The Wernicke area

Binder, Jeffrey R.

doi:10.1212/wnl.0000000000002219

Cited by 183 publications

(84 citation statements)

References 32 publications

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“…Tremblay & Dick, 2016]. Of particular relevance to clinicians is a compelling recent reanalysis and reinterpretation of the nature of Wernicke's area [Binder, 2015], which suggests discrete bilateral and unilateral components in typically organized individuals [see also Price, 2012], as and the suggestion that more sophisticated tasks (e.g., evaluating grammar) may better map language regions such as the angular gyrus [Polczynska et al, 2017]. …”

Section: Discussionmentioning

confidence: 99%

Presurgical language fMRI: Clinical practices and patient outcomes in epilepsy surgical planning

Benjamin

Blumenfeld

et al. 2018

Human Brain Mapping

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The goal of this study was to document current clinical practice and report patient outcomes in presurgical language functional MRI (fMRI) for epilepsy surgery. Epilepsy surgical programs worldwide were surveyed as to the utility, implementation, and efficacy of language fMRI in the clinic; 82 programs responded. Respondents were predominantly from the US (61%) academic programs (85%), and evaluated adults (44%), adults and children (40%), or children only (16%). Nearly all (96%) reported using language fMRI. Surprisingly, fMRI is used to guide surgical margins (44% of programs) as well as language lateralization (100%). Sites using fMRI for localization most often use a distance margin around activation of 10mm. While considered useful, 56% of programs reported at least one instance of disagreement with other measures. Direct brain stimulation typically confirmed fMRI findings (74%) when guiding margins, but instances of unpredicted decline were reported by 17% of programs and unexpected preservation of function by 54%. Programs reporting unexpected decline did not clearly differ from those which did not. Clinicians using fMRI to guide surgical margins do not typically map known language-critical areas beyond Broca’s and Wernicke’s. This initial data shows many clinical teams are confident using fMRI not only for language lateralization but also to guide surgical margins. Reported cases of unexpected language preservation when fMRI activation is resected, and cases of language decline when it is not, emphasize a critical need for further validation. Comprehensive studies comparing commonly-used fMRI paradigms to predict stimulation mapping and post-surgical language decline remain of high importance.

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Section: Discussionmentioning

confidence: 99%

Presurgical language fMRI: Clinical practices and patient outcomes in epilepsy surgical planning

Benjamin

Blumenfeld

et al. 2018

Human Brain Mapping

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“…Patterns of neural injury also differ between the two, in that the semantic variant of PPA features atrophy predominantly affecting the anterior, ventral, and lateral aspects temporal lobes. By contrast, the lesioned area in Wernicke's aphasia is traditionally seen in the posterior aspect of the left temporal lobe, although some recent evidence suggests that the anterior temporal lobe may also play an important role in language comprehension (Binder, 2015). While temporal lobe atrophy is often seen bilaterally in semantic variant PPA, it is typically most pronounced on the left (Hodges and Patterson, 2007).…”

Section: Comparing Causes and Consequences Of Aphasiamentioning

confidence: 99%

Non-invasive Brain Stimulation in the Treatment of Post-stroke and Neurodegenerative Aphasia: Parallels, Differences, and Lessons Learned

Norise

Hamilton

2017

Front. Hum. Neurosci.

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Numerous studies over the span of more than a decade have shown that non-invasive brain stimulation (NIBS) techniques, namely transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), can facilitate language recovery for patients who have suffered from aphasia due to stroke. While stroke is the most common etiology of aphasia, neurodegenerative causes of language impairment—collectively termed primary progressive aphasia (PPA)—are increasingly being recognized as important clinical phenotypes in dementia. Very limited data now suggest that (NIBS) may have some benefit in treating PPAs. However, before applying the same approaches to patients with PPA as have previously been pursued in patients with post-stroke aphasia, it will be important for investigators to consider key similarities and differences between these aphasia etiologies that is likely to inform successful approaches to stimulation. While both post-stroke aphasia and the PPAs have clear overlaps in their clinical phenomenology, the mechanisms of injury and theorized neuroplastic changes associated with the two etiologies are notably different. Importantly, theories of plasticity in post-stroke aphasia are largely predicated on the notion that regions of the brain that had previously been uninvolved in language processing may take on new compensatory roles. PPAs, however, are characterized by slow distributed degeneration of cellular units within the language system; compensatory recruitment of brain regions to subserve language is not currently understood to be an important aspect of the condition. This review will survey differences in the mechanisms of language representation between the two etiologies of aphasia and evaluate properties that may define and limit the success of different neuromodulation approaches for these two disorders.

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“…Early work attributed Wernicke's large swathes of posterior cortex [Figure , Penfield and Roberts, ] and attempts to clarify its location and nature have been long‐standing [Bogen and Bogen, ]. Multiple varied definitions remain in use [Binder, ; Tremblay and Dick, ]. In more recent decades, it has been appreciated that Wernicke's is not simply a receptive language region [e.g., Kagan and Saling, ].…”

Section: Introductionmentioning

confidence: 99%

“…In more recent decades, it has been appreciated that Wernicke's is not simply a receptive language region [e.g., Kagan and Saling, ]. An excellent recent overview [Binder, ] outlines evidence for (i) an anterior section of the superior temporal gyrus (STG), which is bilaterally engaged in phonological perception [see also Price, ], (ii) a posterior section extending to the supramarginal gyrus (SMG) involved in phonological retrieval (and processing), and (iii) evidence that damage to the posterior segment alone impairs phonological retrieval but not comprehension. In our experience, the inferior portion centers on BA 22, the superior, BA 22/39/40.…”

Section: Introductionmentioning

confidence: 99%

“…fMRI tasks involving the processing and comprehension of auditory and written speech engage this region [Gaillard et al, ]. Damage causes impairment of phonological processing (posterior STG, SMG) and comprehension (temporal lobe more broadly) while disruption of phonological perception (pure word deafness) typically requires bilateral lesions to the anterior STG region [Binder, ].…”

Section: Introductionmentioning

confidence: 99%

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Presurgical language fMRI: Mapping of six critical regions

Benjamin

Walshaw

Hale

et al. 2017

Human Brain Mapping

101

118

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Language mapping is a key goal in neurosurgical planning. fMRI mapping typically proceeds with a focus on Broca's and Wernicke's areas, although multiple other language‐critical areas are now well‐known. We evaluated whether clinicians could use a novel approach, including clinician‐driven individualized thresholding, to reliably identify six language regions, including Broca's Area, Wernicke's Area (inferior, superior), Exner's Area, Supplementary Speech Area, Angular Gyrus, and Basal Temporal Language Area. We studied 22 epilepsy and tumor patients who received Wada and fMRI (age 36.4[12.5]; Wada language left/right/mixed in 18/3/1). fMRI tasks (two × three tasks) were analyzed by two clinical neuropsychologists who flexibly thresholded and combined these to identify the six regions. The resulting maps were compared to fixed threshold maps. Clinicians generated maps that overlapped significantly, and were highly consistent, when at least one task came from the same set. Cases diverged when clinicians prioritized different language regions or addressed noise differently. Language laterality closely mirrored Wada data (85% accuracy). Activation consistent with all six language regions was consistently identified. In blind review, three external, independent clinicians rated the individualized fMRI language maps as superior to fixed threshold maps; identified the majority of regions significantly more frequently; and judged language laterality to mirror Wada lateralization more often. These data provide initial validation of a novel, clinician‐based approach to localizing language cortex. They also demonstrate clinical fMRI is superior when analyzed by an experienced clinician and that when fMRI data is of low quality judgments of laterality are unreliable and should be withheld. Hum Brain Mapp 38:4239–4255, 2017. © 2017 Wiley Periodicals, Inc.

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The Wernicke area

Cited by 183 publications

References 32 publications

Presurgical language fMRI: Clinical practices and patient outcomes in epilepsy surgical planning

Presurgical language fMRI: Clinical practices and patient outcomes in epilepsy surgical planning

Non-invasive Brain Stimulation in the Treatment of Post-stroke and Neurodegenerative Aphasia: Parallels, Differences, and Lessons Learned

Presurgical language fMRI: Mapping of six critical regions

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