Atypical cortical language organization in epilepsy patients: evidence for divergent hemispheric dominance for receptive and expressive language function.

The central goal of presurgical language mapping is to identify brain regions that subserve cortical language function to minimize postsurgical language deficits. Presurgical language mapping in patients with epilepsy presents a key challenge because of the atypical pattern of hemispheric language dominance found in this population, with higher incidences of bilateral and right-biased language dominance than typical. In this prospective study, we combine magnetoencephalography with a panel of tasks designed to separately assess receptive and expressive function to provide a sensitive measure of language function in 15 candidates for resective surgery. We report the following: 4 of 15 patients (27%) showed left hemisphere dominance across all tasks, 4 of 15 patients (27%) showed right hemisphere dominance across all tasks, and 7 of 15 (46%) showed discordant language dominance, with right-dominant receptive and left-dominant expressive language. All patients with discordant language dominance showed this right-receptive and left-expressive pattern. Results provide further evidence supporting the importance of using a panel of tasks to assess separable aspects of language function. The clinical relevance of the findings is discussed, especially about current clinical operative measures for assessing language dominance, which use single hemisphere procedure (intracarotid amobarbital procedure and awake intraoperative stimulation) for determining language laterality.

Rethinking clinical language mapping approaches: discordant receptive and expressive hemispheric language dominance in epilepsy surgery candidates.

Neuroimaging studies have shed light on cortical language organization, with findings implicating the left and right temporal lobes in speech processing converging to a left-dominant pattern. Findings highlight the fact that the state of theoretical language knowledge is ahead of current clinical language mapping methods, motivating a rethinking of these approaches. The authors used magnetoencephalography and multiple tasks in seven candidates for resective epilepsy surgery to investigate language organization. The authors scanned 12 control subjects to investigate the time course of bilateral receptive speech processes. Laterality indices were calculated for left and right hemisphere late fields ∼150 to 400 milliseconds. The authors report that (1) in healthy adults, speech processes activated superior temporal regions bilaterally converging to a left-dominant pattern, (2) in four of six patients, this was reversed, with bilateral processing converging to a right-dominant pattern, and (3) in three of four of these patients, receptive and expressive language processes were laterally discordant. Results provide evidence that receptive and expressive language may have divergent hemispheric dominance. Right-sided receptive language dominance in epilepsy patients emphasizes the need to assess both receptive and expressive language. Findings indicate that it is critical to use multiple tasks tapping separable aspects of language function to provide sensitive and specific estimates of language localization in surgical patients.

Temporal resolution properties of human auditory cortex: reflections in the neuromagnetic auditory evoked M100 component.

UNLABELLED: Previous work has provided evidence for a brief, finite ( approximately 35 ms) temporal window of integration (TWI) in M100 formation, during which stimulus attributes are accumulated in processes leading to the M100 peak. Here, we investigate resolution within the TWI by recording responses to tones containing silent gaps (0-20 ms). Gaps were inserted in 1 kHz tones in 2 conditions: +10 ms post-onset (10 ms masker) wherein the masker and gap of longest duration (20 ms) were contained within the initial 35 ms of the stimulus and +40 ms (40 ms masker) wherein all gaps were inserted +40 ms post-onset. Tones were presented binaurally and responses sampled from both hemispheres in 12 adults using a twin 37-channel biomagnetometer (MAGNES-II, BTi, San Diego, CA). Results--10 ms masker: M100 latency was prolonged and amplitude decreased as a function of gap duration, even with the shortest duration (2 ms) gap, indicating that integrative processes underlying M100 formation are sensitive to fine-grained discontinuities within a brief, finite TWI. Results--40 ms masker: M100 latency and amplitude were unaffected by gaps inserted at +40 ms, providing further evidence for an M100 TWI of <40 ms. CONCLUSION: within a brief integrative window in M100 formation, population-level responses are sensitive to discontinuities in sounds on a scale corresponding to psychophysical detection thresholds and minimum detectable gap thresholds in single unit recordings. Cumulatively, results provide evidence that M100 resolution for brief fluctuations in sounds reflects temporal acuity properties that are both intrinsic to the auditory system and critical to the accurate perception of speech.

Hemispheric asymmetries in auditory evoked neuromagnetic fields in response to place of articulation contrasts.

A growing body of evidence indicates bilateral but asymmetric hemispheric involvement in speech perception. We used magnetoencephalography to record neuromagnetic evoked responses in 10 adults to consonant-vowel syllables that differ in a single phonetic feature, place of articulation. We report differential activation patterns in M100 latency, with larger differences in the right hemisphere than the left. These findings suggest that left and right auditory fields make differential contributions to speech processing.