High-density electrocorticography to understand cortical speech arrest sites

描述(由申请者提供)：只有大脑的几个部分似乎对人类说话是完全必要的。因此，对这几个独特地区的破坏是毁灭性的。当患者出现脑肿瘤或癫痫灶等必须手术切除的局灶性病变时，必须非常小心，以避免伤害附近正常功能的语言区域。在神经外科手术中保留语言区域的黄金标准技术是直接电刺激大脑。基本上，当清醒的患者说话时，一个小探头在大脑表面缓慢推进，提供短暂的电刺激序列。刺激停止说话的区域--也就是导致言语停顿的区域--被认为是言语的必要部分，并保持不变。其他“安静”区域被认为是安全移除的。然而，尽管这种技术被使用得多么频繁，我们并不了解它是如何工作的。言语逮捕地点因人而异。它们的大小、形状和分布是不规则的。然而，它们的存在为正常言语背后的生理学提供了重要线索。为什么言语逮捕地点是特殊的？为什么它们会位于它们所在的位置？它们在正常的言语产生中起什么作用？我们的研究旨在回答这些问题。我们将使用新型的高密度皮层脑电图仪(ECoG)来记录癫痫手术患者正常语音产生时的大脑活动。我们已经使用类似的阵列在人脑中找到了语音清晰度的地图。我们假设，在这些相同的发音地图中将会发现言语截止点。我们还假设，言语捕获点将享有与其他言语产生区的功能连接。这两个目标都将通过以下方式实现：首先确定清醒、行为患者的言语抑制部位的位置，然后确定这些部位在发音图中的作用并确定它们的功能连接性 与同一地图中的其他站点。这项工作使用新技术来回答有关语音的长期问题。最终，这项工作不仅将帮助我们理解语音的生理学，还将使我们能够更好地预测手术发病率，并在手术切除前改进口才皮质的映射。这些改善将直接惠及脑瘤、癫痫和语言障碍患者。

DESCRIPTION (provided by applicant): Only a few parts of the brain appear utterly essential for human speech. Damage to these few, unique areas is therefore devastating. When patients develop focal lesions like brain tumors or epileptic foci that must be surgically removed, great care must be taken to avoid injuring nearby, normally functioning speech areas. The gold-standard technique by which speech areas are preserved during neurosurgical procedures is direct electrical stimulation of the brain. Essentially, a small probe is slowly advanced over the brain surface, delivering brief trains of electrical stimulation, while an awake patient speaks. Areas where stimulation stops speech-that is, causes speech arrest-are deemed essential for speech and left intact. Other "quiet" areas are thought safely removed. Yet despite how often this technique is used, we do not understand how it works. Speech arrest sites are highly variable from person to person. Their size, shape, and distribution are irregular. Yet their existence offers an important clue for the physiology underlying normal speech. Why are speech arrest sites special? Why are they located where they are? What role do they serve in normal speech production? Our research aims to answer these questions. We will use novel, high-density electrocorticography (ECoG) to record brain activity during normal speech production in patients undergoing epilepsy surgery. We have already used similar arrays to find maps of speech articulation in the human brain. We hypothesize that speech arrest sites will be found within these same articulation maps. We also hypothesize that speech arrest sites will be privileged in their functional connectivity to other speech-producing regions. Both aims will be achieved by first identifying the location of speech arrest sites in awake, behaving patients, and then determining the sites' role in articulation maps and determining their functional connectivity with other sites within the same maps. This work uses new technology to answer longstanding questions about speech. Ultimately, this work will not only help us understand the physiology of speech, but will also enable improved prediction of surgical morbidity and improved mapping of eloquent cortex prior to surgical resection. Such improvements will directly benefit patients with brain tumors, epilepsy, and disorders of language.