Goldstein Hannah E, Poliakov Andrew, Barry Dwight, Warner Molly H, Shaw Dennis W, Novotny Edward J, Saneto Russell P, Patrick Kristina E, Bowen Katherine S, Hauptman Jason S, Ojemann Jeffrey G, Shurtleff Hillary A
Departments of1Neurological Surgery.
2Division of Neurosurgery.
J Neurosurg Pediatr. 2024 Dec 27;35(3):266-275. doi: 10.3171/2024.9.PEDS2471. Print 2025 Mar 1.
Functional MRI (fMRI) helps with the identification of eloquent cortex to assist with function preservation in patients who undergo epilepsy surgery. Language and memory tasks can even be used effectively in clinically involved pediatric patients. Most pediatric studies report on English speaking-only cohorts from English-dominant countries, yet languages other than English (LOEs) are increasingly prevalent in countries such as the US. This study evaluated the efficacy of pediatric fMRI for primarily bilingual patients with LOEs undergoing epilepsy surgery workups.
The authors reviewed patients who underwent epilepsy surgery workup at Seattle Children's Hospital and identified all patients who had valid verbal fluency fMRI tasks from 2007 to 2021, including the bilingual and LOE patients within this cohort who had LOE fMRI language scans. The percentage of LOE-bilingual patients and the LOEs were identified, and the LOE versus English activation in bilingual patients was compared.
Of the 363 patients with epilepsy surgery workup who had successful verbal fluency fMRI tasks during 2007-2021, 63 (17%) were bilingual or LOE-only patients and 300 were monolingual English-language patients. Of the 63 patients, 18 were bilingual and had LOE plus English scans; 3 patients were fluent only in one non-English language and thus underwent LOE scans only; 30 were bilingual but chose to have only English language scans; and 12 additional patients had limited or questionable LOE proficiency and underwent English-only scans. Sixteen of 18 bilingual scans allowed reliable calculation for the language-related region of interest (ROI), and this study focused on the comparison of the first language and second language Broca's area and Wernicke's area ROI measurements. All patients had activation in both languages, with 100% concordance in terms of laterality for Broca's area ROIs and 94% concordance for Wernicke's area ROIs. However, while lateralization indices were largely concordant, variability in exact areas and extent of activation was noted.
This preliminary pediatric study suggests that language fMRI tasks can be completed effectively with bilingual and LOE pediatric patients as part of epilepsy surgery workups, regardless of the language spoken by the patient. Individual patient LOE and English activations were generally concordant in terms of lateralization, although exact areas of activation varied. Important future steps need to include larger samples, better pre-fMRI evaluation of bilingual proficiency, and standards for fMRI assessments with a diversity of patients, particularly bilingual pediatric patients.
功能磁共振成像（fMRI）有助于识别明确的皮层，以协助癫痫手术患者保留功能。语言和记忆任务甚至可有效地用于临床相关的儿科患者。大多数儿科研究报告的是来自英语主导国家的仅说英语的队列，但在美国等国家，英语以外的语言（LOEs）越来越普遍。本研究评估了儿科fMRI对主要为双语且使用LOEs的癫痫手术检查患者的疗效。
作者回顾了在西雅图儿童医院接受癫痫手术检查的患者，并确定了2007年至2021年期间所有进行了有效的言语流畅性fMRI任务的患者，包括该队列中进行了LOE fMRI语言扫描的双语和使用LOEs的患者。确定了使用LOEs的双语患者的百分比和所使用的LOEs，并比较了双语患者中LOE与英语的激活情况。
在2007 - 2021年期间进行了成功的言语流畅性fMRI任务的363例癫痫手术检查患者中，63例（17%）为双语或仅使用LOEs的患者，300例为单语英语患者。在这63例患者中，18例为双语，进行了LOE加英语扫描；3例仅精通一种非英语语言，因此仅进行了LOE扫描；30例为双语，但选择仅进行英语扫描；另外12例患者的LOE熟练程度有限或存疑，仅进行了英语扫描。18例双语扫描中有16例允许对感兴趣的语言相关区域（ROI）进行可靠计算，本研究重点比较了第一语言和第二语言的布洛卡区和韦尼克区ROI测量值。所有患者两种语言均有激活，布洛卡区ROI的偏侧性一致性为100%，韦尼克区ROI的一致性为94%。然而，虽然偏侧化指数基本一致，但注意到激活的确切区域和范围存在差异。
这项初步的儿科研究表明，作为癫痫手术检查的一部分，双语和使用LOEs的儿科患者可以有效地完成语言fMRI任务，无论患者说何种语言。就偏侧化而言，个体患者的LOE和英语激活通常是一致的，尽管激活的确切区域有所不同。未来重要的步骤需要包括更大的样本、对双语熟练程度进行更好的fMRI前评估，以及针对不同患者，特别是双语儿科患者的fMRI评估标准。
