Timing and location of speech errors induced by direct cortical stimulation.
Timing and location of speech errors induced by direct cortical stimulation.
复制标题
直接皮层刺激引起的言语错误的时间和位置。
DOI：
10.1101/2023.09.14.557732
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Flinker,Adeen
中科院分区：
文献类型：
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作者：
Kabakoff,Heather;Yu,Leyao;Friedman,Daniel;Dugan,Patricia;Doyle,WernerK;Devinsky,Orrin;Flinker,Adeen
在研究和临床设置中，通常使用神经成像技术建立支持语言产生的皮层区域。然而，对于神经外科目的，结构功能通常在术中使用直接皮层电刺激来绘制。虽然这种方法是识别神经外科患者保留的有效皮层区域的金标准，但缺乏实际潜在认知过程被中断的特异性。为了解决这个问题，我们建议通过量化刺激和语言缺陷之间的潜伏期来绘制语言停滞的时间动态图。通过这样做，我们能够证实关于不同区域特定功能角色的假设（例如，计划与运动执行）。在这项回顾性观察性研究中，我们分析了20例难治性癫痫患者（12名女性，年龄14-43岁），这些患者在临床床边语言绘图期间接受了持续的术外颅内脑电图监测自动语音任务。在控制个体言语速率的情况下，计算从刺激开始到言语停止的潜伏期。96例中，87.5%发生在感觉运动皮层，言语骤停潜伏期居中，分布峰值为0.47 s。言语阻滞发生在多个区域，其中边缘上回潜伏期较短（0.46 s），颞上回潜伏期较短（0.51 s），颞中回潜伏期较短（0.54 s），其次是感觉运动皮层潜伏期较长（0.72 s），额下回潜伏期特别长（0.95 s）。言语停止的非参数测试表明，该区域预测潜伏期；边缘上回和颞上回潜伏期短于感觉运动皮层和额下回潜伏期。感觉运动皮层主要负责基于运动的阻滞。边缘上回和颞上回（以及较小程度的颞中回）的言语阻滞潜伏期与感觉运动皮层的运动阻滞潜伏期一致。这种相对较快的言语停止模式表明，刺激这些区域会干扰输出运动的执行。相比之下，额下回和感觉运动皮层腹侧区的言语阻滞潜伏期明显长于颞顶叶区。在更多的额叶区域（包括额下回和中央前回和中央后回的腹侧区域）出现较长的潜伏期表明，刺激这些区域会中断与计划有关的高级语言产生过程。这些结果暗示感觉运动皮层（包括中央前回和中央后回）的腹侧特化在运动执行之上和之外负责言语计划。
Cortical regions supporting speech production are commonly established using neuroimaging techniques in both research and clinical settings. However, for neurosurgical purposes, structural function is routinely mapped peri-operatively using direct electrocortical stimulation. While this method is the gold standard for identification of eloquent cortical regions to preserve in neurosurgical patients, there is lack of specificity of the actual underlying cognitive processes being interrupted. To address this, we propose mapping the temporal dynamics of speech arrest across peri-sylvian cortices by quantifying the latency between stimulation and speech deficits. In doing so, we are able to substantiate hypotheses about distinct region-specific functional roles (e.g. planning versus motor execution). In this retrospective observational study, we analysed 20 patients (12 female; age range 14–43) with refractory epilepsy who underwent continuous extra-operative intracranial EEG monitoring of an automatic speech task during clinical bedside language mapping. Latency to speech arrest was calculated as time from stimulation onset to speech arrest onset, controlling for individual speech rate. Most instances of motor-based arrest (87.5% of 96 instances) were in sensorimotor cortex with mid-range latencies to speech arrest with a distributional peak at 0.47 s. Speech arrest occurred in numerous regions, with relatively short latencies in supramarginal gyrus (0.46 s), superior temporal gyrus (0.51 s) and middle temporal gyrus (0.54 s), followed by relatively long latencies in sensorimotor cortex (0.72 s) and especially long latencies in inferior frontal gyrus (0.95 s). Non-parametric testing for speech arrest revealed that region predicted latency; latencies in supramarginal gyrus and in superior temporal gyrus were shorter than in sensorimotor cortex and in inferior frontal gyrus. Sensorimotor cortex is primarily responsible for motor-based arrest. Latencies to speech arrest in supramarginal gyrus and superior temporal gyrus (and to a lesser extent middle temporal gyrus) align with latencies to motor-based arrest in sensorimotor cortex. This pattern of relatively quick cessation of speech suggests that stimulating these regions interferes with the outgoing motor execution. In contrast, the latencies to speech arrest in inferior frontal gyrus and in ventral regions of sensorimotor cortex were significantly longer than those in temporoparietal regions. Longer latencies in the more frontal areas (including inferior frontal gyrus and ventral areas of precentral gyrus and postcentral gyrus) suggest that stimulating these areas interrupts a higher-level speech production process involved in planning. These results implicate the ventral specialization of sensorimotor cortex (including both precentral and postcentral gyri) for speech planning above and beyond motor execution.