Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A.
Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, U.S.A.
J Clin Neurophysiol. 2020 Mar;37(2):90-103. doi: 10.1097/WNP.0000000000000499.
Transcranial magnetic stimulation (TMS) has recently emerged as a noninvasive alternative to the intracarotid sodium amytal (Wada) procedure for establishing hemispheric dominance (HD) for language. The accuracy of HD determined by TMS was examined by comparing against the HD derived by magnetoencephalography (MEG), a prominent clinical technique with excellent concordance with the Wada procedure.
Sixty-seven patients (54 patients ≤18 years) underwent language mapping with TMS and MEG as part of clinical epilepsy and tumor presurgical assessment. Language was mapped in MEG during an auditory word recognition paradigm, and a laterality index was calculated using the number of dipoles and their spatial extent in the two hemispheres. Transcranial magnetic stimulation language mapping was performed as patients performed a naming task, and TMS-induced speech disruptions were recorded during 5-Hz TMS applied to anterior and posterior language cortices. Transcranial magnetic stimulation laterality index was estimated using the number and type of speech disruption in the language regions of each hemisphere.
Transcranial magnetic stimulation and MEG estimates of HD were concordant in 42 (63%) patients, resulting in a sensitivity of 74% and a specificity of 72%. The overall accuracy of TMS was 73%, equivalent to an odds ratio of 7.35.
In this first large-scale comparative study in a clinical population, we demonstrate that TMS is a safe and reliable noninvasive tool in determining HD for language. Improving the accuracy of TMS by optimizing TMS parameters and improving task choice will further facilitate the use of TMS to characterize language function, especially in pediatrics.
经颅磁刺激（TMS）最近作为一种替代颈内动脉注射苯巴比妥（Wada）试验以确定语言优势半球（HD）的非侵入性方法出现。通过将 TMS 确定的 HD 与磁源性影像（MEG）进行比较，来检查 TMS 确定的 HD 的准确性，MEG 是一种具有出色一致性的重要临床技术。
67 例患者（54 例≤18 岁）接受 TMS 和 MEG 语言定位作为临床癫痫和肿瘤术前评估的一部分。在听觉单词识别范式中，MEG 对语言进行定位，并使用两个半球中偶极子的数量及其空间范围计算侧化指数。TMS 语言定位是在患者进行命名任务时进行的，在应用于前后语言皮质的 5Hz TMS 期间记录 TMS 诱导的语音中断，并使用每个半球语言区域中的语音中断的数量和类型来估计 TMS 侧化指数。
TMS 和 MEG 对 HD 的估计在 42 例（63％）患者中一致，敏感性为 74％，特异性为 72％。TMS 的总体准确性为 73％，相当于优势比为 7.35。
在这项首次在临床人群中进行的大规模比较研究中，我们证明 TMS 是一种安全可靠的非侵入性工具，可用于确定语言的 HD。通过优化 TMS 参数和改进任务选择来提高 TMS 的准确性，将进一步促进 TMS 用于描述语言功能，特别是在儿科领域。
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