The frequency modulated auditory evoked response (FMAER), a technical advance for study of childhood language disorders: cortical source localization and selected case studies
The frequency modulated auditory evoked response (FMAER), a technical advance for study of childhood language disorders: cortical source localization and selected case studies
复制标题
DOI：
10.1186/1471-2377-13-12
复制
发表时间：
2013-01-25
期刊：
影响因子：
2.6
通讯作者：
Als, Heidelise
中科院分区：
文献类型：
--
作者：
Duffy, Frank H.;Eksioglu, Yaman Z.;Als, Heidelise
背景：语言理解需要对复杂的、快速变化的语音流进行解码。检测语音中的调频（FM）变化被假设为准确的音素检测所必需的，因此，对于口语单词的理解。尽管FM听觉诱发反应（FMAER）在语言障碍研究中的应用已经得到证实，但它在临床上很少被使用。本报告的目的是通过解释分析陷阱，展示皮质起源的位点，并说明潜在的实用性，以促进临床应用。从语言障碍儿童中收集的FMAER，包括发育性言语障碍、Landau-Kleffner综合征（LKS），和自闭症谱系障碍（ASD）以及正常对照-利用离散源分析辅助的多通道无参考记录-提供了皮质起源的证明和临床应用的例子。记录从住院癫痫患者与留置皮质电极提供了直接评估FMAER的起源。FMAER通常起源于双侧后上级颞回和颞叶周围。儿童语言障碍与明显的接受性缺陷相关，表现为左侧或双侧FMAER颞叶反应缺失。当接受性语言不存在时，FMAER可能仍然存在于双侧。基于乳突或耳参考电极的分析显示会导致错误的结论。系列FMAER研究可以动态跟踪LKS中潜在语言处理的状态。有语言障碍的ASD患者的FMAER可能正常或异常。结论：FMAER测量了上级颞回和邻近皮层对听觉流中快速频率调制的处理。与接受缺陷相关的临床疾病表现为左侧或双侧反应缺失。连续FMAER可能有助于跟踪LKS中的语言变化。皮质FMAER可增强癫痫手术患者的侵入性皮质语言测试。在ASD和其他语言障碍中，当病理学不影响上级颞回及其周围，但可能涉及其他脑区时，FMAER可能是正常的。应避免使用耳/乳突参考电极，并使用多通道无参考记录。源分析可能有助于更好地理解复杂的FMAER结果。
Background: Language comprehension requires decoding of complex, rapidly changing speech streams. Detecting changes of frequency modulation (FM) within speech is hypothesized as essential for accurate phoneme detection, and thus, for spoken word comprehension. Despite past demonstration of FM auditory evoked response (FMAER) utility in language disorder investigations, it is seldom utilized clinically. This report's purpose is to facilitate clinical use by explaining analytic pitfalls, demonstrating sites of cortical origin, and illustrating potential utility.Results: FMAERs collected from children with language disorders, including Developmental Dysphasia, Landau-Kleffner syndrome (LKS), and autism spectrum disorder (ASD) and also normal controls - utilizing multi-channel reference-free recordings assisted by discrete source analysis - provided demonstratrions of cortical origin and examples of clinical utility. Recordings from inpatient epileptics with indwelling cortical electrodes provided direct assessment of FMAER origin. The FMAER is shown to normally arise from bilateral posterior superior temporal gyri and immediate temporal lobe surround. Childhood language disorders associated with prominent receptive deficits demonstrate absent left or bilateral FMAER temporal lobe responses. When receptive language is spared, the FMAER may remain present bilaterally. Analyses based upon mastoid or ear reference electrodes are shown to result in erroneous conclusions. Serial FMAER studies may dynamically track status of underlying language processing in LKS. FMAERs in ASD with language impairment may be normal or abnormal. Cortical FMAERs can locate language cortex when conventional cortical stimulation does not.Conclusion: The FMAER measures the processing by the superior temporal gyri and adjacent cortex of rapid frequency modulation within an auditory stream. Clinical disorders associated with receptive deficits are shown to demonstrate absent left or bilateral responses. Serial FMAERs may be useful for tracking language change in LKS. Cortical FMAERs may augment invasive cortical language testing in epilepsy surgical patients. The FMAER may be normal in ASD and other language disorders when pathology spares the superior temporal gyrus and surround but presumably involves other brain regions. Ear/mastoid reference electrodes should be avoided and multichannel, reference free recordings utilized. Source analysis may assist in better understanding of complex FMAER findings.