Résumé
El término epónimo área de Broca corresponde a una región cortical cerebral humana dedicada a la expresión del lenguaje oral y que no siempre se ubica en el giro frontal inferior del lobo frontal en el hemisferio izquierdo. Al estudiar 25 artículos del año 2022 y 25 libros de enseñanza de la neuroanatomía, neurofisiología, neurociencia o áreas asociadas del presente siglo, se estableció y cuantificó la existencia del término área de Broca encontrándose que en los libros había un 96 % de inclusión epónima sobre esta área cortical cerebral y en artículos de revista existía un 100 % del mismo epónimo, además, en ninguno de los libros y artículos se encontró un epónimo diferente. Aunque a lo largo del tiempo, en las ciencias médicas se han usado epónimos para designar estructuras anatómicas como en el caso para tratar de designar el área del cerebro que genera el lenguaje oral, este término no proporciona ninguna información descriptiva ni funcional, lo que equivale a un desatino en la lógica del pensamiento morfológico actual, además que lleva a confusión, pues hace pensar que su descubrimiento inicial fue dado por Broca, equivocando el conocimiento histórico que vincula a Marc Dax como el primero en descubrir esta zona.
SUMMARY: The eponymous Broca's area is a human cerebral cortical region that controls the expression of oral language, and which is not always located in the inferior frontal gyrus of the frontal lobe in the left hemisphere. In a study of 25 articles published in 2022, and 25 teaching books on neuroanatomy, neurophysiology, neuroscience or associated areas, it was found that the term Broca's area was established and quantified. In books there was a 96 % eponymous inclusion of this cerebral cortical area and in journal articles there was 100 % of the same eponym. Furthermore, no other eponyms were found in any of the books and articles. Although over time, eponyms have been used in medical sciences to identify anatomical structures, as in the designation of the area in the brain that controls oral language, this term does not provide any descriptive or functional information. The result is contradictory to current morphological thought and also leads to confusion, erroneously suggesting that the initial discovery was made by Broca, when in fact Marc Dax was the first to discover this area some 30 years earlier.
Sujets)
Aire de Broca/anatomie et histologie , Neuroanatomie/histoire , Terminologie comme sujet , ÉponymesRésumé
ABSTRACT Purpose Aphasia is a common and debilitating manifestation of stroke. Transcranial electrical stimulation uses low-intensity electric currents to induce changes in neuronal activity. Recent evidence suggests that noninvasive techniques can be a valuable rehabilitation tool for patients with aphasia. However, it is difficult to recruit patients with aphasia for trials, and the reasons for this are not well understood. This study aimed to elucidate the main difficulties involved in patient's recruitment and inclusion in a randomized clinical study of neuromodulation in aphasia. Methods We evaluated the reasons for the exclusion of patients in a pilot, randomized, double-blinded clinical trial in which patients diagnosed with motor aphasia after stroke were recruited from March to November 2018. A descriptive statistical analysis was performed. Results Only 12.9% (4) of patients with ischemic stroke were included in the clinical trial. A total of 87.1% (27) of the 31 recruited patients were excluded for various reasons including: sensory aphasia (32.2%), dysarthria (25.8%), spontaneous clinical recovery (16.1%), previous stroke (6.4%), and death or mutism (3.2%). Conclusion The presence of other types of aphasia, dysarthria, spontaneous recovery, deaths, and mutism were barriers to recruiting patients evidenced in this neuromodulation study.
RESUMO Objetivo A afasia é uma manifestação comum e debilitante do acidente vascular cerebral (AVC). A estimulação elétrica transcraniana por corrente contínua oferece uma corrente elétrica de baixa intensidade que induz alterações na atividade neuronal e evidências recentes sugerem que técnicas não invasivas podem servir como uma ferramenta benéfica para a reabilitação de pacientes afásicos. No entanto, é muito difícil recrutar esses pacientes para estudos clínicos e as razões não são claras. O objetivo do estudo foi identificar as principais dificuldades envolvidas no recrutamento e inclusão de pacientes em ensaio clínico piloto randomizado sobre neuromodulação em pacientes com afasia. Método Foram avaliadas as razões para a exclusão e não inclusão de pacientes em um ensaio clínico piloto, randomizado, duplo-cego no qual foram incluídos pacientes diagnosticados com afasia motora após AVC no período de março a novembro de 2018. Análise estatística descritiva foi realizada. Resultados Apenas 12,9% (4) dos pacientes com AVC isquêmico foram incluídos no estudo. Um total de 87,1% (27) dos 31 pacientes recrutados foram excluídos por apresentarem afasia sensorial (32,2%), disartria (25,8%), recuperação clínica espontânea (16,1%), AVC prévio (6,4%) e óbito ou mutismo (3,2%). Conclusão A presença de outros tipos de afasia, disartria, recuperação espontânea, óbitos e mutismo foram as principais barreiras ao recrutamento de pacientes evidenciadas nesse estudo de neuromodulação.
Sujets)
Humains , Accident vasculaire cérébral/complications , Stimulation transcrânienne par courant continu , Réadaptation après un accident vasculaire cérébral , Aphasie de Broca , Essais contrôlés randomisés comme sujet , Projets pilotesRésumé
Este artículo de revisión intenta examinar las diferentes estructuras del sistema nervioso, tanto central como periférico, involucradas en el proceso del lenguaje. Tras cuestionar el modelo clásico que atribuye las funciones del lenguaje exclusivamente a las áreas de Broca y Wernicke, se presenta la hipótesis de que el lenguaje se basa en redes neuronales complejas interconectadas con áreas cognitivas. A punto de partida de la premisa de que todo estímulo es categorizable, es decir transformable y codificable en forma de lenguaje, se estipula que para una correcta interacción con el entorno y una comunicación lingüística fructífera, la coordinación, funcionamiento y comunicación entre diferentes estructuras neuroanatómicas son factores necesarios cuya descripción y explicación se presentan de manera sistemática.
The aim of this paper is to review the different structures of the nervous system, both central and peripheral, involved in the language process. The classical model in which language functions are attributed to and localized in the areas of Broca and Wernicke is questioned, and the hypothesis that language is based on interconnections of complex neural networks and cognitive areas, is presented. On the basis of the premise that every stimulus is categorizable, that is, transformable and codifiable in the form of language, it is stipulated that in order to reach a correct interaction with the surroundings and an effective linguistic communication, the coordination, functioning and communication between different neuroanatomical structures whose description and explanation are systematically presented, are much needed factors.
Résumé
Objective To investigate effects of transcranial direct current stimulation on picture naming by those with Broca's aphasia recovering from a stroke.Methods Five patients with Broca's aphasia 6-12 months post-stroke served as their own controls.They all had lesions of the left frontal gyms or the basal ganglia.They received either anodic, cathodic or sham stimulation of the left Broca's area.They were then given a picture naming test.Results The average number of correct namings was 13.13 with anodic stimulation, 9.80 with cathodic and 10.15 with the sham stimulation.Compared with cathodic or sham stimulation, anodic stimulation of the left Broca's area can improve the picture-naming ability of aphasic stroke patients significantly more effectively.Conclusions Anodic stimulation of the left Broca's area can improve the picture-naming of cerebral apoplexy patients with Broca's aphasia.Such stimulation may increase the excitability of the left cortex, suggesting that the left Broca's area and its periphery play a very important role in language recovery after stroke.
Résumé
OBJECTIVE: A randomized double-blind cross-over trial was conducted in patients with persistent auditory hallucinations (AHs) to investigate whether bilateral repetitive transcranial magnetic stimulation (rTMS) at the temporoparietal area or Broca's area is more effective at high- or low-frequencies compared to a sham condition. METHODS: Twenty three patients with persistent AHs who remained stable on the same medication for 2 months were enrolled. They were randomized to one of four conditions: low-frequency (1 Hz)-rTMS to the temporoparietal area (L-TP), high-frequency (20 Hz)-rTMS to the temporoparietal area (H-TP), high-frequency (20 Hz)-rTMS to Broca's area (H-B), or sham. RESULTS: All the four rTMS conditions resulted in significant decrease in the scores under the auditory hallucination rating scale and hallucination change scale over time. However, there were no significant treatment effects or interaction between time and treatment, suggesting no superior effects of the new paradigms over the sham condition. CONCLUSION: Our findings suggest that bilateral rTMS at the temporoparietal area or Broca's area with high- or low-frequency does not produce superior effects in reducing AHs compared to sham stimulation.
Sujets)
Humains , Études croisées , Lobe frontal , Hallucinations , Schizophrénie , Stimulation magnétique transcrânienneRésumé
Objective:To investigate the brain activation patten associated with visual sexual stimuli.Method:Thirteen healthy right-handed women were enrolled through advertisements on campus.They were scanned under functional magnetic resonance imaging(fMRI) when they watched emotional neutral films excepts and erotic films excepts.Statistic on theses data reveals the difference of brain activation.Result:The results showed that,compared to emotional neutral films,sexual visual stimuli were associated with the activation of a set of bilateral brain areas including lateral occipital cortex,postcentral gyrus,superior parietal lobule,occipital fusiform gyrus, hippocampus,and so on.Most activated brain areas are bilateral.Only in inferior frontal gyrus pars opercularis(Z=3.64,P<0.0001) and pars triangular(Z=3.42,P=0.003) there were significant right hemispheric activation.Conclusion:fMRI results indicate that inferior frontal gyrus is related to the visual sexual stimuli of women subjects,and is specified on the right hemisphere rather than left one.This sphere-special area may play an important role on sexual message processing.
Résumé
Objective To evaluate the value of fMRI guided brain surgery for the lesions in or around Broca's area.Methods Forty-three patients with lesions in or adjacent to the Broca's area were studied.fMRI imaging was obtained by BOLD technique with the tasks of reciting.Fiber tract imaging of white matter was obtained by DTI technique.All functional imaging and anatomic imaging were transferred to neuronavigation system.The technique of direct cortical stimulation was used to validate the language cortex in fMRI.The lesions were resected in microscope.Results Broca's area activation was detected in 38 cases..The distance between the fMRI peak and direct cortical stimulation was rated as overlapping (<1 cm diatance) in 25 cases and neighbouring (<2 cm diatance) in 11 cases.Total lesion resection was achieved in 17 cases, subtotal resection in 14 cases, and partial resection in 12 cases.Postoperative neurological functions were improved in 8 cases, unchanged in 31 cases, and temporary worsen in 4 cases.Conclusions The identification of the Broca's area by reciting task in fMRI is sensitive and precise.The fMRI is helpful to decrease the side effect injury in the brain surgery for the lesions in or around the Broca's area.
Résumé
OBJECTIVE: To present the case of a 54-year-old man with loss of speech, but with preservation of voluntary facio-lingual motility, language and other cognitive abilities (Broca's aphemia). METHOD: Observation of patient oral communicative abilities and general behavior, neuropsychological assessment and cranial computed tomography. RESULTS: Computed tomography showed a hyperdense lesion in the subcortex of the left precentral gyrus corresponding to Brodmann's area 6 and 44. Neuropsychological assessment confirmed that the major cognitive domains were intact. CONCLUSION: Our patient reiterates the validity of Broca's aphemia as a clinico-anatomic entity allowing us to portray it for the first time in pictures. From a neurobehavioral perspective, aphemia is related to apraxia rather than to aphasia, a fact that may have hampered the full grasp of its far-reaching implications for neurology and aphasiology.
OBJETIVO: Apresentar o caso de um paciente de 54 anos de idade com perda da fala, mas preservação da linguagem, das demais capacidades cognitivas, e da motilidade fácio-lingual voluntária (afemia de Broca). MÉTODO: Observação da capacidade de comunicação oral e do comportamento geral, exame neuropsicológico e tomografia computadorizada do crânio. RESULTADOS: A tomografia computadorizada revelou lesão hiperdensa no subcórtex do giro precentral esquerdo correspondendo às áreas 6 e 44 de Brodmann. O exame neuropsicológico confirmou que os principais domínios cognitivos se encontravam intactos. CONCLUSÃO: Nosso paciente reiterou a validade da afemia de Broca como entidade anátomo-clínico permitindo documentá-la em fotos pela primeira vez. Da perspectiva neurocomportamental, a afemia está vinculada às apraxias e não às afasias, o que pode ter prejudicado a apreensão plena do seu profundo significado para a neurologia e para a afasiologia.