Effects of low- and high-frequency repetitive transcranial magnetic stimulation on long-latency auditory evoked potentials.

Long-latency auditory event potentials (LLAEPs) involving local and global auditory processes have been investigated to examine the impact of low-frequency (LF) and high-frequency (HF) repetitive transcranial magnetic stimulation (rTMS) on the cortical excitability of the temporal cortex. We hypothesized that both stimulation frequencies have the same modulation effect, in accordance with clinical data showing a reduction in auditory verbal hallucinations (AVHs) after LF and HF temporal rTMS in patients with schizophrenia. With 30 right-handed healthy volunteer participants enrolled in a crossover trial, we analyzed LLAEPs before and after LF- and HF-rTMS of the left temporal cortex. While we observed no changes in latencies, we did observe a similar inhibitory action of both rTMS frequencies on LLAEP amplitudes. Analysis of surface potential maps and cortical generators revealed some differences regarding auditory processes: HF-rTMS produced earlier, more diffuse, and more right-lateralized effects than LF-rTMS. Beyond a local impact, rTMS exerted a remote modulation influence on the frontal cortex that might be involved in attentional processes. This association could explain the therapeutic effect of temporal HF-rTMS on AVH.

High-Frequency Neuronavigated rTMS in Auditory Verbal Hallucinations: A Pilot Double-Blind Controlled Study in Patients With Schizophrenia.

INTRODUCTION: Despite extensive testing, the efficacy of low-frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) of temporo-parietal targets for the treatment of auditory verbal hallucinations (AVH) in patients with schizophrenia is still controversial, but promising results have been reported with both high-frequency and neuronavigated rTMS. Here, we report a double-blind sham-controlled study to assess the efficacy of high-frequency (20 Hz) rTMS applied over a precise anatomical site in the left temporal region using neuronavigation. METHODS: Fifty-nine of 74 randomized patients with schizophrenia or schizoaffective disorders (DSM-IV R) were treated with rTMS or sham treatment and fully evaluated over 4 weeks. The rTMS target was determined by morphological MRI at the crossing between the projection of the ascending branch of the left lateral sulcus and the superior temporal sulcus (STS). RESULTS: The primary outcome was response to treatment, defined as a 30% decrease of the Auditory Hallucinations Rating Scale (AHRS) frequency item, observed at 2 successive evaluations. While there was no difference in primary outcome between the treatment groups, the percentages of patients showing a decrease of more than 30% of AHRS score (secondary outcome) did differ between the active (34.6%) and sham groups (9.1%) (P = .016) at day 14. DISCUSSION: This controlled study reports negative results on the primary outcome but demonstrates a transient effect of 20 Hz rTMS guided by neuronavigation and targeted on an accurate anatomical site for the treatment of AVHs in schizophrenia patients.

Network modeling of resting state connectivity points towards the bottom up theories of schizophrenia.

The dysconnectivity theory of schizophrenia proposes that schizophrenia symptoms arise from abnormalities in neuronal synchrony. Resting-state Functional Connectivity (FC) techniques allow us to highlight synchronization of large-scale networks, the Resting-state Networks (RNs). A large body of work suggests that disruption of RN synchronization could give rise to specific schizophrenia symptoms. The present study aimed to explore within- and between-network FC strength of 34 RNs in 29 patients suffering from schizophrenia, and their relationships with schizophrenia symptoms. Resting-state data were analyzed using independent component analysis and dual-regression techniques. Our results showed that both within-RN and between-RN FC were disrupted in patients with schizophrenia, with a global trend toward weaker FC. This decrease affected more particularly visual, auditory and crossmodal binding networks. These alterations were correlated with negative symptoms, positive symptoms and hallucinations, indicating abnormalities in visual processing and crossmodal binding in schizophrenia. Moreover, we stressed an anomalous synchronization between a visual network and a network thought to be engaged in mental imaging processes, correlated with delusions and hallucinations. Altogether, our results supported the assumption that some schizophrenia symptoms may be related to low-order sensory alterations impacting higher-order cognitive processes, i.e. the "bottom-up" hypothesis of schizophrenia symptoms.

Functional deficit of the medial prefrontal cortex during emotional sentence attribution in schizophrenia.

BACKGROUND: Functional brain imaging research has already demonstrated that patients with schizophrenia had difficulties with emotion processing, namely in facial emotion perception and emotional prosody. However, the moderating effect of social context and the boundary of perceptual categories of emotion attribution remain unclear. This study investigated the neural bases of emotional sentence attribution in schizophrenia. METHODS: Twenty-one schizophrenia patients and 25 healthy subjects underwent an event-related functional magnetic resonance imaging paradigm including two tasks: one to classify sentences according to their emotional content, and the other to classify neutral sentences according to their grammatical person. RESULTS: First, patients showed longer response times as compared to controls only during the emotion attribution task. Second, patients with schizophrenia showed reduction of activation in bilateral auditory areas irrespective of the presence of emotions. Lastly, during emotional sentences attribution, patients displayed less activation than controls in the medial prefrontal cortex (mPFC). CONCLUSIONS: We suggest that the functional abnormality observed in the mPFC during the emotion attribution task could provide a biological basis for social cognition deficits in patients with schizophrenia.

Functional and structural brain asymmetries in patients with schizophrenia and bipolar disorders.

OBJECTIVES: This study aimed to compare the functional and gray matter asymmetries in patients with schizophrenia (SZ), patients with bipolar disorders (BD), and healthy controls (HCs) to test whether decreased leftward functional hemispheric lateralization and gray matter volume asymmetry could mark the boundary between schizophrenia and bipolar disorder. METHODS: A total of 31 right-handed SZ and 20 right-handed BD underwent a session of functional MRI with a speech listening paradigm. Participants were matched with HCs for gender, age, and education. Functional laterality indices (FLI) and gray matter volume asymmetry indices (GVAI) were computed from the individual functional language network. Correlations between the FLI and GVAI indices were also examined. RESULTS: SZ exhibited significantly decreased leftward functional hemispheric lateralization whereas BD did not. The GVAIs did not differ significantly between SZ and HCs or between BD and HCs. There were positive correlations between GVAIs and FLIs in all groups. CONCLUSIONS: Loss of laterality for language comprehension with retention of gray matter volume asymmetry indicates that gray matter loss alone will not account for the pathophysiology of schizophrenia. Impaired leftward functional hemispheric lateralization for language but not gray matter volume asymmetry can be considered a biomarker of SZ.

Social cognition in schizophrenic patients: the effect of semantic content and emotional prosody in the comprehension of emotional discourse.

BACKGROUND: The recognition of the emotion expressed during conversation relies on the integration of both semantic processing and decoding of emotional prosody. The integration of both types of elements is necessary for social interaction. No study has investigated how these processes are impaired in patients with schizophrenia during the comprehension of an emotional speech. Since patients with schizophrenia have difficulty in daily interactions, it would be of great interest to investigate how these processes are impaired. We tested the hypothesis that patients present lesser performances regarding both semantic and emotional prosodic processes during emotional speech comprehension compared with healthy participants. METHODS: The paradigm is based on sentences built with emotional (anger, happiness, or sadness) semantic content uttered with or without congruent emotional prosody. The study participants had to decide with which of the emotional categories each sentence corresponded. RESULTS: Patients performed significantly worse than their matched controls, even in the presence of emotional prosody, showing that their ability to understand emotional semantic content was impaired. Although prosody improved performances in both groups, it benefited the patients more than the controls. CONCLUSION: Patients exhibited both impaired semantic and emotional prosodic comprehensions. However, they took greater advantage of emotional prosody adjunction than healthy participants. Consequently, focusing on emotional prosody during carrying may improve social communication.

Functional and white matter abnormalities in the language network in patients with schizophrenia: a combined study with diffusion tensor imaging and functional magnetic resonance imaging.

BACKGROUND: Schizophrenia is a mental disorder characterized by functional abnormalities in the language network. Anatomical white matter (WM) abnormalities (volume and integrity) have also been reported for this pathology. Nevertheless, few studies have investigated anatomo-functional relationships in schizophrenia, and none has focused on the language comprehension network in relation to various diffusion parameters. We hypothesized that the WM abnormalities that are reflected by several diffusion parameters underlie functional deficits in the language network. METHODS: Eighteen DSM-IV patients with schizophrenia and 18 healthy controls without any significant differences in sex, age, or level of education were included. First, functional brain activation within the language network was estimated. Then, using diffusion tensor imaging, fractional anisotropy (FA), radial diffusivity (RD), and mean diffusivity (MD) values were extracted within WM regions adjacent to this network and their anatomo-functional relationships were investigated. RESULTS: Compared with healthy participants, both functional and diffusion deficits were observed in patients with schizophrenia. Primarily, an altered diffusion-functional relationship was observed in patients in the left middle temporal region: functional activations were positively correlated with FA, but were negatively correlated with RD. CONCLUSIONS: Our findings indicate a close relationship between diffusion and functional deficits in patients with schizophrenia, suggesting that WM integrity disturbance might be one cause of functional alterations in the language network in patients with schizophrenia. Thus, the present multimodal study improves our understanding of the pathophysiology of schizophrenia.

Functional hemispheric lateralization for language in patients with schizophrenia.

BACKGROUND: It is widely reported that patients with schizophrenia exhibit decreased hemispheric lateralization. However, no study has evaluated relationships between the hemispheric anatomical and functional asymmetry in language areas. The present study aimed to determine whether decreased leftward hemispheric lateralization could be related to asymmetry of the grey matter volume in patients with schizophrenia. This investigation was the first to use a functional index of laterality to analyze the global functional network specifically involved in the language task. METHODS: Twenty-seven right-handed patients with schizophrenia and 54 right-handed control subjects underwent a session of a functional magnetic resonance imaging (fMRI) with a speech listening paradigm. Functional laterality indices (FLI) were calculated (Wilke, M. and Lidzba, K., 2007. LI-tool: a new toolbox to assess lateralization in functional MR-data. J Neurosci Methods. 163, 128-136). The indices of asymmetry in the volume of grey matter (GVAIs) were computed from the functional language network. RESULTS: Patients with schizophrenia exhibited significantly decreased leftward hemispheric lateralization. There was a positive correlation between GVAIs and FLIs in healthy subjects, while no such correlation was seen in patients with schizophrenia. DISCUSSION: This study reports for the first time a significant relationship between the anatomical and functional asymmetry in healthy subjects, but not in patients with schizophrenia. While decreased leftward functional lateralization for language was observed in patients with schizophrenia compared to the control group, this functional abnormality was not related to asymmetry in the volume of grey matter.

Links among resting-state default-mode network, salience network, and symptomatology in schizophrenia.

Neuroimaging data support the idea that schizophrenia is a brain disorder with altered brain structure and function. New resting-state functional connectivity techniques allow us to highlight synchronization of large-scale networks, such as the default-mode network (DMN) and salience network (SN). A large body of work suggests that disruption of these networks could give rise to specific schizophrenia symptoms. We examined the intra-network connectivity strength and gray matter content (GMC) of DMN and SN in 26 schizophrenia patients using resting-state functional magnetic resonance imaging and voxel-based morphometry. Resting-state data were analyzed with independent component analysis and dual-regression techniques. We reported reduced functional connectivity within both DMN and SN in patients with schizophrenia. Concerning the DMN, patients showed weaker connectivity in a cluster located in the right paracingulate cortex. Moreover, patients showed decreased GMC in this cluster. With regard to the SN, patients showed reduced connectivity in the left and right striatum. Decreased connectivity in the paracingulate cortex was correlated with difficulties in abstract thinking. The connectivity decrease in the left striatum was correlated with delusion and depression scores. Correlation between the connectivity of DMN frontal regions and difficulties in abstract thinking emphasizes the link between negative symptoms and the likely alteration of the frontal medial cortex in schizophrenia. Correlation between the connectivity of SN striatal regions and delusions supports the aberrant salience hypothesis. This work provides new insights into dysfunctional brain organization in schizophrenia and its contribution to specific schizophrenia symptoms.

A shared neural substrate for mentalizing and the affective component of sentence comprehension.

Using event-related fMRI in a sample of 42 healthy participants, we compared the cerebral activity maps obtained when classifying spoken sentences based on the mental content of the main character (belief, deception or empathy) or on the emotional tonality of the sentence (happiness, anger or sadness). To control for the effects of different syntactic constructions (such as embedded clauses in belief sentences), we subtracted from each map the BOLD activations obtained during plausibility judgments on structurally matching sentences, devoid of emotions or ToM. The obtained theory of mind (ToM) and emotional speech comprehension networks overlapped in the bilateral temporo-parietal junction, posterior cingulate cortex, right anterior temporal lobe, dorsomedial prefrontal cortex and in the left inferior frontal sulcus. These regions form a ToM network, which contributes to the emotional component of spoken sentence comprehension. Compared with the ToM task, in which the sentences were enounced on a neutral tone, the emotional sentence classification task, in which the sentences were play-acted, was associated with a greater activity in the bilateral superior temporal sulcus, in line with the presence of emotional prosody. Besides, the ventromedial prefrontal cortex was more active during emotional than ToM sentence processing. This region may link mental state representations with verbal and prosodic emotional cues. Compared with emotional sentence classification, ToM was associated with greater activity in the caudate nucleus, paracingulate cortex, and superior frontal and parietal regions, in line with behavioral data showing that ToM sentence comprehension was a more demanding task.

Impact of Repetitive Transcranial Magnetic Stimulation (rTMS) on Brain Functional Marker of Auditory Hallucinations in Schizophrenia Patients.

UNLABELLED: Several cross-sectional functional Magnetic Resonance Imaging (fMRI) studies reported a negative correlation between auditory verbal hallucination (AVH) severity and amplitude of the activations during language tasks. The present study assessed the time course of this correlation and its possible structural underpinnings by combining structural, functional MRI and repetitive Transcranial Magnetic Stimulation (rTMS). METHODS: Nine schizophrenia patients with AVH (evaluated with the Auditory Hallucination Rating scale; AHRS) and nine healthy participants underwent two sessions of an fMRI speech listening paradigm. Meanwhile, patients received high frequency (20 Hz) rTMS. RESULTS: Before rTMS, activations were negatively correlated with AHRS in a left posterior superior temporal sulcus (pSTS) cluster, considered henceforward as a functional region of interest (fROI). After rTMS, activations in this fROI no longer correlated with AHRS. This decoupling was explained by a significant decrease of AHRS scores after rTMS that contrasted with a relative stability of cerebral activations. A voxel-based-morphometry analysis evidenced a cluster of the left pSTS where grey matter volume negatively correlated with AHRS before rTMS and positively correlated with activations in the fROI at both sessions. CONCLUSION: rTMS decreases the severity of AVH leading to modify the functional correlate of AVH underlain by grey matter abnormalities.

Disentangling the brain networks supporting affective speech comprehension.

Areas involved in social cognition, such as the medial prefrontal cortex (mPFC) and the left temporo-parietal junction (TPJ) appear to be active during the classification of sentences according to emotional criteria (happy, angry or sad, [Beaucousin et al., 2007]). These two regions are frequently co-activated in studies about theory of mind (ToM). To confirm that these regions constitute a coherent network during affective speech comprehension, new event-related functional magnetic resonance imaging data were acquired, using the emotional and grammatical-person sentence classification tasks on a larger sample of 51 participants. The comparison of the emotional and grammatical tasks confirmed the previous findings. Functional connectivity analyses established a clear demarcation between a "Medial" network, including the mPFC and TPJ regions, and a bilateral "Language" network, which gathered inferior frontal and temporal areas. These findings suggest that emotional speech comprehension results from interactions between language, ToM and emotion processing networks. The language network, active during both tasks, would be involved in the extraction of lexical and prosodic emotional cues, while the medial network, active only during the emotional task, would drive the making of inferences about the sentences' emotional content, based on their meanings. The left and right amygdalae displayed a stronger response during the emotional condition, but were seldom correlated with the other regions, and thus formed a third entity. Finally, distinct regions belonging to the Language and Medial networks were found in the left angular gyrus, where these two systems could interface.

Reproducibility of fMRI activations during a story listening task in patients with schizophrenia.

A prerequisite to longitudinal fMRI studies in schizophrenia is the knowledge on fMRI signal reliability in schizophrenia patients. We assessed the reproducibility of activations elicited by two fMRI sessions, which were 21 months apart, of a story listening paradigm in 10 schizophrenia patients and 10 healthy subjects. In both groups, we observed a high degree of spatial overlap of activation maps as well as a good reproducibility of signal variations assessed on a voxel-wise basis in temporal areas underlying early stages of language processing. Task performance, assessed through a comprehension questionnaire, had no impact on the activation reproducibility.

A common neural system is activated in hearing non-signers to process French sign language and spoken French.

We used functional magnetic resonance imaging to investigate the areas activated by signed narratives in non-signing subjects naïve to sign language (SL) and compared it to the activation obtained when hearing speech in their mother tongue. A subset of left hemisphere (LH) language areas activated when participants watched an audio-visual narrative in their mother tongue was activated when they observed a signed narrative. The inferior frontal (IFG) and precentral (Prec) gyri, the posterior parts of the planum temporale (pPT) and of the superior temporal sulcus (pSTS), and the occipito-temporal junction (OTJ) were activated by both languages. The activity of these regions was not related to the presence of communicative intent because no such changes were observed when the non-signers watched a muted video of a spoken narrative. Recruitment was also not triggered by the linguistic structure of SL, because the areas, except pPT, were not activated when subjects listened to an unknown spoken language. The comparison of brain reactivity for spoken and sign languages shows that SL has a special status in the brain compared to speech; in contrast to unknown oral language, the neural correlates of SL overlap LH speech comprehension areas in non-signers. These results support the idea that strong relationships exist between areas involved in human action observation and language, suggesting that the observation of hand gestures have shaped the lexico-semantic language areas as proposed by the motor theory of speech. As a whole, the present results support the theory of a gestural origin of language.

Language lateralization in left-handed patients with schizophrenia.

We evaluated hemispheric lateralization of language production in non-right-handed (NRH) patients with schizophrenia compared with matched right-handed (RH) patients, NRH control, and RH control subjects. First, the ability to generate verbs during overt training trials was checked in 78 subjects. They were then evaluated with functional magnetic resonance imaging (fMRI) while performing a covert verb generation task. No significant interactions between illness and handedness and no illness effect were observed in functional asymmetry. There was significantly less leftward asymmetry of the inferior frontal, precentral, and supramarginal gyri as well as the intra-parietal sulcus in non-right-handers compared to right-handers taking into account the task performances. Our findings suggested that decreased lateralization for language production was more closely related to handedness than to schizophrenia.

Left hemisphere lateralization for language in right-handers is controlled in part by familial sinistrality, manual preference strength, and head size.

We investigated the effects of familial sinistrality (FS+; presence of left-handedness in one's close relatives), manual preference strength (MPS), and head size on the hemispheric lateralization of language in right-handers. Functional magnetic resonance imaging was used to map 49 individuals while listening to a story in their mother tongue. We found that individuals who had both the FS+ trait and weak MPS had no left hemisphere dominance for this lexicosyntactic task, whereas others showed a leftward functional asymmetry. In addition, the smaller the brain size, the smaller the leftward asymmetry for language, independent of FS and MPS. None of these effects were observed when the same subjects performed a spatial attention task that elicited right hemispheric functional asymmetry. These results demonstrate that the left hemisphere dominance for language in right-handers is a variable controlled, in part, by a number of specific factors, including FS, MPS, and head size.

Impact of cognitive performance on the reproducibility of fMRI activation in schizophrenia.

BACKGROUND: Longitudinal functional magnetic resonance imaging (fMRI) studies in patients with schizophrenia allow exploration of the course of the illness and brain activity after therapy. A crucial question, however, is whether fMRI findings are reliable, because they can be affected by performance deficits in patients with schizophrenia. Our aim was to evaluate the reproducibility of fMRI activations in highly integrated language areas in patients with schizophrenia, taking into account task performance. METHODS: Ten patients with schizophrenia and 10 matched healthy controls were scanned twice, 21 months apart, while performing a story comprehension task. The reproducibility of the activations in each participant was evaluated globally by the percentage of spatial overlap between the 2 sessions and locally by a voxel-wise computation of the between-session relative standard deviation. We performed between-group comparisons both with and without the inclusion of comprehension scores (measuring task performance) as a covariate. RESULTS: On average, patients with schizophrenia had significantly lower comprehension scores than controls (4.5/12 v. 7.8/12, p = 0.002). The mean spatial overlap between fMRI sessions was 30.6% in the patient group and 47.0% in the control group (p = 0.017). Locally, the lower reproducibility in patients was most prominent in the left posterior middle temporal gyrus, inferior frontal gyrus and medial prefrontal cortex (p < 0.001 uncorrected for multiple comparisons). Comprehension scores were positively correlated with both reproducibility measures in patients (overlap: r = 0.82, p = 0.004; relative standard deviation: several significant clusters at p < 0.001). When we included the comprehension scores as a covariate, most of the local between-group differences in reproducibility were removed, and the difference in overlap was not significant. LIMITATIONS: Owing to the small sample size, we could not investigate the impact of clinical subtypes and different types of medications on reproducibility. CONCLUSION: Our findings suggest that the greater variability in activation in patients with schizophrenia compared with controls concerns high-level areas and is mainly attributable to deficient task performance. Consequently, cognitive performance must be carefully controlled when longitudinal fMRI studies are undertaken.

The early context effect reflects activity in the temporo-prefrontal semantic system: evidence from electrical neuroimaging of abstract and concrete word reading.

Spatial and temporal characteristics of lexico-semantic retrieval are frequently examined with semantic context (i.e., priming) paradigms. These paradigms measure context (i.e., priming) effects in word processing evoked by semantically related context. Besides the well-known attention-dependent N400 context effect (>250 ms), recent studies demonstrate early automatic context effects in the P1-N1 time period (<200 ms). However, in visual word presentation the semantic origin of these early effects remains debated. This study examined spatio-temporal activation dynamics of the early context effect as well as the modulation of the effect by differences in structure and accessibility of verbal semantics existent in abstract and concrete words. The early context effect was measured in visually displayed words that followed semantically related single-word context. Spatial and temporal aspects of the effect were analyzed by applying topographic and source analyses on the word-triggered Event Related Potentials. The early context effect was enhanced in abstract compared to concrete words as indicated by a difference in the occurrence of P1-N1 transition map and a corresponding topographic dissimilarity (116-140 ms). This concreteness-dependent modulation demonstrates the sensitivity of the early context effect to structural differences in verbal semantics. Furthermore, the topographic difference was explained by enhanced activation in the left inferior prefrontal cortex for related compared to unrelated words in addition to temporo-parietal generators recruited in both conditions. The result suggests automatic feedforward processing of context-related information in temporo-prefrontal brain regions critical to semantic analysis. Taken together our findings show that the early context effect reflects activation processes in verbal semantic memory.