Supplementary motor area in speech initiation: A large-scale intracranial EEG evaluation of stereotyped word articulation.

Speech production engages a distributed network of cortical and subcortical brain regions. The supplementary motor area (SMA) has long been thought to be a key hub in coordinating across these regions to initiate voluntary movements, including speech. We analyzed direct intracranial recordings from 115 patients with epilepsy as they articulated a single word in a subset of trials from a picture-naming task. We aimed to characterize the temporal dynamics of SMA relative to other cortical regions. SMA and preSMA were among the first regions to activate after cue onset, peaked in activity before articulation onset, and were the earliest regions to predict trial-to-trial response time. Neural activity at single electrodes in SMA and preSMA was closely associated with speech initiation; activity began at a highly predictable time after stimulus onset and extended until speech onset for any given trial. Our results support the idea that SMA is a key node in the speech initiation network.