressing artifacts caused by vagus nerve stimulation for magnetoencephalography recordings

Magnetoencephalography (MEG) has been successfully applied to presurgical epilepsy foci localization and brain functional mapping. Because the neuronal magnetic signals from the brain are extremely weak, MEG measurement requires both low environment noise and the subject/patient being free of artifact-generating metal objects. This strict requirement makes it hard for patients with vagus nerve stimulator, or other similar medical devices, to benefit from the presurgical MEG examinations. Therefore, an approach that can effectively reduce the environmental noise and faithfully recover the brain signals is highly desirable. We applied spatiotemporal signal space separation method, an advanced signal processing approach that can recover bio-magnetic signal from inside the MEG sensor helmet and suppress external disturbance from outside the helmet in empirical MEG measurements, on MEG recordings from normal control subjects and patients who has vagus nerve stimulator. The original MEG recordings were heavily contaminated, and the data could not be assessed. After applying temporal signal space separation, the strong external artifacts from outside the brain were successfully removed, and the neuronal signal from the human brain was faithfully recovered. Both of the goodness-of-fit and 95% confident limit volume confirmed the significant improvement after temporal signal space separation. Hence, temporal signal space separation makes presurgical MEG examinations possible for patients with implanted vagus nerve stimulator or similar medical devices.

Hemispheric language dominance in magnetoencephalography: sensitivity, specificity, and data reduction techniques

Understanding the areas involved in language functions not only enables investigators to understand neuroanatomical structures, but may be a promising technique in the presurgical evaluation of epilepsy. The predictive power of various data reduction techniques was tested on language data obtained by magnetoencephalography (MEG) of 16 patients and 12 control subjects. Words were presented aurally in two phases: the study phase and the recognition phase. Subjects were asked to remember words from the study phase and indicate if they remembered those words during the recognition phase. Single equivalent-current dipoles were calculated to determine laterality indices and the neuroanatomical correlates of language function. For all patients, results indicated a concordance, sensitivity, and specificity of 0.75. After consideration of IQ scores and exclusion from the analysis of those patients with scores below the average range, the results indicated a concordance of 0.90, sensitivity of 0.86, and specificity of 1.00. These findings are consistent with previous MEG investigations of language function in comparison with the Wada technique and support the use of MEG language mapping in most patients with an IQ within or above the average range.

A comparison of functional MRI and magnetoencephalography for receptive language mapping

We compared functional magnetic resonance imaging (fMRI) and magnetoencephalography (MEG) for the mapping of receptive language function. Participants performed the same language task in the two different imaging environments. MEG activation profiles showed prominent bilateral activity in superior temporal gyrus and left-lateralized activity in middle temporal gyrus. fMRI activation profiles revealed bilateral activity in prefrontal, superior temporal, middle temporal, and visual areas. Laterality quotients derived from the two modalities showed poor agreement between the two methods for commonly active regions of interest. Locations of peak activity also varied considerably within participants between the two methods.

Reliability of language mapping with magnetic source imaging in epilepsy surgery candidates

The external validity of a noninvasive language mapping protocol with magnetoencephalography (MEG) has been established through direct comparisons with invasive functional mapping techniques. This study examines the test-retest and interrater reliability of this protocol under realistic testing conditions in 21 epilepsy surgery candidates. Brain activation maps were obtained in the context of an auditory word recognition task and represented by temporally contiguous dipolar activity sources. Both the duration and strength of the associated magnetic flux were used as measures of the magnitude of regional brain activity. Hemispheric asymmetry indices based on these measures showed good interrater reliability and intraparticipant reproducibility. Similar findings were obtained with respect to the location of the geometric center of receptive language-specific cortex (Wernicke's) area in the dominant hemisphere. The results further support the adequacy of this MEG-based brain mapping protocol as a noninvasive tool for receptive language localization in epilepsy surgery candidates.

Presurgical Language fMRI in Patients with Drug-resistant Epilepsy: Effects of Task Performance

PURPOSE

To determine whether language functional magnetic resonance imaging (fMRI) before epilepsy surgery can be similarly interpreted in patients with greatly different performance levels.

METHODS

An fMRI paradigm using a semantic decision task with performance control and a perceptual control task was applied to 226 consecutive patients with drug-resistant localization-related epilepsy during their presurgical evaluations. The volume of activation and lateralization in an inferior frontal and a temporoparietal area was assessed in correlation with individual performance levels.

RESULTS

We observed differential effects of task performance on the volume of activation in the inferior frontal and the temporoparietal region of interest, but performance measures did not correlate with the lateralization of activation.

CONCLUSIONS

fMRI, as applied here, in patients with a wide range of cognitive abilities, can be interpreted regarding language lateralization in a similar way.

Comparing language lateralization determined by dichotic listening and fMRI activation in frontal and temporal lobes in children with epilepsy

We investigated the relationship between ear advantage scores on the Fused Dichotic Words Test (FDWT), and laterality of activation in fMRI using a verb generation paradigm in fourteen children with epilepsy. The magnitude of the laterality index (LI), based on spatial extent and magnitude of activation in classical language areas (BA 44/45, 21/22, 39) differed significantly for patients classified with unilateral left, compared to bilateral, language representation based on FDWT scores. Concordance with fMRI was higher for those classified with unilateral left, than bilateral language representation on the FDWT. Of note, asymmetry in temporal lobe, rather than frontal lobe, activation was more strongly related to the LI from the dichotic listening test. This study shows that the FDWT can provide a quick and valid estimate of lateralization in pre-surgical candidates, which can be readily adopted for other clinical or research purposes when an estimate of language dominance is desired.

Translational research on early language development: current challenges and future directions

There is a pressing need for the early and accurate identification of young children at risk for language and other developmental disabilities and the provision of timely, age-appropriate intervention, as mandated by Part C of the Individuals with Disabilities Education Act. Research has shown that early intervention is effective for many language impaired children in different etiological groups, and can reduce the functional impact of persistent disorders on children and their families. Yet, the accurate identification of infants and toddlers at risk for language impairment remains elusive, especially for late-talking children without obvious genetic or neurological conditions. In this paper, the need for translational research on basic processes in early language development in typical and atypical populations and the contextual factors that affect them are discussed, along with current challenges and future directions for its successful implementation. Implications of this research for clinical evidence-based practice are also considered.