How To Obtain 100% in Tests & Exams (Meg & Spiky 14)
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Any panic values for a particular test are placed here after the word Panic. The reference ranges provided are from several large medical centers; consult your own clinical laboratory for those used in your institution. This column also shows which tube to use for collecting blood and other body fluids, how much the test costs using symbols; see below , and how to collect the specimen.
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Clinical Sports Medicine Collection. Motor testing during MEG imaging demonstrated event-related beta-power decrease in bilateral motor cortex with right index finger movements and beta-power decrease in contralateral motor cortex with movement of the left index finger see Nagarajan et al. The patient had a resection of the left temporal mass; pathology was suggestive of a low-grade glioma. There was no post-operative language deficit on clinical examination. A 38 year-old, ambidextrous man with localization-related epilepsy secondary to a left mesial temporal mass extending into the subinsular region.
IAP testing demonstrated left hemisphere dominant language. Pre-operative auditory evoked fields showed primary auditory activation in the left hemisphere posterior to the lesion.
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The patient had a resection of the left mesial temporal mass; pathology showed a gemistocytic astrocytoma. Our findings demonstrate that hemispheric dominance of language is a dynamic process that can be reliably observed with magnetoencephalographic imaging during an auditory verb generation task.
We found significant beta-power decreases in both the dominant and contralateral cerebral hemispheres that were bilateral for the first few hundred milliseconds following auditory speech presentation, and hundreds of milliseconds prior to overt speech production. Consistent and significant lateralization is only observed during a window of time between speech perception and production. A detailed analysis of this process, with iterative extraction of parameters that best discriminated left and right IAP subject groups, resulted in the development of a highly sensitive and specific approach to language lateralization using MEG imaging.
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The reliability of this method was subsequently assessed prospectively in a heterogeneous population of neurosurgical patients and we found excellent correlation with results from the IAP in this independent cohort. In the present study, subjects with left-hemisphere dominance by IAP demonstrated beta-power decrease in the left inferior and middle frontal regions prior to verb generation. This was seen up until msec prior to vocalization, when beta-power decrease increased bilaterally and spread into the precentral regions.
Patients with right-hemisphere dominance by IAP demonstrated bilateral beta-power decrease in the inferior and middle frontal regions during the same time period. Language lateralization was highly correlated with IAP results during both word-stimulation and verb-generation periods; maximal correlation was seen at — msec following word stimulation and and ms prior to vocalization.
These findings are consistent with language models that describe expressive language as a highly lateralized process Hickok and Poeppel, , and are similar to fMRI studies that have demonstrated maximum language lateralization in the inferior frontal gyrus Bizzi et al. A recent study used ECoG to assess the dynamics of cortical activation in right-handed epilepsy patients performing a verb generation task Edwards et al.buviletaca.cf
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Findings within individual subjects demonstrated power changes in beta and gamma frequency bands that were similar spatially and temporally to the activity distributions seen in the current MEG study Figs 3 — 4. This activity was followed by power changes in the inferior frontal gyrus msec after stimulation, and in the inferior frontal and peri-rolandic regions — msec prior to verb generation Edwards et al. Some earlier MEG language lateralization studies using dipole analysis have demonstrated good correlation with the IAP based on enumerating dipoles within the posterior superior temporal region Papanicolaou et al.
MEG signal in this region has been shown to localize to regions of electrocorticographic ECoG activity during language tasks Castillo et al. However, the validity of using sequential single dipoles to represent complex cortical activation patterns associated with language tasks, and difficulty in inferring neural mechanisms underlying these methods, motivate exploration of other techniques for MEG imaging of language.
Other recent language lateralization studies have used spatial-filtering algorithms with MEG and have demonstrated strongly lateralized task-evoked decreases in beta- and low-gamma power in the inferior frontal region Hirata et al. While data from these prior studies have not clearly shown that hemispheric dominance may be a dynamic process, the present study confirms and elaborates upon the findings of robust beta-power decrease across a wide fronto-temporal network of brain regions during an expressive language task and the bihemispheric dynamics of these oscillations.
The current study also extends recent work by Hirata et al. Hirata et al. In contrast to their study, where the words were presented visually, we focus here on auditory presentation of words. Because their study used a word-reading task, their results may reflect orthographic encoding rather than phonological and linguistic processes.
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In contrast to their report, our study shows that posterior superior temporal regions indeed also exhibit language lateralization when examined at appropriate time windows. Although Hirata et al. Further analysis of beta-power decrease averaged across subjects demonstrated that the difference in average F-values for left- and right-IAP subjects was seen only in the right hemisphere. It remains unclear what features of right hemisphere beta-power change are sufficient and necessary to result in lateralization e.
These observations further suggest that a purely hemispheric approach to language lateralization, e. In our study, an approach to language lateralization was developed based on analysis of the maximally sensitive time-windows within cortical regions-of-interest for both receptive and expressive language. These values are comparable to or somewhat improved from those found in prior studies utilizing MEG for language lateralization Hirata et al.
These findings suggest that an inclusive approach to language analysis, combining analyses of receptive and expressive language function, more closely matches language lateralization by IAP. Although ours was a small population, the sensitivity and specificity may be comparable to that seen in fMRI studies of language lateralization Desmond et al. To further validate our findings, a second group of patients was studied using the objective measures developed in the first group.
Thirteen of fourteen subjects including two right-side language dominant subjects demonstrated language lateralization corresponding to their IAP result. This heterogeneous group of subjects included those with large tumors, which are known to distort the anatomical representation of language Wellmer et al.
These findings again achieved excellent correlation with the IAP by focusing on time periods in which the dynamic process of language processing is maximally lateralized. An additional group of 21 neurologically normal subjects were tested using our paradigm. All 18 right-handed and 2 left-handed subjects demonstrated left-side language dominance; the one case of right-side language dominance was seen in a subject who was left-handed.
Although MEG language dominance could not be compared to IAP for these healthy controls, these findings conform to the expected distribution of language dominance within left and right-handed subject groups Victor, This finding supports the idea that our MEG language paradigm may generalize widely to other clinical populations. Given that prior studies have demonstrated significant alteration of the topographic representation of language in people with epilepsy and mass lesions Pataraia et al.
Overall, maximal lateralization of beta-power decrease was seen both in temporal and in inferior and middle frontal regions, a finding in agreement with several fMRI studies of language lateralization during expressive language tasks Kamada et al. Functional MRI studies performed with receptive language tasks have less reliably lateralized language Salmelin et al.
At present, routinely available fMRI research scanners are unable to evaluate event-related signal changes occurring under time periods of 1 second Babiloni et al.
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It is therefore important that MEG protocols for language lateralization are designed differently from fMRI studies, taking advantage of discrete time windows that accurately reflect the dynamic, bilateral process of cortical language processing. Although fMRI lacks the temporal sensitivity to record brief periods of lateralized receptive language activity within the superior temporal region, the combination of fMRI and MEG may present the best tools for estimating hemispheric dominance for language, and future studies combining these modalities are warranted.
This is especially critical in patients with significant brain pathology, as there can be dissociations in laterality between receptive and expressive language function. This has been reported in a patient who showed expressive language function in the left hemisphere with fMRI and receptive language function in the right hemisphere with MEG Kamada et al. Additional cases demonstrating a similar dissociation have been reported with fMRI alone Baciu et al.
One of these patients was ambidextrous and another was left handed. All four patients had structural lesions tumor or cortical dysplasia , but no additional unifying features. We describe, in several subjects, an interhemispheric dissociation between receptive and language function using MEG These cases demonstrate the importance of testing both receptive and expressive components of language with MEG imaging, and analyzing cortical regions responsible for each. By using results from each functional region, a closer approximation is made to the IAP, which analyzes many facets of language Loring et al.
Had these patients only performed isolated receptive or expressive language tasks, false lateralization may have occurred. There are several limitations to the current study that need to be acknowledged. Although the total number of patients 35 analyzed is larger than that found in early, comparable studies Hirata et al. Future studies will need to be performed on larger groups of patients in a prospective fashion.
Given the immediate aims of our study, we have yet to correlate our findings with long-term functional language outcomes in the post-operative period.
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In addition, the current study used VOIs consisting of broad cortical regions that grossly correspond to receptive and expressive language areas. Future studies may benefit from designation of specific sub-regions that more accurately encompass known language processing centers Hickok and Poeppel, By using higher spatial specificity along with discrete time windows, higher test sensitivity may be achieved.
This approach would also allow for a more direct comparison between spatial distributions of task-evoked power change using MEG and ECoG recorded during language tasks Edwards et al. This approach may benefit from the concomitant use of other functional imaging modalities such as fMRI. Previous studies have demonstrated increased sensitivity for language lateralization when combining fMRI with MEG dipole analysis or magnetoencephalographic imaging Grummich et al.