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Stasenko A, Kaestner E, Arienzo D, Schadler A, Reyes A, Shih JJ, Helm JL, Połczyńska M, McDonald CR. Bilingualism and Structural Network Organization in Temporal Lobe Epilepsy: Resilience in Neurologic Disease. Neurology 2023; 100:e1887-e1899. [PMID: 36854619 PMCID: PMC10159767 DOI: 10.1212/wnl.0000000000207087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 01/06/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is growing evidence that bilingualism can induce neuroplasticity and modulate neural efficiency, resulting in greater resistance to neurologic disease. However, whether bilingualism is beneficial to neural health in the presence of epilepsy is unknown. We tested whether bilingual individuals with temporal lobe epilepsy (TLE) have improved whole-brain structural white matter network organization. METHODS Healthy controls and individuals with TLE recruited from 2 specialized epilepsy centers completed diffusion-weighted MRI and neuropsychological testing as part of an observational cohort study. Whole-brain connectomes were generated via diffusion tractography and analyzed using graph theory. Global analyses compared network integration (path length) and specialization (transitivity) in TLE vs controls and in a 2 (left vs right TLE) × 2 (bilingual vs monolingual) model. Local analyses compared mean local efficiency of predefined frontal-executive and language (i.e., perisylvian) subnetworks. Exploratory correlations examined associations between network organization and neuropsychological performance. RESULTS A total of 29 bilingual and 88 monolingual individuals with TLE matched on several demographic and clinical variables and 81 age-matched healthy controls were included. Globally, a significant interaction between language status and side of seizure onset revealed higher network organization in bilinguals compared with monolinguals but only in left TLE (LTLE). Locally, bilinguals with LTLE showed higher efficiency in frontal-executive but not in perisylvian networks compared with LTLE monolinguals. Improved whole-brain network organization was associated with better executive function performance in bilingual but not monolingual LTLE. DISCUSSION Higher white matter network organization in bilingual individuals with LTLE suggests a neuromodulatory effect of bilingualism on whole-brain connectivity in epilepsy, providing evidence for neural reserve. This may reflect attenuation of or compensation for epilepsy-related dysfunction of the left hemisphere, potentially driven by increased efficiency of frontal-executive networks that mediate dual-language control. This highlights a potential role of bilingualism as a protective factor in epilepsy, motivating further research across neurologic disorders to define mechanisms and develop interventions.
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Affiliation(s)
- Alena Stasenko
- From the Center for Multimodal Imaging and Genetics (A. Stasenko, E.K., D.A., A. Schadler, A.R., C.R.M.), Department of Psychiatry (A. Stasenko, E.K., D.A., A. Schadler, C.R.M.), Department of Radiation Medicine & Applied Sciences (A.R., C.R.M.), and Department of Neurosciences (J.J.S.), University of California, San Diego; Department of Psychology (J.L.H.), San Diego State University, CA; and Department of Psychiatry and Biobehavioral Sciences (M.P.), David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Erik Kaestner
- From the Center for Multimodal Imaging and Genetics (A. Stasenko, E.K., D.A., A. Schadler, A.R., C.R.M.), Department of Psychiatry (A. Stasenko, E.K., D.A., A. Schadler, C.R.M.), Department of Radiation Medicine & Applied Sciences (A.R., C.R.M.), and Department of Neurosciences (J.J.S.), University of California, San Diego; Department of Psychology (J.L.H.), San Diego State University, CA; and Department of Psychiatry and Biobehavioral Sciences (M.P.), David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Donatello Arienzo
- From the Center for Multimodal Imaging and Genetics (A. Stasenko, E.K., D.A., A. Schadler, A.R., C.R.M.), Department of Psychiatry (A. Stasenko, E.K., D.A., A. Schadler, C.R.M.), Department of Radiation Medicine & Applied Sciences (A.R., C.R.M.), and Department of Neurosciences (J.J.S.), University of California, San Diego; Department of Psychology (J.L.H.), San Diego State University, CA; and Department of Psychiatry and Biobehavioral Sciences (M.P.), David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Adam Schadler
- From the Center for Multimodal Imaging and Genetics (A. Stasenko, E.K., D.A., A. Schadler, A.R., C.R.M.), Department of Psychiatry (A. Stasenko, E.K., D.A., A. Schadler, C.R.M.), Department of Radiation Medicine & Applied Sciences (A.R., C.R.M.), and Department of Neurosciences (J.J.S.), University of California, San Diego; Department of Psychology (J.L.H.), San Diego State University, CA; and Department of Psychiatry and Biobehavioral Sciences (M.P.), David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Anny Reyes
- From the Center for Multimodal Imaging and Genetics (A. Stasenko, E.K., D.A., A. Schadler, A.R., C.R.M.), Department of Psychiatry (A. Stasenko, E.K., D.A., A. Schadler, C.R.M.), Department of Radiation Medicine & Applied Sciences (A.R., C.R.M.), and Department of Neurosciences (J.J.S.), University of California, San Diego; Department of Psychology (J.L.H.), San Diego State University, CA; and Department of Psychiatry and Biobehavioral Sciences (M.P.), David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Jerry J Shih
- From the Center for Multimodal Imaging and Genetics (A. Stasenko, E.K., D.A., A. Schadler, A.R., C.R.M.), Department of Psychiatry (A. Stasenko, E.K., D.A., A. Schadler, C.R.M.), Department of Radiation Medicine & Applied Sciences (A.R., C.R.M.), and Department of Neurosciences (J.J.S.), University of California, San Diego; Department of Psychology (J.L.H.), San Diego State University, CA; and Department of Psychiatry and Biobehavioral Sciences (M.P.), David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Jonathan L Helm
- From the Center for Multimodal Imaging and Genetics (A. Stasenko, E.K., D.A., A. Schadler, A.R., C.R.M.), Department of Psychiatry (A. Stasenko, E.K., D.A., A. Schadler, C.R.M.), Department of Radiation Medicine & Applied Sciences (A.R., C.R.M.), and Department of Neurosciences (J.J.S.), University of California, San Diego; Department of Psychology (J.L.H.), San Diego State University, CA; and Department of Psychiatry and Biobehavioral Sciences (M.P.), David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Monika Połczyńska
- From the Center for Multimodal Imaging and Genetics (A. Stasenko, E.K., D.A., A. Schadler, A.R., C.R.M.), Department of Psychiatry (A. Stasenko, E.K., D.A., A. Schadler, C.R.M.), Department of Radiation Medicine & Applied Sciences (A.R., C.R.M.), and Department of Neurosciences (J.J.S.), University of California, San Diego; Department of Psychology (J.L.H.), San Diego State University, CA; and Department of Psychiatry and Biobehavioral Sciences (M.P.), David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Carrie R McDonald
- From the Center for Multimodal Imaging and Genetics (A. Stasenko, E.K., D.A., A. Schadler, A.R., C.R.M.), Department of Psychiatry (A. Stasenko, E.K., D.A., A. Schadler, C.R.M.), Department of Radiation Medicine & Applied Sciences (A.R., C.R.M.), and Department of Neurosciences (J.J.S.), University of California, San Diego; Department of Psychology (J.L.H.), San Diego State University, CA; and Department of Psychiatry and Biobehavioral Sciences (M.P.), David Geffen School of Medicine at UCLA, University of California, Los Angeles.
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Sierpowska J, Rofes A, Dahlslätt K, Mandonnet E, ter Laan M, Połczyńska M, Hamer PDW, Halaj M, Spena G, Meling TR, Motomura K, Reyes AF, Campos AR, Robe PA, Zigiotto L, Sarubbo S, Freyschlag CF, Broen MPG, Stranjalis G, Papadopoulos K, Liouta E, Rutten GJ, Viegas CP, Silvestre A, Perrote F, Brochero N, Cáceres C, Zdun-Ryżewska A, Kloc W, Satoer D, Dragoy O, Hendriks MPH, Alvarez-Carriles JC, Piai V. The Aftercare Survey: Assessment and intervention practices after brain tumor surgery in Europe. Neurooncol Pract 2022; 9:328-337. [PMID: 35855456 PMCID: PMC9290892 DOI: 10.1093/nop/npac029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background People with gliomas need specialized neurosurgical, neuro-oncological, psycho-oncological, and neuropsychological care. The role of language and cognitive recovery and rehabilitation in patients' well-being and resumption of work is crucial, but there are no clear guidelines for the ideal timing and character of assessments and interventions. The goal of the present work was to describe representative (neuro)psychological practices implemented after brain surgery in Europe. Methods An online survey was addressed to professionals working with individuals after brain surgery. We inquired about the assessments and interventions and the involvement of caregivers. Additionally, we asked about recommendations for an ideal assessment and intervention plan. Results Thirty-eight European centers completed the survey. Thirty of them offered at least one postsurgical (neuro)psychological assessment, mainly for language and cognition, especially during the early recovery stage and at long term. Twenty-eight of the participating centers offered postsurgical therapies. Patients who stand the highest chances of being included in evaluation and therapy postsurgically are those who underwent awake brain surgery, harbored a low-grade glioma, or showed poor recovery. Nearly half of the respondents offer support programs to caregivers, and all teams recommend them. Treatments differed between those offered to individuals with low-grade glioma vs those with high-grade glioma. The figure of caregiver is not yet fully recognized in the recovery phase. Conclusion We stress the need for more complete rehabilitation plans, including the emotional and health-related aspects of recovery. In respondents' opinions, assessment and rehabilitation plans should also be individually tailored and goal-directed (eg, professional reinsertion).
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Affiliation(s)
- Joanna Sierpowska
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
- Department of Medical Psychology, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Adrià Rofes
- Department of Neurolinguistics, University of Groningen, Groningen, the Netherlands
| | | | | | - Mark ter Laan
- Department of Neurosurgery, Radboud Institute of Health Science, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Monika Połczyńska
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
| | | | - Matej Halaj
- Department of Neurosurgery, University Hospital Olomouc, Olomouc, Czech Republic
| | | | - Torstein R Meling
- Department of Neurosurgery, Geneva University Hospital, Geneva, Switzerland
| | - Kazuya Motomura
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Japan
| | - Andrés Felipe Reyes
- Experimental Psychology Lab, Faculty of Psychology, Universidad El Bosque, Bogotá, Colombia
- Graduate School for the Humanities (GSH), University of Groningen, Groningen, the Netherlands
| | - Alexandre Rainha Campos
- Department of Neurosurgery, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Pierre A Robe
- Department of Neurology and Neurosurgery, University Medical Center of Utrecht, Utrecht, the Netherlands
| | - Luca Zigiotto
- Department of Neurosurgery, “S. Chiara” Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
- Structural and Functional Connectivity Lab Project, “S. Chiara” Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Silvio Sarubbo
- Department of Neurosurgery, “S. Chiara” Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
- Structural and Functional Connectivity Lab Project, “S. Chiara” Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | | | - Martijn P G Broen
- Department of Neurology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - George Stranjalis
- Department of Neurosurgery, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Konstantinos Papadopoulos
- Department of Neurosurgery, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Evangelia Liouta
- Department of Neurosurgery, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Geert-Jan Rutten
- Department of Neurosurgery, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
| | | | - Ana Silvestre
- Department of Neurosurgery, Hospital Garcia de Orta, Lisbon, Portugal
| | - Federico Perrote
- Department of Neurosurgery and Neurology, Private University Hospital of Córdoba, Córdoba, Argentina
| | - Natacha Brochero
- Department of Neurosurgery and Neurology, Private University Hospital of Córdoba, Córdoba, Argentina
| | - Cynthia Cáceres
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Agata Zdun-Ryżewska
- Department of Quality-of-Life Research, Medical University of Gdansk, Gdansk, Poland
| | - Wojciech Kloc
- Department of Psychology and Sociology of Health and Public Health School of Public Health Collegium Medicum, University of Warmia—Mazury in Olsztyn, Olsztyn, Poland
- Department of Neurosurgery, Copernicus PL, Gdansk, Poland
| | - Djaina Satoer
- Department of Neurosurgery, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Olga Dragoy
- Center for Language and Brain, HSE University, Moscow, Russia
| | - Marc P H Hendriks
- Academic Centre for Epileptology, Kempenhaeghe, Heeze, the Netherlands
- Department of Neurosurgery, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Juan C Alvarez-Carriles
- Clinical Neuropsychology Unit, Liaison Mental Health Service, Hospital Universitario Central de Asturias, Oviedo, Spain
- Department of Psychology, University of Oviedo, Oviedo, Spain
- ISPA, Health Research Institute of Principado de Asturias, Oviedo, Spain
| | - Vitória Piai
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
- Department of Medical Psychology, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
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Stasenko A, Schadler A, Kaestner E, Reyes A, Díaz-Santos M, Połczyńska M, McDonald CR. Can bilingualism increase neuroplasticity of language networks in epilepsy? Epilepsy Res 2022; 182:106893. [PMID: 35278806 PMCID: PMC9050932 DOI: 10.1016/j.eplepsyres.2022.106893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/17/2022] [Accepted: 02/22/2022] [Indexed: 11/03/2022]
Abstract
Individuals with left temporal lobe epilepsy (TLE) have a higher rate of atypical (i.e., bilateral or right hemisphere) language lateralization compared to healthy controls. In addition, bilinguals have been observed to have a less left-lateralized pattern of language representation. We examined the combined influence of bilingual language experience and side of seizure focus on language lateralization profiles in TLE to determine whether bilingualism promotes re-organization of language networks. Seventy-two monolingual speakers of English (21 left TLE; LTLE, 22 right TLE; RTLE, 29 age-matched healthy controls; HC) and 24 English-dominant bilinguals (6 LTLE, 7 RTLE, 11 HC) completed a lexical-semantic functional MRI task and standardized measures of language in English. Language lateralization was determined using laterality indices based on activations in left vs right homologous perisylvian regions-of-interest (ROIs). In a fronto-temporal ROI, LTLE showed the expected pattern of weaker left language lateralization relative to HC, and monolinguals showed a trend of weaker left language lateralization relative to bilinguals. Importantly, these effects were qualified by a significant group by language status interaction, revealing that bilinguals with LTLE had greater rightward language lateralization relative to monolingual LTLE, with a large effect size particularly in the lateral temporal region. Rightward language lateralization was associated with better language scores in bilingual LTLE. These preliminary findings suggest a combined effect of bilingual language experience and a left hemisphere neurologic insult, which may together increase the likelihood of language re-organization to the right hemisphere. Our data underscore the need to consider bilingualism as an important factor contributing to language laterality in patients with TLE. Bilingualism may be neuroprotective pre-surgically and may mitigate post-surgical language decline following left anterior temporal lobectomy, which will be important to test in larger samples.
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Affiliation(s)
- Alena Stasenko
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA.
| | - Adam Schadler
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | - Erik Kaestner
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | - Anny Reyes
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Mirella Díaz-Santos
- Department of Neurology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA; Mary S. Easton Center for Alzheimer's Disease Research, University of California, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Monika Połczyńska
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Carrie R McDonald
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA; Department of Radiation Medicine and Applied Sciences, University of California, San Diego, CA, USA
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Benjamin CFA, Li AX, Blumenfeld H, Constable RT, Alkawadri R, Bickel S, Helmstaedter C, Meletti S, Bronen R, Warfield SK, Peters JM, Reutens D, Połczyńska M, Spencer DD, Hirsch LJ. Presurgical language fMRI: Clinical practices and patient outcomes in epilepsy surgical planning. Hum Brain Mapp 2018. [PMID: 29528160 PMCID: PMC6033659 DOI: 10.1002/hbm.24039] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The goal of this study was to document current clinical practice and report patient outcomes in presurgical language functional MRI (fMRI) for epilepsy surgery. Epilepsy surgical programs worldwide were surveyed as to the utility, implementation, and efficacy of language fMRI in the clinic; 82 programs responded. Respondents were predominantly US (61%) academic programs (85%), and evaluated adults (44%), adults and children (40%), or children only (16%). Nearly all (96%) reported using language fMRI. Surprisingly, fMRI is used to guide surgical margins (44% of programs) as well as lateralize language (100%). Sites using fMRI for localization most often use a distance margin around activation of 10mm. While considered useful, 56% of programs reported at least one instance of disagreement with other measures. Direct brain stimulation typically confirmed fMRI findings (74%) when guiding margins, but instances of unpredicted decline were reported by 17% of programs and 54% reported unexpected preservation of function. Programs reporting unexpected decline did not clearly differ from those which did not. Clinicians using fMRI to guide surgical margins do not typically map known language‐critical areas beyond Broca's and Wernicke's. This initial data shows many clinical teams are confident using fMRI not only for language lateralization but also to guide surgical margins. Reported cases of unexpected language preservation when fMRI activation is resected, and cases of language decline when it is not, emphasize a critical need for further validation. Comprehensive studies comparing commonly‐used fMRI paradigms to predict stimulation mapping and post‐surgical language decline remain of high importance.
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Affiliation(s)
| | - Alexa X Li
- Quinnipiac University School of Medicine, 370 Bassett Rd, North Haven, CT, USA
| | - Hal Blumenfeld
- Yale University School of Medicine, 333 Cedar Ave, New Haven, CT, USA
| | - R Todd Constable
- Yale University School of Medicine, 333 Cedar Ave, New Haven, CT, USA
| | - Rafeed Alkawadri
- Yale University School of Medicine, 333 Cedar Ave, New Haven, CT, USA
| | | | | | - Stefano Meletti
- University of Modena and Reggio Emilia, Via Università, 4, Modena, MO, Italy
| | - Richard Bronen
- Yale University School of Medicine, 333 Cedar Ave, New Haven, CT, USA
| | | | | | - David Reutens
- The University of Queensland, St. Lucia QLD, Australia
| | | | - Dennis D Spencer
- Yale University School of Medicine, 333 Cedar Ave, New Haven, CT, USA
| | - Lawrence J Hirsch
- Yale University School of Medicine, 333 Cedar Ave, New Haven, CT, USA
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Połczyńska M, Kuhn T, You SC, Walshaw P, Curtiss S, Bookheimer S. Assessment of grammar optimizes language tasks for the intracarotid amobarbital procedure. Epilepsy Behav 2017; 76:89-100. [PMID: 28923498 DOI: 10.1016/j.yebeh.2017.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/24/2017] [Accepted: 08/14/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE A previous study showed that assessment of language laterality could be improved by adding grammar tests to the recovery phase of the intracarotid amobarbital procedure (IAP) (Połczyńska et al. 2014). The aim of this study was to further investigate the extent to which grammar tests lateralize language function during the recovery phase of the IAP in a larger patient sample. METHODS Forty patients with drug-resistant epilepsy (14 females, thirty-two right-handed, mean age 38.5years, SD=10.6) participated in this study. On EEG, 24 patients had seizures originating in the left hemisphere (LH), 13 in the right hemisphere (RH), and 4 demonstrated mixed seizure origin. Thirty participants (75%) had bilateral injections, and ten (25%) had unilateral injections (five RH and five LH). Based on results from the encoding phase, we segregated our study participants to a LH language dominant and a mixed dominance group. In the recovery phase of the IAP, the participants were administered a new grammar test (the CYCLE-N) and a standard language test. We analyzed the laterality index measure and effect sizes in the two tests. KEY FINDINGS In the LH-dominant group, the CYCLE-N generated more profound language deficits in the recovery phase than the standard after injection to either hemisphere (p<0.001). At the same time, the laterality index for the grammar tasks was still higher than for the standard tests. Critically, the CYCLE-N administered in the recovery phase was nearly as effective as the standard tests given during the encoding phase. SIGNIFICANCE The results may be significant for individuals with epilepsy undergoing IAP. The grammar tests may be a highly efficient measure for lateralizing language function in the recovery phase.
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Affiliation(s)
- Monika Połczyńska
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, USA; Faculty of English, Adam Mickiewicz University, Poznań, Poland.
| | - Taylor Kuhn
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, USA.
| | - S Christine You
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, USA.
| | - Patricia Walshaw
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, USA.
| | | | - Susan Bookheimer
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, USA.
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Połczyńska M, Japardi K, Curtiss S, Moody T, Benjamin C, Cho A, Vigil C, Kuhn T, Jones M, Bookheimer S. Improving language mapping in clinical fMRI through assessment of grammar. Neuroimage Clin 2017; 15:415-427. [PMID: 28616382 PMCID: PMC5458087 DOI: 10.1016/j.nicl.2017.05.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 05/03/2017] [Accepted: 05/25/2017] [Indexed: 11/27/2022]
Abstract
Introduction Brain surgery in the language dominant hemisphere remains challenging due to unintended post-surgical language deficits, despite using pre-surgical functional magnetic resonance (fMRI) and intraoperative cortical stimulation. Moreover, patients are often recommended not to undergo surgery if the accompanying risk to language appears to be too high. While standard fMRI language mapping protocols may have relatively good predictive value at the group level, they remain sub-optimal on an individual level. The standard tests used typically assess lexico-semantic aspects of language, and they do not accurately reflect the complexity of language either in comprehension or production at the sentence level. Among patients who had left hemisphere language dominance we assessed which tests are best at activating language areas in the brain. Method We compared grammar tests (items testing word order in actives and passives, wh-subject and object questions, relativized subject and object clauses and past tense marking) with standard tests (object naming, auditory and visual responsive naming), using pre-operative fMRI. Twenty-five surgical candidates (13 females) participated in this study. Sixteen patients presented with a brain tumor, and nine with epilepsy. All participants underwent two pre-operative fMRI protocols: one including CYCLE-N grammar tests (items testing word order in actives and passives, wh-subject and object questions, relativized subject and object clauses and past tense marking); and a second one with standard fMRI tests (object naming, auditory and visual responsive naming). fMRI activations during performance in both protocols were compared at the group level, as well as in individual candidates. Results The grammar tests generated more volume of activation in the left hemisphere (left/right angular gyrus, right anterior/posterior superior temporal gyrus) and identified additional language regions not shown by the standard tests (e.g., left anterior/posterior supramarginal gyrus). The standard tests produced more activation in left BA 47. Ten participants had more robust activations in the left hemisphere in the grammar tests and two in the standard tests. The grammar tests also elicited substantial activations in the right hemisphere and thus turned out to be superior at identifying both right and left hemisphere contribution to language processing. Conclusion The grammar tests may be an important addition to the standard pre-operative fMRI testing. We added comprehensive grammar tests to standard presurgical fMRI of language. The grammar tests generated more volume of activation bilaterally. The tests identified additional language regions not shown by the standard tests. The grammar tests may be an important addition to standard pre-operative fMRI.
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Affiliation(s)
- Monika Połczyńska
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA; Faculty of English, Adam Mickiewicz University, Poznań, Poland.
| | - Kevin Japardi
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA
| | | | - Teena Moody
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA.
| | | | - Andrew Cho
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA
| | - Celia Vigil
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA
| | - Taylor Kuhn
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA.
| | - Michael Jones
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA
| | - Susan Bookheimer
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA.
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Połczyńska M, Curtiss S, Walshaw P, Siddarth P, Benjamin C, Moseley BD, Vigil C, Jones M, Eliashiv D, Bookheimer S. Grammar tests increase the ability to lateralize language function in the Wada test. Epilepsy Res 2014; 108:1864-73. [DOI: 10.1016/j.eplepsyres.2014.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 08/12/2014] [Accepted: 09/13/2014] [Indexed: 10/24/2022]
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