The selective amobarbital test in the anterior choroidal artery: perfusion pattern assessed by intraarterial SPECT and prediction of postoperative verbal memory.

To screen for patients at risk for memory decline after temporal lobe epilepsy (TLE) surgery, selective amobarbital procedures, such as injection into the anterior choroidal artery (ACA-IAT), are sometimes used. We investigated the extent of the territory affected during ACA-IAT and its predictive value with respect to postoperative memory. Seventeen patients with TLE underwent ACA-IAT. In 9 of 17 patients, intraarterial SPECT co-registrated to MRI allowed delineation of amobarbital-perfused structures. Another subgroup of 9 of 17 patients underwent anterior temporal lobectomy. Verbal memory was tested pre- and postoperatively and during ACA-IAT. Major variations in the ACA-IAT perfusion pattern occurred and were not correlated with the verbal memory scores during ACA-IAT. Postoperatively, no patient experienced a severe verbal memory decline, but individual postoperative performance was not correlated with results during ACA-IAT. Our study suggests that ACA-IAT can be used to screen for severe postoperative amnesia in inconclusive cases, but cannot predict individual outcome, even when the perfusion pattern is taken into account.

Speech arrest with stimulation may not reliably predict language deficit after epilepsy surgery.

The authors present a patient in whom electrical cortical stimulation of the posterior temporal cortex induced speech arrest, comprehension deficits, and other language-related impairments. This area was ultimately resected because of persistence of a severe seizure disorder. No postoperative aphasia was observed despite the cortical stimulation results, and the patient is since seizure free. These findings question the well-established principle that corticography directly reflects local cortical functions in all patients.

Pure global acalculia following a left subangular lesion.

We describe the case of a right-handed patient who presented a severe acalculia in the context of a pure Gerstmann syndrome following a subangular lesion that spared the left inferior parietal lobule (IPL). The patient showed impairments in Arabic and verbal codes, in number production and comprehension, as well as in numerical facts and problem solving. By using the EC301 calculation battery, semantic and syntactic tasks in Arabic and verbal codes, we tested the different hypotheses raised by the cognitive neuropsychological models of acalculia. The patients' difficulties, which were not associated with a general intellectual deterioration, and those affecting number processing as a particular semantic class, were indicative of a "global acalculia". This deficit, which exceeded the anarithmetia usually described in Gerstmann syndrome following left IPL lesion, suggested that the isolation of this area may constitute a sufficient condition for producing such a global acalculia. These results are discussed in terms of a disorder in the manipulation of mental images of spatially related objects.

Representation of anatomical constraints in motor imagery: mental rotation of a body segment.

Classically, the mental rotation paradigm has shown that when subjects are asked to judge whether objects that differ in orientation are spatially congruent, reaction times increase with angular discrepancy, although some reports have shown that this is not always the case. Would similar results be obtained with realistic figures of body segments? In this work, the mental rotation of a hand attached to its forearm and arm in anatomically possible and impossible starting positions is compared with the mental rotation of a hammer. The main results show that reaction times increase monotonically with the angle of discrepancy for both stimuli and that the speed of rotation is higher for anatomically possible orientations in the case of the hand. Thus, mental rotation of body segments follows the same empirical rules as objects of another nature, and biomechanical constraints imposed to the motility of these segments can be considered as attributes of the mental representation.

Electric source imaging of human brain functions.

We review recent methodological advances in electromagnetic source imaging and present EEG data from our laboratory obtained by application of these methods. There are two principal steps in our analysis of multichannel electromagnetic recordings: (i) the determination of functionally relevant time periods in the ongoing electric activity and (ii) the localization of the sources in the brain that generate these activities recorded on the scalp. We propose a temporal segmentation of the time-varying activity, which is based on determination of changes in the topography of the electric fields, as an approach to the first step, and a distributed linear inverse solution based on realistic head models as an approach to the second step. Data from studies of visual motion perception, visuo-motor transfer, mental imagery, semantic decision, and cognitive interference illustrate that this analysis allows us to define the patterns of electric activity that are present at given time periods after stimulus presentation, as well as those time periods where significantly different patterns appear between different stimuli and tasks. The presented data show rapid and parallel activation of different areas within complex neuronal networks, including early activity of brain regions remote from the primary sensory areas. In addition, the data indicate information exchange between homologous areas of the two hemispheres in cases where unilateral stimulus presentation requires interhemispheric transfer.

The time course of semantic category processing in the cerebral hemispheres: an electrophysiological study.

Using visual half-field presentations of words to the right (RVF) and to the left visual field (LVF), this study investigated the time course of the hemispheric involvement in the processing of semantic category information. Multi-channel event related brain potentials (ERPs) were recorded from 15 healthy subjects during a categorisation task of sequentially presented word pairs. Subjects had to judge mentally after the appearance of the second word whether the words of a pair were semantically related (SR) or not (SU). ERPs were computed, from 100 ms before the onset of the second word to 600 ms, for SR and SU conditions in the LVF and in the RVF separately. The temporal segmentation of ERP map series into sequences of quasi-stable map configurations revealed a total of seven segments in each visual field of which only the first five (S1-S5, appearing between 70 and 400 ms) showed different map configurations as a function of visual field but presented a similar temporal sequence in both visual fields. By contrast, of the last two segments (S6 and S7) which appeared between approximately 400 and approximately 600 ms, only S7 differentiated SR and SU conditions in terms of its duration. Source localisation analysis of the segments showed that following the initial activation of posterior brain regions as a function of the visual field of presentation, a common neural network was activated in the left hemisphere (LH) although the dynamics of activation varied as a function of visual field. Concerning the role of the right hemisphere (RH) in lexico-semantic processing, the results presented here appear to be compatible with a 'callosal relay model' and suggest that, in healthy subjects, information is transferred rapidly ( approximately 150 ms) from the RH to the language dominant-LH.

So near yet so far: neglect in far or near space depends on tool use.

The study of unilateral spatial neglect has shown that space can be dissociated on a peripersonal versus extrapersonal basis. We report a novel type of dissociation based on tool use in a patient suffering from left neglect. Line bisection was carried out in near and far space, using a stick and a laser pointer. A rightward bias was always found for the former, but not for the latter. Neglect thus appears to be contingent not only on distance, but also on the motor action required by the task.

New insights into the Stroop effect: a spatio-temporal analysis of electric brain activity.

Recent clinical and imaging studies suggest the involvement of anterior brain regions in the Stroop effect without providing consensus on the hemisphere being involved. Here, we investigated the dynamics of brain activation during a modified Stroop task using behavioural, event-related potential map series, and source localization analysis. Behavioural analysis showed an increased RT in the interference (IC) as compared to the neutral (NC) and congruence conditions (CC). Map series analysis in these conditions displayed a similar sequence of 10 stable segments. From these, only segment S6, occurring at approximately 300 ms and displaying a dominant right anterior activation, was of increased duration in IC. Furthermore, in IC only, RT was shown to correlate with S6 duration. These results are discussed in terms of increased duration of an attentional process needed to solve the conflict.

Semantic category and rhyming processing in the left and right cerebral hemisphere.

In this study, the question of hemispheric abilities in processing explicit semantic and phonological information was addressed by measuring response latencies and performances in two judgement tasks. In the semantic task, word pairs were sequentially presented to the left or right visual field and subjects were asked to judge whether these words were categorically related or not. In the phonological task, the same subjects were asked to decide whether pairs of orthographically dissimilar words rhymed or not. Statistical analysis showed that reaction times (RT) were significantly shorter in both tasks when words were presented to the right visual field. Furthermore, in the semantic task, faster responses were observed in both visual fields when the words were related than when they were unrelated. This response facilitation tended to be stronger when words were presented to the left visual field. This result is in accordance with other results obtained by lexical decision studies showing that priming in the right hemisphere is due to controlled processing. By contrast, RT differences between rhyming and non-rhyming word pairs in the phonological task did not reach significance. This supports previous findings showing that phonological facilitation cannot occur when orthographic and phonological indices are in conflict.

Spatio-temporal analysis of electric brain activity during semantic and phonological word processing.

There is an ongoing debate in cognitive neuroscience about the time course and the functional independence of the different processes involved in encoding written language material. New data indicate very fast and highly parallel language analysis networks in the brain. Here we demonstrate a methodological approach to study the temporal dynamics of this network by searching for time periods where different task demands emphasize different aspects of the network. Multi-channel event related potentials (ERPs) were recorded during a semantic and a phonological reading task from 14 healthy subjects. Signals were analyzed exclusively on the basis of the spatial configuration of the electric potential distributions (ERP maps), since differences in these spatial patterns directly reflect changes in the configuration of the active sources in the brain. This analysis did not reveal any differences of the evoked brain electric fields between the two tasks up to 280 ms post-stimulus. The ERP maps then differed for a brief period between 280 and 380 ms, before they were similar again. The analysis of the maps using a global linear localization procedure revealed a network of areas, active in both tasks, that mainly involved the left postero-temporal and left antero-temporal regions. The left posterior activation was found already around 100 ms post-stimulus, indicating that language-specific functions appear early in time. We therefore conclude that phonological and semantic processing are essentially performed in both tasks and that only late decision-related processes influence the relative strength of activity of the different modules in the complex language network.

A pure case of Gerstmann syndrome with a subangular lesion.

The four symptoms composing Gerstmann's syndrome were postulated to result from a common cognitive denominator (Grundstörung) by Gerstmann himself. He suggested that it is a disorder of the body schema restricted to the hand and fingers. The existence of a Grundstörung has since been contested. Here we suggest that a common psychoneurological factor does exist, but should be related to transformations of mental images rather than to the body schema. A patient (H.P.) was studied, who presented the four symptoms of Gerstmann's syndrome in the absence of any other neuropsychological disorders. MRI showed a focal ischaemic lesion, situated subcortically in the inferior part of the left angular gyrus and reaching the superior posterior region of T1. The cortical layers were spared and the lesion was seen to extend to the callosal fibres. On the basis of an extensive cognitive investigation, language, praxis, memory and intelligence disorders were excluded. The four remaining symptoms (finger agnosia, agraphia, right-left disorientation and dyscalculia) were investigated thoroughly with the aim of determining any characteristics that they might share. Detailed analyses of the tetrad showed that the impairment was consistently attributable to disorders of a spatial nature. Furthermore, cognitive tests necessitating mental rotation were equally shown to be impaired, confirming the essentially visuospatial origin of the disturbance. In the light of this report, the common cognitive denominator is hypothesized to be an impairment in mental manipulation of images and not in body schema.

Semantically-triggered reading epilepsy: an experimental case study.

Primary reading epilepsy (PRE) is a rare syndrome in which epileptic seizures are electively provoked by reading. Cognitive neuropsychology has demonstrated the existence of at least two pathways for reading, the sublexical pathway involved in converting graphemes to phonemes, and the lexical pathway used when meaning is conveyed. Which of these specific pathways is relevant in triggering epileptic discharges remains largely unknown. We report the case of a patient suffering from PRE in which the two routes were distinguished on the basis of the reading material employed. Significantly less epileptic discharges were observed when the patient read non-words than words. In view of our findings, we tentatively contrast a lexical form of PRE, triggered by the activation of semantic knowledge structures, with a sublexical form, triggered by non-word reading. Evidence from the literature suggests that the former is characterized by bilateral EEG activating patterns, whereas the latter involves preferentially the left hemisphere.

Comprehensive postictal neuropsychology improves focus localization in epilepsy.

In recent years, new techniques such as single photon emission computed tomography (SPECT), positron emission tomography (PET) and magnetic resonance imaging (MRI) have been used to improve the localization of epileptic foci during the noninvasive evaluation procedure for epilepsy surgery. Since ictal/or immediate postictal SPECT studies were shown to localize epileptic foci better than interictal SPECT, we addressed the question of whether immediate postictal neuropsychological examination would show the same effect. Neuropsychological examinations were carried out postictally and interictally using a broad range of tests. Postictal results were analyzed with regard to lateralizing and localizing information about the epileptogenic region. Seventeen patients suffering from temporal and extratemporal pharmacoresistant epilepsy were investigated postictally with a subset of tests used for the interictal neuropsychological examination. A significant improvement in focus localization was seen in comparison with interictal neuropsychology (p = 0.014). We conclude that neuropsychology can yield lateralizing and sometimes localizing information, even for extratemporal foci, if carried out during the postictal period and based on a global analysis of the clinical neuropsychological picture.

Random motor generation in a finger tapping task: influence of spatial contingency and of cortical and subcortical hemispheric brain lesions.

OBJECTIVE: To test the hypothesis that, during random motor generation, the spatial contingencies inherent to the task would induce additional preferences in normal subjects, shifting their performances farther from randomness. By contrast, perceptual or executive dysfunction could alter these task related biases in patients with brain damage. METHODS: Two groups of patients, with right and left focal brain lesions, as well as 25 right handed subjects matched for age and handedness were asked to execute a random choice motor task--namely, to generate a random series of 180 button presses from a set of 10 keys placed vertically in front of them. RESULTS: In the control group, as in the left brain lesion group, motor generation was subject to deviations from theoretical expected randomness, similar to those when numbers are generated mentally, as immediate repetitions (successive presses on the same key) are avoided. However, the distribution of button presses was also contingent on the topographic disposition of the keys: the central keys were chosen more often than those placed at extreme positions. Small distances were favoured, particularly with the left hand. These patterns were influenced by implicit strategies and task related contingencies. By contrast, right brain lesion patients with frontal involvement tended to show a more square distribution of key presses--that is, the number of key presses tended to be more equally distributed. The strategies were also altered by brain lesions: the number of immediate repetitions was more frequent when the lesion involved the right frontal areas yielding a random generation nearer to expected theoretical randomness. The frequency of adjacent key presses was increased by right anterior and left posterior cortical as well as by right subcortical lesions, but decreased by left subcortical lesions. CONCLUSIONS: Depending on the side of the lesion and the degree of cortical-subcortical involvement, the deficits take on a different aspect and direct repetions and adjacent key presses have different patterns of alterations. Motor random generation is therefore a complex task which seems to necessitate the participation of numerous cerebral structures, among which those situated in the right frontal, left posterior, and subcortical regions have a predominant role.

Unraveling the cerebral dynamics of mental imagery.

Evidence from functional brain imaging studies suggests that mental imagery processes, like other higher cognitive functions, simultaneously activate different neuronal networks involving multiple cortical areas. The question of whether these different areas are truly simultaneously active or whether they are temporally distinct and might reflect different steps of information processing cannot be answered by these imaging methods. We applied spatiotemporal analysis techniques to multichannel event-related potential (ERP) recordings in order to elucidate the topography and chronology of brain processes involved in mental rotation. We measured 41-electrode ERPs in 12 healthy subjects who had to evaluate whether rotated letters were in a normal or mirror-reflected position. These figures were presented in the left, right, or central visual fields and were randomly rotated by 0 degrees, 50 degrees, 100 degrees, or 150 degrees. Behaviorally, we replicated the observation that reaction time increases with greater angles of rotation. Electrophysiologically, we identified a set of dominant electric potential distributions, each of them stable for a certain time period. Only one of these time segments (appearing between 400-600 msec) increased significantly in duration with greater angles of rotation mirroring reaction time. We suggest that the rotation of mental images is carried out during this time segment. A general linear inverse solution applied to this segment showed occipito-parietal cerebral activity that was lateralized to the right hemisphere.