Language mapping with navigated repetitive TMS: proof of technique and validation.
Language mapping with navigated repetitive TMS: proof of technique and validation.
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DOI：
10.1016/j.neuroimage.2013.05.018
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发表时间：
2013-11-15
期刊：
影响因子：
5.7
通讯作者：
Nagarajan, Srikantan S.
中科院分区：
文献类型：
--
作者：
Tarapore, Phiroz E.;Findlay, Anne M.;Honma, Susanne M.;Mizuiri, Danielle;Houde, John F.;Berger, Mitchel S.;Nagarajan, Srikantan S.
关键词：
只有在使用直接皮质刺激(DC)的侵入性神经外科手术中，才有可能进行基于病变的语音通路标测。然而，导航经颅磁刺激(NTMS)可能允许基于病变的语言通路的非侵入性询问。虽然不是基于病变，但脑磁图成像(MEGI)是另一种非侵入性的语言映射方式。在这项研究中，我们比较了nTMS和MEGI与分布式控制系统的准确性。对大脑皮质语言区周围病变的受试者进行术前nTMS和MEGI语言标测。在图片命名任务期间，使用重复的TMS协议来产生nTMS映射以传递一连串的刺激。在图片命名和动词生成任务中，MEGI激活图来自对β频段功率降低的自适应空间滤波，然后再进行公开语音。受试者随后通过术中分布式控制系统进行清醒的语言映射。记录并比较从3种模式获得的语言地图。对12例受试者进行了nTMS和MEGI检查。NTMS产生了21个阳性语言干扰位点(11个言语障碍，5个异常和5个其他)，而DC产生了10个阳性位点(2个言语障碍，5个异常和3个其他)。MEGI从语言任务中分离出32个激活峰值。在所有三种模式中，最常见的语言阳性部位都出现在穹隆部区。9例阳性的DCs位点对应于阳性的nTMS位点，1例不对应。在4例中，nTMS阳性对应于阴性的dcs位点，而169例ntms和dcs阴性的病例被记录。与术中比较，nTMS的敏感性为90%，特异性为98%，阳性预测值为69%，阴性预测值为99%。5名受试者的动词生成和宾语命名的MEGI语言站点与nTMS站点相关，2名受试者的MEGI语言站点与dcs站点相关。由nTMS生成的语言功能图与由DCS生成的语言功能图具有很好的相关性。负的nTMS定位也与负的dcs定位相关。在我们的研究中，MEGI缺乏与术中标测相同水平的相关性，但它在某些情况下提供了有用的辅助信息。NTMS可能提供一种基于病变的无创询问语言通路的方法，并在处理有周围病变的患者中有价值。
Lesion-based mapping of speech pathways has been possible only during invasive neurosurgical procedures using direct cortical stimulation (DCS). However, navigated transcranial magnetic stimulation (nTMS) may allow for lesion-based interrogation of language pathways noninvasively. Although not lesion-based, magnetoencephalographic imaging (MEGI) is another noninvasive modality for language mapping. In this study, we compare the accuracy of nTMS and MEGI with DCS. Subjects with lesions around cortical language areas underwent preoperative nTMS and MEGI for language mapping. nTMS maps were generated using a repetitive TMS protocol to deliver trains of stimulations during a picture naming task. MEGI activation maps were derived from adaptive spatial filtering of beta-band power decreases prior to overt speech during picture naming and verb generation tasks. The subjects subsequently underwent awake language mapping via intraoperative DCS. The language maps obtained from each of the 3 modalities were recorded and compared. nTMS and MEGI were performed on 12 subjects. nTMS yielded 21 positive language disruption sites (11 speech arrest, 5 anomia, and 5 other) while DCS yielded 10 positive sites (2 speech arrest, 5 anomia, and 3 other). MEGI isolated 32 sites of peak activation with language tasks. Positive language sites were most commonly found in the pars opercularis for all three modalities. In 9 instances the positive DCS site corresponded to a positive nTMS site, while in 1 instance it did not. In 4 instances, a positive nTMS site corresponded to a negative DCS site, while 169 instances of negative nTMS and DCS were recorded. The sensitivity of nTMS was therefore 90%, specificity was 98%, the positive predictive value was 69% and the negative predictive value was 99% as compared with intraoperative DCS. MEGI language sites for verb generation and object naming correlated with nTMS sites in 5 subjects, and with DCS sites in 2 subjects. Maps of language function generated with nTMS correlate well with those generated by DCS. Negative nTMS mapping also correlates with negative DCS mapping. In our study, MEGI lacks the same level of correlation with intraoperative mapping; nevertheless it provides useful adjunct information in some cases. nTMS may offer a lesion-based method for noninvasively interrogating language pathways and be valuable in managing patients with peri-eloquent lesions.
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影响因子：
--
作者：
Dalal SS;Zumer JM;Guggisberg AG;Trumpis M;Wong DD;Sekihara K;Nagarajan SS
通讯作者：
Nagarajan SS
影响因子：
4.1
作者：
Chang, SM;Parney, IF;Berger, M
通讯作者：
Berger, M
影响因子：
19.7
作者：
Dym, R. Joshua;Burns, Judah;Lipton, Michael L.
通讯作者：
Lipton, Michael L.
影响因子：
4.7
作者：
Epstein, CM;Meador, KJ;Davey, KR
通讯作者：
Davey, KR
DOI：
10.1016/j.yebeh.2010.08.004
发表时间：
2011-02
期刊：
Epilepsy & behavior : E&B
影响因子：
--
作者：
Binder JR
通讯作者：
Binder JR