Inducing transient language disruptions by mapping of Broca's area with modified patterned repetitive transcranial magnetic stimulation protocol

Rogić, Maja; Deletis, Vedran; Fernández-Conejero, Isabel

doi:10.3171/2013.11.jns13952

Cited by 54 publications

(44 citation statements)

References 33 publications

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“…7,23,35,40 At present, however, very few data are available on the use of HFMS for language mapping. Previous works employing transcranial magnetic stimulation and grid electrodes 3,32 have described the use of HF stimulation over the Broca's area producing speech arrest rendered results similar to those observed with LF stimulation. Our study confirmed these observations intraoperatively.…”

Section: Discussionmentioning

confidence: 66%

Monopolar high-frequency language mapping: can it help in the surgical management of gliomas? A comparative clinical study

Riva¹,

Fava²,

Gallucci

et al. 2016

JNS

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T he current strategy for addressing intrinsic brain lesions, such as gliomas, is aimed at maximal tumor resection while preserving the patient's functional integrity. 9,31,33,[36][37][38] Achieving these aims can be hampered by the infiltrative nature of gliomas, which can involve essential functional structures. 16 Intraoperative direct electrical stimulation (DES) coupled with neuropsychological testing has been increasingly recognized as an efficient strategy to improve the extent of resection (EOR) and reduce postoperative morbidity. 10,13,18 In fact, DES allows identification and localization (mapping) of eloquent structures, at both the cortical and subcortical level. 5,15,[17][18][19]30,34,39 In addition, a tailored neuropsychological evaluation provides an appropriate cognitive picture of the patient, leading to an objective definition of their cognitive status and guiding resection during language and cognitive mapping. obJective Intraoperative language mapping is traditionally performed with low-frequency bipolar stimulation (LFBS). High-frequency train-of-five stimulation delivered by a monopolar probe (HFMS) is an alternative technique for motor mapping, with a lower reported seizure incidence. The application of HFMS in language mapping is still limited. Authors of this study assessed the efficacy and safety of HFMS for language mapping during awake surgery, exploring its clinical impact compared with that of LFBS. methods Fifty-nine patients underwent awake surgery with neuropsychological testing, and LFBS and HFMS were compared. Frequency, type, and site of evoked interference were recorded. Language was scored preoperatively and 1 week and 3 months after surgery. Extent of resection was calculated as well. results High-frequency monopolar stimulation induced a language disturbance when the repetition rate was set at 3 Hz. Interference with counting (p = 0.17) and naming (p = 0.228) did not vary between HFMS and LFBS. These results held true when preoperative tumor volume, lesion site, histology, and recurrent surgery were considered. Intraoperative responses (1603) in all patients were compared. The error rate for both modalities differed from baseline values (p < 0.001) but not with one another (p = 0.06). Low-frequency bipolar stimulation sensitivity (0.458) and precision (0.665) were slightly higher than the HFMS counterparts (0.367 and 0.582, respectively). The error rate across the 3 types of language errors (articulatory, anomia, paraphasia) did not differ between the 2 stimulation methods (p = 0.279). coNclusioNs With proper setting adjustments, HFMS is a safe and effective technique for language mapping.

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Section: Discussionmentioning

confidence: 66%

Monopolar high-frequency language mapping: can it help in the surgical management of gliomas? A comparative clinical study

Riva¹,

Fava²,

Gallucci

et al. 2016

JNS

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“…There is evidence in earlier studies for the justification of both PTIs. 30,55,63,81 Thus, our protocol was modified after 25 patients.…”

Section: Methodsmentioning

confidence: 99%

Combined noninvasive language mapping by navigated transcranial magnetic stimulation and functional MRI and its comparison with direct cortical stimulation

Ille

Sollmann

Hauck

et al. 2015

JNS

100

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T he resection of tumors within or adjacent to language-eloquent brain regions is still a neurosurgical quest, and a profound presurgical workup is crucial to achieving the best functional and oncological result. 6,71 Today, the most precise way to localize individual language-eloquent regions is direct cortical stimulation (DCS) during awake craniotomy. 9,12,26,44,45,54,62,65,74 Using only DCS, however, we cannot provide the longitudinal abbreviatioNs BOLD = blood oxygen level-dependent; CPS = cortical parcellation system; DCS direct cortical stimulation; ER = error rate; ERT error rate threshold; fMRI = functional MRI; IPI = interpicture interval; NPV = negative predictive value; nTMS navigated TMS; PPV = positive predictive value; PTI = picture-to-trigger interval; RMT = resting motor threshold; ROC = receiver operating characteristic; rTMS repetitive navigated TMS; TMS = transcranial magnetic stimulation. obJect Repetitive navigated transcranial magnetic stimulation (rTMS) is now increasingly used for preoperative language mapping in patients with lesions in language-related areas of the brain. Yet its correlation with intraoperative direct cortical stimulation (DCS) has to be improved. To increase rTMS's specificity and positive predictive value, the authors aim to provide thresholds for rTMS's positive language areas. Moreover, they propose a protocol for combining rTMS with functional MRI (fMRI) to combine the strength of both methods. methods The authors performed multimodal language mapping in 35 patients with left-sided perisylvian lesions by using rTMS, fMRI, and DCS. The rTMS mappings were conducted with a picture-to-trigger interval (PTI, time between stimulus presentation and stimulation onset) of either 0 or 300 msec. The error rates (ERs; that is, the number of errors per number of stimulations) were calculated for each region of the cortical parcellation system (CPS). Subsequently, the rTMS mappings were analyzed through different error rate thresholds (ERT; that is, the ER at which a CPS region was defined as language positive in terms of rTMS), and the 2-out-of-3 rule (a stimulation site was defined as language positive in terms of rTMS if at least 2 out of 3 stimulations caused an error). As a second step, the authors combined the results of fMRI and rTMS in a predefined protocol of combined noninvasive mapping. To validate this noninvasive protocol, they correlated its results to DCS during awake surgery. results The analysis by different rTMS ERTs obtained the highest correlation regarding sensitivity and a low rate of false positives for the ERTs of 15%, 20%, 25%, and the 2-out-of-3 rule. However, when comparing the combined fMRI and rTMS results with DCS, the authors observed an overall specificity of 83%, a positive predictive value of 51%, a sensitivity of 98%, and a negative predictive value of 95%. coNclusioNs In comparison with fMRI, rTMS is a more sensitive but less specific tool for preoperative language mapping than DCS. Moreover, rTMS is most reliable when using ERTs of 15%, 20...

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“…We have successfully applied recently developed methodology in healthy subjects [6][7][8] for mapping the M1 for laryngeal muscles and opercular part of Broca's area in the first patient with tumor in the frontal cortex of the left hemisphere invading the Broca's area and the lateral part of the M1 cortex. The findings of preoperative nTMS served the neurosurgeon as the guide for planning the operation.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of the studies used rTMS as a virtual lesion model to investigate the contribution of specific cortical areas to language processing by inducing various types of language errors [4,5]. Recently our group developed the nTMS methodology along with the intraoperative methodology for mapping motor speech related cortical areas (primary motor cortex (M1) for laryngeal muscles and caudal opercular part of inferior frontal gyrus (corresponding to Broca's area) by recording evoked potentials from laryngeal muscle [6][7][8]. The modified patterned rTMS protocol was used to map the M1 for laryngeal muscles while recording corticobulbar motor evoked potentials (CoMEPs) from cricothyroid muscle.…”

Section: Introductionmentioning

confidence: 99%

“…Single magnetic pulse was used for mapping the left M1 for hand muscles, while modified patterned rTMS protocol consisting of 4 bursts of 4 stimuli each, with an interstimulus interval of 6 ms, and a burst repetition rate of 4 Hz [8] was used for mapping motor speech areas: the left M1 for laryngeal muscles and the posterior part of the inferior frontal gyrus corresponding to the opercular part of the Broca's area. The patient performed a visual object naming task during mapping of the M1 for laryngeal muscles and the Broca's area, which was synchronized with the stimulation onset and controlled via presentation software Presentation® (©Neurobehavioural Systems, Inc., version 14.7 11.10.10), running a custom made script.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Preoperative Mapping of Primary Motor and Broca’s Area with Transcranial Magnetic Stimulation (TMS) – Case Report

Vidaković¹,

Vujović²

2017

J Neurol Exp Neurosci

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Inducing transient language disruptions by mapping of Broca's area with modified patterned repetitive transcranial magnetic stimulation protocol

Abstract: The stimulation paradigm with the modified patterned nTMS protocol was shown to be promising and might gain more widespread use in speech localization in clinical and research applications.

Cited by 54 publications

References 33 publications

Monopolar high-frequency language mapping: can it help in the surgical management of gliomas? A comparative clinical study

Monopolar high-frequency language mapping: can it help in the surgical management of gliomas? A comparative clinical study

Combined noninvasive language mapping by navigated transcranial magnetic stimulation and functional MRI and its comparison with direct cortical stimulation

Preoperative Mapping of Primary Motor and Broca’s Area with Transcranial Magnetic Stimulation (TMS) – Case Report

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