Concordance between Wada, Transcranial Magnetic Stimulation, and Magnetoencephalography for Determining Hemispheric Dominance for Language: A Retrospective Study.

Determination of language hemispheric dominance (HD) in patients undergoing evaluation for epilepsy surgery has traditionally relied on the sodium amobarbital (Wada) test. The emergence of non-invasive methods for determining language laterality has increasingly shown to be a viable alternative. In this study, we assessed the efficacy of transcranial magnetic stimulation (TMS) and magnetoencephalography (MEG), compared to the Wada test, in determining language HD in a sample of 12 patients. TMS-induced speech errors were classified as speech arrest, semantic, or performance errors, and the HD was based on the total number of errors in each hemisphere with equal weighting of all errors (classic) and with a higher weighting of speech arrests and semantic errors (weighted). Using MEG, HD for language was based on the spatial extent of long-latency activity sources localized to receptive language regions. Based on the classic and weighted language laterality index (LI) in 12 patients, TMS was concordant with the Wada in 58.33% and 66.67% of patients, respectively. In eight patients, MEG language mapping was deemed conclusive, with a concordance rate of 75% with the Wada test. Our results indicate that TMS and MEG have moderate and strong agreement, respectively, with the Wada test, suggesting they could be used as non-invasive substitutes.

Comparing the efficacy of awake and sedated MEG to TMS in mapping hand sensorimotor cortex in a clinical cohort.

Non-invasive methods such as Transcranial Magnetic Stimulation (TMS) and magnetoencephalography (MEG) aid in the pre-surgical evaluation of patients with epilepsy or brain tumor to identify sensorimotor cortices. MEG requires sedation in children or patients with developmental delay. However, TMS can be applied to awake patients of all ages with any cognitive abilities. In this study, we compared the efficacy of TMS with MEG (in awake and sedated states) in identifying the hand sensorimotor areas in patients with epilepsy or brain tumors. We identified 153 patients who underwent awake- (n = 98) or sedated-MEG (n = 55), along with awake TMS for hand sensorimotor mapping as part of their pre-surgical evaluation. TMS involved stimulating the precentral gyrus and recording electromyography responses, while MEG identified the somatosensory cortex during median nerve stimulation. Awake-MEG had a success rate of 92.35 % and TMS had 99.49 % (p-value = 0.5517). However, in the sedated-MEG cohort, TMS success rate of 95.61 % was significantly higher compared to MEG's 58.77 % (p-value = 0.0001). Factors affecting mapping success were analyzed. Logistic regression across the entire cohort identified patient sedation as the lone significant predictor, contrary to age, lesion, metal, and number of antiseizure medications (ASMs). A subsequent analysis replaced sedation with anesthetic drug dosage, revealing no significant predictors impacting somatosensory mapping success under sedation. This study yields insights into the utility of TMS and MEG in mapping hand sensorimotor cortices and underscores the importance of considering factors that influence eloquent cortex mapping limitations during sedation.

The Clinical Utility of Transcranial Magnetic Stimulation in Determining Hemispheric Dominance for Language: A Magnetoencephalography Comparison Study.

PURPOSE: Transcranial magnetic stimulation (TMS) has recently emerged as a noninvasive alternative to the intracarotid sodium amytal (Wada) procedure for establishing hemispheric dominance (HD) for language. The accuracy of HD determined by TMS was examined by comparing against the HD derived by magnetoencephalography (MEG), a prominent clinical technique with excellent concordance with the Wada procedure. METHODS: Sixty-seven patients (54 patients ≤18 years) underwent language mapping with TMS and MEG as part of clinical epilepsy and tumor presurgical assessment. Language was mapped in MEG during an auditory word recognition paradigm, and a laterality index was calculated using the number of dipoles and their spatial extent in the two hemispheres. Transcranial magnetic stimulation language mapping was performed as patients performed a naming task, and TMS-induced speech disruptions were recorded during 5-Hz TMS applied to anterior and posterior language cortices. Transcranial magnetic stimulation laterality index was estimated using the number and type of speech disruption in the language regions of each hemisphere. RESULTS: Transcranial magnetic stimulation and MEG estimates of HD were concordant in 42 (63%) patients, resulting in a sensitivity of 74% and a specificity of 72%. The overall accuracy of TMS was 73%, equivalent to an odds ratio of 7.35. CONCLUSIONS: In this first large-scale comparative study in a clinical population, we demonstrate that TMS is a safe and reliable noninvasive tool in determining HD for language. Improving the accuracy of TMS by optimizing TMS parameters and improving task choice will further facilitate the use of TMS to characterize language function, especially in pediatrics.

On the relative merits of invasive and non-invasive pre-surgical brain mapping: New tools in ablative epilepsy surgery.

Cortical Stimulation Mapping (CSM) and the Wada procedure have long been considered the gold standard for localizing motor and language-related cortical areas and for determining the language and memory-dominant hemisphere, respectively. In recent years, however, non-invasive methods such as magnetoencephalography (MEG), functional magnetic resonance imaging (fMRI), and transcranial magnetic stimulation (TMS) have emerged as promising alternatives to the aforementioned procedures, particularly in cases where the invasive localization of eloquent cortex has proven to be challenging. To illustrate this point, we will first introduce the evidence of the compatibility of invasive and non-invasive methods and subsequently outline the rationale and the conditions where the latter methods are applicable.

Variation in the topography of the speech production cortex verified by cortical stimulation and high gamma activity.

In this study, we have addressed the question of functional brain reorganization for language in the presence and absence of anatomical lesions in two patients with epilepsy using cortical stimulation mapping and high gamma (HG) activity in subdural grid recordings. In both, the expressive language cortex was defined as the cortical patch below the electrode(s) that when stimulated resulted in speech arrest, and during speech expression tasks generated HG activity. This patch fell within the borders of Broca's area, as defined anatomically, in the case of the patient with a lesion, but outside that area in the other, lesion-free patient. Such results highlight the necessity for presurgical language mapping in all cases of surgery involving the language-dominant hemisphere and suggest that HG activity during expressive language tasks can be informative and helpful in conjunction with cortical stimulation mapping for expressive language mapping.

Same day tri-modality functional brain mapping prior to resection of a lesion involving eloquent cortex: technical feasibility.

Non-invasive functional evaluation of the brain complements structural MRI imaging and has largely supplanted invasive techniques such as awake craniotomy. Techniques used for functional mapping of the brain include BOLD-functional MRI (fMRI), magnetoencephalography (MEG), and transcranial magnetic stimulation (TMS). We describe the case of a right-handed patient with a lesion centered in the left inferior perirolandic cortex who underwent fMRI, MEG, and TMS on a single day to facilitate maximal lesion resection while preserving eloquent cortex and eloquent white matter tracts.

Time-constrained functional connectivity analysis of cortical networks underlying phonological decoding in typically developing school-aged children: a magnetoencephalography study.

The study investigated functional associations between left hemisphere occipitotemporal, temporoparietal, and inferior frontal regions during oral pseudoword reading in 58 school-aged children with typical reading skills (aged 10.4±1.6, range 7.5-12.5years). Event-related neuromagnetic data were used to compute source-current density waveforms using a minimum norm algorithm. Temporally-constrained contributions were established for four ROIs (STG, SMG, ANG, and IFG) by controlling for the autoregressive effects of activity in each ROI. Unique contributions made by activity in one ROI to subsequent activity in a second ROI were assessed through multiple regression analyses. Forward associations between lateral (LOC) and ventral occipitotemporal cortices (fusiform gyrus) to each of the four main ROIs were also examined. The earliest significant contributions to SMG and ANG activation (at 200-250ms) were made by preceding activity in the fusiform gyrus. The degree of activity in IFG appeared to be determined by earlier activity in ANG and STG.

Extracting biomarkers of autism from MEG resting-state functional connectivity networks.

The present study is a preliminary attempt to use graph theory for deriving distinct features of resting-state functional networks in young adults with autism spectrum disorder (ASD). Networks modeled neuromagnetic signal interactions between sensors using three alternative interdependence measures: (a) a non-linear measure of generalized synchronization (robust interdependence measure [RIM]), (b) mutual information (MI), and (c) partial directed coherence (PDC). To summarize the information contained in each network model we employed well-established global graph measures (average strength, assortativity, clustering, and efficiency) as well as graph measures (average strength of edges) tailored to specific hypotheses concerning the spatial distribution of abnormalities in connectivity among individuals with ASD. Graph measures then served as features in leave-one-out classification analyses contrasting control and ASD participants. We found that combinations of regionally constrained graph measures, derived from RIM, performed best, discriminating between the two groups with 93.75% accuracy. Network visualization revealed that ASD participants displayed significantly reduced interdependence strength, both within bilateral frontal and temporal sensors, as well as between temporal sensors and the remaining recording sites, in agreement with previous studies of functional connectivity in this disorder.

Functional disruption of the brain mechanism for reading: effects of comorbidity and task difficulty among children with developmental learning problems.

OBJECTIVE: The study investigated the relative degree and timing of cortical activation associated with phonological decoding in poor readers. METHOD: Regional brain activity was assessed during performance of a pseudoword reading task and a less demanding, letter-sound naming task by three groups of students: children who experienced reading difficulties without attention problems (N = 50, RD) and nonreading impaired (NI) readers either with (N = 20) or without attention-deficit/hyperactivity disorder (ADHD; N = 50). Recordings were obtained with a whole-head neuromagnetometer, and activation profiles were computed through a minimum norm algorithm. RESULTS: Children with RD showed decreased amplitude of neurophysiological activity in the superior temporal gyrus, bilaterally, and in the left supramarginal and angular gyri during late stages of decoding, compared to typical readers. These effects were restricted to the more demanding pseudoword reading task. No differences were found in degree of activity between NI and ADHD students. Regression analyses provided further support for the crucial role of left hemisphere temporoparietal cortices and the fusiform gyrus for basic reading skills. CONCLUSIONS: Results were in agreement with fMRI findings and replicate previous MEG findings with a larger sample, a higher density neuromagnetometer, an overt pseudoword reading task, and a distributed current source-modeling method.

Functional Neuroimaging of Language Using Magnetoencephalography.

Magnetoencephalography (MEG) is a novel functional brain mapping technique capable of non-invasively measuring neurophysiological activity based on direct measures of the magnetic flux at the head surface associated with the synchronized electrical activity of neuronal populations. Among the most actively sought applications of MEG has been localization of language-specific cortex. This is in part due to its practical application for pre-surgical evaluation of patients with epilepsy or brain tumors. Until recently, comprehensive language mapping during surgical planning has relied on the application of invasive diagnostic methods, namely the Wada procedure and direct electrocortical stimulation mapping, often considered as the "gold standard" techniques for identifying language-specific cortex. In this review, we evaluate the utility of MEG as a tool for functional mapping of language in both clinical and normal populations. In particular, we provide a general description of MEG, with emphasis on facets of the technique related to language mapping. Additionally, we discuss the application of appropriate MEG language-mapping protocols developed to reliably generate spatiotemporal profiles of language activity, and address the validity of the technique against the "gold standards" of the Wada and electrocortical mapping procedures.