Hertz-Pannier L, Gaillard W D, Mott S H, Cuenod C A, Bookheimer S Y, Weinstein S, Conry J, Papero P H, Schiff S J, Le Bihan D, Theodore W H
Diagnostic Radiology Department, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Washington, DC, USA.
Neurology. 1997 Apr;48(4):1003-12. doi: 10.1212/wnl.48.4.1003.
Assessment of language organization is crucial in patients considered for epilepsy surgery. In children, the current techniques, intra-carotid amobarbital test (IAT) for language dominance, and cortical electrostimulation mapping (ESM), are invasive and risky. Functional magnetic resonance imaging (fMRI) is an alternative method for noninvasive functional mapping, through the detection of the hemodynamic changes associated with neuronal activation. We used fMRI, to assess language dominance in children with partial epilepsy.
Eleven right handed children and adolescents performed a word generation task during fMRI acquisition focused on the frontal lobes. Areas where the signal time course correlated with the test paradigm (r = 0.7) were considered activated. Extent and magnitude of signal changes were used to calculate asymmetry indices. Seven patients had IAT, ESM, or surgery outcome available for comparison.
fMRI language dominance always agreed with IAT (6 cases) and ESM (1 case), showing left dominance in six and bilateral language in one. fMRI demonstrated left dominance in three additional children, and right dominance in one with early onset of left temporal epilepsy. Four children whose initial studies were equivocal due to noncompliance or motion artifacts were restudied successfully.
fMRI can be used to assess language lateralization noninvasively in children. It has the potential to replace current functional mapping techniques in patients, and to provide important data on brain development.
对于考虑进行癫痫手术的患者，语言组织评估至关重要。在儿童中，目前用于确定语言优势半球的技术，如颈动脉内异戊巴比妥试验（IAT）和皮质电刺激图谱（ESM），具有侵入性且存在风险。功能磁共振成像（fMRI）是一种用于无创功能图谱绘制的替代方法，它通过检测与神经元激活相关的血流动力学变化来实现。我们使用fMRI来评估部分性癫痫儿童的语言优势半球。
11名右利手儿童和青少年在fMRI采集过程中执行了一项聚焦于额叶的单词生成任务。信号时间进程与测试范式相关（r = 0.7）的区域被视为激活区域。利用信号变化的范围和幅度来计算不对称指数。7名患者有IAT、ESM或手术结果可供比较。
fMRI确定的语言优势半球总是与IAT（6例）和ESM（1例）一致，6例显示左侧优势半球，1例显示双侧语言优势。fMRI还在另外3名儿童中显示出左侧优势半球，在1例早期左侧颞叶癫痫患者中显示出右侧优势半球。4名最初因不配合或运动伪影导致研究结果不明确的儿童经再次检查获得了成功结果。
fMRI可用于无创评估儿童的语言侧化。它有潜力取代目前用于患者的功能图谱绘制技术，并提供有关大脑发育的重要数据。
