High-density electrocorticography to understand cortical speech arrest sites

描述（由申请人提供）：大脑中只有少数部分似乎对人类语言至关重要。因此，对这些少数独特地区的破坏是毁灭性的。当患者出现局灶性病变，如脑肿瘤或癫痫灶，必须通过手术切除时，必须非常小心，以避免损伤附近正常功能的语言区域。在神经外科手术过程中保存语言区域的黄金标准技术是直接电刺激大脑。从本质上讲，一个小探针在大脑表面缓慢移动，在清醒的病人说话时提供短暂的电刺激。刺激导致语言停止的区域——也就是导致语言停滞的区域——被认为对语言至关重要，并且完好无损。其他“安静”的区域被认为是安全的。然而，尽管这种技术经常被使用，我们并不了解它是如何工作的。言论逮捕的地点因人而异。它们的大小、形状和分布都是不规则的。然而，它们的存在为正常语言背后的生理学提供了重要线索。为什么言论逮捕网站是特别的？他们为什么会在这里？它们在正常的语言产生中起什么作用？我们的研究旨在回答这些问题。我们将使用新颖的高密度皮质电图（ECoG）来记录癫痫手术患者正常言语产生期间的大脑活动。我们已经使用类似的阵列来寻找人类大脑的语音发音图。我们假设在这些相同的发音图中也会发现言语逮捕点。我们还假设，语言阻滞区域在与其他语言产生区域的功能连接方面将享有特权。这两个目标都将通过首先确定清醒、有行为的患者的言语停止部位的位置，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来实现

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.