低血糖生成指数饮食对精神分裂症的增效治疗

目的 分析低血糖生成指数饮食联合抗精神病药物治疗精神分裂症患者的临床效果。 方法 选择2019 年9 月至2020 年8 月在上海市黄浦区精神卫生中心住院的80 例精神分裂症患者作为 研究对象。采用随机数字表法分为对照组和观察组，各40 例。观察组在原有抗精神病药物治疗的基 础上给予低血糖生成指数饮食治疗，对照组则在原有抗精神病药物治疗的基础上给予普通病房饮食。 比较两组的治疗效果。结果 饮食治疗后，观察组的阳性与阴性症状量表（PANSS）总分及其阳性症 状因子分、阴性症状因子分和一般精神病理症状因子分均呈下降趋势。经重复测量方差分析，PANSS 总分显示组间主效应、时间主效应、时间和分组交互效应的差异均有统计学意义（F1=6.783，P1=0.011； F2=41.378，P2 ＜ 0.001；F3=41.378，P3 ＜ 0.001）；阳性症状因子分显示时间主效应及时间和分组交互 效应的差异有统计学意义（F1=10.302，P1 ＜ 0.001；F2=6.483，P3 ＜ 0.001），组间主效应差异无统计学意 义（F=0.384，P=0.537）；阴性症状因子分显示组间主效应及时间和分组交互效应的差异有统计学意义 （F1=4.655，P1=0.035；F2=37.087，P3 ＜ 0.001），时间主效应差异无统计学意义（F=2.594，P=0.054）；一般精 神病理症状因子分显示时间主效应及时间和分组交互效应差异有统计学意义（F1=36.177，P1 ＜ 0.001； F2=37.087，P2 ＜ 0.001），组间主效应差异无统计学意义（F=3.670，P=0.071）。从第8 周末开始，PANSS 总 分、阴性症状因子分和一般精神病理症状因子分的组间差异具有统计学意义，第8 周末分别为（t1=3.507， P1=0.001；t2=2.126，P2=0.037；t3=2.839，P3=0.006），第12 周末分别为（t1=4.337，P1=0.001；t2=3.201， P2=0.002；t3=3.000，P3=0.004）。从第4 周末开始，观察组的PANSS总分、阳性症状因子分和一般精神病 理症状因子分与治疗前比较具有统计学意义，第4 周末分别为（t1=7.481；t2=3.616；t3=5.430，P ＜ 0.05）， 第8 周末分别为（t1=7.649；t2=4.572；t3=7.531，P ＜ 0.05），第12 周末分别为（t1=7.564；t2=4.869；t3=7.622， P ＜ 0.05）。结论 低血糖生成指数饮食可能增加抗精神病药物改善精神症状的作用，对阴性、阳性症 状的进一步改善可能均有一定作用，且安全性好，可能是一种有效的治疗方案。     

单纯药物与药物联合重复经颅磁刺激治疗首发精神分裂症幻听症状的随机对照研究

目的：探讨单纯药物与药物联合重复经颅磁刺激（rTMS）治疗首发精神分裂症患者幻听症状的疗效及安全性。方法将80例具有幻听症状的首发精神分裂症患者随机分为研究组和对照组,每组各40例。研究组在药物（利培酮）基础上联合rTMS治疗,对照组采用单纯药物（利培酮）治疗。分别于治疗前及治疗1,2,4周末应用阳性和阴性症状量表（PANSS）评定临床疗效,通过不良反应评价其安全性。结果治疗4周末,两组患者PANSS总分及各因子分均较治疗前显著下降（P＜0．01）;治疗4周末,研究组PANSS阳性症状因子显效率（30％）高于对照组（10％）,差异有统计学意义（P＜0．05）;研究组PANSS总分和阳性症状因子分在第2周和4周末均低于对照组（P ＜0．05）。两组患者各不良反应发生率的差异无统计学意义（P ＞0．05）。结论 rTMS可以缩短药物治疗精神分裂症幻听症状的起效时间,并可提高药物的疗效,且安全性好。     

阿立哌唑治疗利培酮所致男性精神分裂症患者泌乳素升高的疗效分析

目的 探讨阿立哌唑治疗利培酮所致男性精神分裂症患者泌乳素升高的疗效及安全性。 方法 60例患者使用利培酮治疗4周末随机分配为研究组（利培酮+阿立哌唑）和对照组（利培酮）各30例， 观察至8 周末。在基线、第4 周末、第8 周末监测两组患者的泌乳素（PRL）水平，并进行阳性与阴性症状 量表（PANSS）和UKU 不良反应量表评估。结果 使用利培酮治疗4 周末，两组患者PRL水平均显著升 高（P＜ 0.01）。第8 周末研究组PRL水平与自身相比显著降低（P＜ 0.01），且与对照组比较差异有统计学 意义（P＜ 0.01）；两组患者PANSS 评分均较前显著降低（P＜ 0.01），但两组间PANSS 评分差异无统计学意 义。两组均多见的不良反应有男性乳房发育、乏力、思睡、静坐不能、肌张力障碍、震颤，但上述不良反 应发生率组间比较差异均无统计学意义（P＞0.05）。结论 利培酮可导致男性精神分裂症患者PRL增加， 合并使用阿立哌唑可显著降低利培酮所致的男性精神分裂症患者PRL增高，但未增加不良反应发生率。     

利培酮联合改良电休克或重复经颅磁刺激治疗精神分裂症的疗效观察

目的 探讨在非典型抗精神病药物利培酮作用基础上联合改良电休克治疗（MECT）或重复经颅磁刺激（rTMS）治疗精神分裂症的疗效及不良反应.方法 将72例精神分裂症患者采用随机数字表法分为MECT组与rTMS组,各36例,分别给予利培酮（起始剂量3 ml/d,最大剂量6 ml/d）联合MECT或rTMS,在治疗1、2、4及8周末,采用阳性与阴性症状量表（PANSS）评定临床疗效,并且在2周末采用不良反应症状量表（TESS）评估不良反应.结果 经过8周治疗后,MECT组与rTMS组的有效率之间（72.22％比63.88％）差异无统计学意义（x2=2.017,P＞0.05）.两组在治疗前和治疗各阶段PANSS总分及各因子分差异均无统计学意义,在治疗8周末与组内治疗前比较,各项评分均显著下降,差异有统计学意义（P＜0.01）.治疗2周末时评估,MECT组发生不良反应例数（25例）明显高于rTMS组（18例）,两组比较差异有统计学意义（x2=5.808,P＜0.05）.结论 利培酮联合MECT或rTMS对精神分裂症状的疗效相当,而rTMS治疗的不良反应更少.     

帕利哌酮缓释剂治疗首发与复发精神分裂症的临床疗效比较

目的比较帕利哌酮缓释剂治疗首发、复发精神分裂症患者的临床疗效。方法以28例首发精神分裂症患者（首发组）和32例复发再次住院的精神分裂症患者（复发组）为研究对象,分别给予帕利哌酮缓释剂治疗,于入院时、治疗2、4及8周末,采用阳性与阴性症状量表（PANSS）评定疗效。结果治疗前首发组与复发组PANSS总分、阳性症状量表分、阴性症状量表分及一般病理量表分差异均无统计学意义（P〉0.05）。治疗后第2、4和第8周末,首发组PANSS总分、阳性症状分量表分、阴性症状分量表分及一般病理量表分逐渐降低,差异有统计学意义（P〈0.05）;复发组PANSS总分、阳性症状分量表分及一般病理量表分逐渐降低,差异有统计学意义（P〈0.05）;而复发组阴性症状分量表分虽也逐渐降低,但至第4周后差异方有统计学意义。治疗8周末首发组显效率为46.43%,复发组显效率为43.75%,两组比较差异无统计学意义（χ2=0.043,P=0.835）。两组患者不良反应差异无统计学意义（P〉0.05）。结论帕利哌酮缓释剂治疗首发、复发精神分裂症患者阴阳性症状均具有良好的疗效,且安全性、依从性好,可在临床进一步推广应用。     

重复经颅磁刺激治疗精神分裂症阴性症状的随机双盲研究

目的探讨重复经颅磁刺激（rTMS）治疗精神分裂症阴性症状的疗效。方法 30例精神分裂症患者被随机分为rTMS真刺激组（治疗组,15例）和rTMS伪刺激组（对照组,15例）,采用θ短阵快速脉冲刺激（TBS）模式刺激左侧前额叶背外侧皮质（DLPFC）,每周5次,共干预20次。于基线、治疗2周及治疗4周时应用阳性与阴性症状量表（PANSS）的阴性因子分和阴性症状量表（SANS）进行疗效评定。结果共有27例患者完成研究,对照组有3例脱落。经rTMS干预4周后,治疗组与对照组的PANSS阴性因子分减分值分别为（4.67±2.47）分和（2.33±1.87）分,两组比较有统计学差异（z=-2.41,P=0.016）;SANS总分减分值分别为（11.87±8.04）分和（5.92±6.47）分,两组比较有统计学差异（z=2.08,P=0.038）。根据PANSS阴性因子分评定,治疗组的有效率达到46.7%,对照组的有效率为16.7%;根据SANS总分评定治疗组的有效率达到46.7%,而对照组的有效率为8.3%;阴性症状的组间疗效差异有统计学意义（P〈0.05）。除了轻微的一过性头痛和入睡困难,未见有其他严重不良反应。结论 TBS模式可改善精神分裂症患者的阴性症状。     

计算机认知矫正治疗联合社交技能训练对精神分裂症患者认知功能的疗效

目的 探讨计算机认知矫正治疗联合社交技能训练改善精神分裂症患者认知功能的效 果。方法 2017 年1—12 月选取168 例慢性精神分裂症患者随机分为干预组（入组82 例，完成79 例）和 对照组（入组86 例，完成84 例），分别接受12 周的计算机认知矫正治疗联合社交技能训练和计算机认知 矫正治疗12周，并随访12个月。采用阳性与阴性症状量表（PANSS）、精神分裂症认知功能成套测验中文 版（MCCB）及个人和社会功能量表（PSP）在基线、12周末及随访12个月末分别进行评估。结果 （1）治疗 12周末，干预组PANSS的认知因子分明显低于对照组（t=-4.22，P＜0.001）；随访12个月末时干预组的阴性 因子分及认知因子分均明显低于对照组（t=-2.36，P=0.020；t=-5.91，P＜0.001）。随访12个月末，干预组的 PANSS总分与基线比较差异有统计学意义（t=3.41，P＜0.001），但与对照组比较差异无统计学意义（t=1.57， P=0.119）。（2）干预组在12个月末的PSP总分、神经认知功能总分和社会认知分均高于对照组，两组比较 差异均有统计学意义（P＜0.05）。结论 计算机认知矫正治疗联合社交技能训练能够显著改善精神分裂 症患者的认知功能，从而有效促进社会功能恢复。     

首发和慢性精神分裂症患者神经认知功能的性别差异

目的 探讨首发未服药精神分裂症（FES）和慢性精神分裂症（CSz）患者的神经认知功能的 性别差异。方法 收集符合ICD-10 的FES 患者53 例和CSz 患者104 例，同期募集健康对照（HC）52 名。 3 组均采用MATRICS 共识认知成套测验（MCCB）中文版评估神经认知功能。结果 （1）MCCB 测验得分 性别差异比较结果显示，组别和性别的交互作用无统计学意义（F=0.80，P=0.67）；组别的主效应显著， MCCB 6 项分测验及神经认知总分差异均有统计学意义；性别的主效应在视觉学习记忆分测验差异有 统计学意义（F=5.12，P=0.03）。CSz组视觉学习记忆女性优于男性（t=2.44， P=0.02），FES 组和HC 组性别 差异无统计学意义。（2）与HC 组比较，除词语学习和记忆外，FES 和 CSz组MCCB 总分和各分测验评分 比较差异均有统计学意义。FES 与CSz 组比较，FES 组在神经认知维度总分优于CSz 组（t=2.36，P=0.05）。 结论 首发和慢性精神分裂症患者的认知功能均受损，且男性慢性患者视觉学习记忆损害较女性更为 严重。     

重复经颅磁刺激对精神分裂症患者阴性症状和认知功能的疗效及安全性研究

目的:探讨重复经颅磁刺激(rTMS)改善精神分裂症患者阴性症状及认知功能的疗效及安全性。方法:入组2018年1月至2019年6月上海市民政第三精神卫生中心就诊的90例病程5年以下精神分裂症患者,给予利培酮药物维持治疗,后随机分为rTMS组(n=47)和伪刺激组(n=43),分别于治疗前、治疗4周末、治疗8周末对研究对象行阳性和阴性综合量表(PANSS)、神经心理状态评定量表(RBANS)测试,比较两组间各变量治疗前后的差异。结果:治疗4周后,rTMS组PANSS量表总分和阴性症状分均低于治疗前,且均低于伪刺激组,差异有统计学意义(P均<0.01)。对分组主效应方差分析发现rTMS组和伪刺激组在PANSS量表阴性分、总分2项和RBANS量表即刻记忆、视空间结构、语言功能、注意力、延迟记忆及RBANS总分6项有统计学差异(P均<0.01)。结论:rTMS治疗对精神分裂症患者阴性症状及认知功能具有改善作用,且疗效有持续效应,安全性好。     

重复经颅磁刺激对首发精神分裂症患者血清脑源性神经营养因子的影响

目的：初步探讨高频重复经颅磁刺激（rTMS）对以阴性症状为主的首发精神分裂症患者血清脑源性神经营养因子（BDN F ）水平的影响。方法采用随机、双盲、对照研究,选取符合国际疾病分类第十版（ICD－10）中精神分裂症诊断标准的门诊患者70例。在常规抗精神病药物治疗的基础上,按照随机数字表法分为真刺激组（n ＝35）和伪刺激组（n ＝35）,并在基线时和治疗4周末时进行BDNF浓度测定和PANSS评估。结果治疗4周后,真刺激组的PANSS总分、阴性症状分和一般精神病理分均低于伪刺激组,BDNF浓度高于伪刺激组,差异均有统计学意义（P ＜0．05）。真刺激组BDNF浓度变化值与PANSS总分及各因子分变化值均无相关性（P ＞0．05）。两组不良反应差异无统计学意义（P ＞0．05）。结论 rTMS治疗可显著增加首发精神分裂症患者的血清BDNF浓度,但其浓度变化与临床症状（尤其是阴性症状）的改善无相关性。     

Magneto-electrical stimulation of central motor pathways compared with percutaneous electrical stimulation

The central motor conduction to the relaxed muscles was studied in 30 normal volunteers using magneto-electrical stimulation (MES) of the central motor pathways. The results were compared with those obtained by the percutaneous electrical stimulation technique (PES) described previously. None of the cortical and spinal latencies (Lcor and Lsp, respectively) and the central motor conduction time were different between MES and PES in the upper limb muscles. In some lower limb muscles, however, the Lsps of MES were significantly shorter than those of PES. This was probably because the magnetic stimulation over the lumbar spinal column activated the motor roots at their exit from the spinal canal rather than the level of conus medullaris, at which activation occurs in the electrical stimulation.     

Pallidal stimulation in advanced Parkinson's patients with contraindications for subthalamic stimulation

The aim of this study was to evaluate the efficacy and safety of bilateral pallidal (GPi) deep brain stimulation (DBS) 6 months after surgery in advanced parkinsonian patients whose dopa‐resistant axial motor signs or cognitive decline constituted contraindications for subthalamic nucleus (STN) DBS. Seventeen patients with a mean age of 59.3 ± 7.1 years (range, 45–70), mean disease duration of 12.5 ± 4.3 years (range, 7–20), and contraindications for STN DBS, underwent bilateral GPi DBS. They were evaluated before surgery and 6 months afterward, in accordance with Core Assessment Program for Intracerebral Transplantation recommendations. There were mean improvements of 41.1% in the UPDRS III motor score in the off‐dopa condition and 20.3% in the activities of daily living score. Motor fluctuations were reduced by 22.9% and dyskinesias by 68.6%. Axial motor signs improved in the off‐dopa condition by 34.2%. Neuropsychological performances remained unchanged at the 6‐month assessment. Bilateral GPi DBS is both safe and effective in advanced parkinsonian patients with untreatable motor fluctuations, for whom STN DBS is contraindicated due to dopa‐resistant axial motor signs or cognitive decline. As such, it should be regarded as a viable option for these patients. © 2010 Movement Disorder Society     

The safety of transcranial magnetic stimulation with deep brain stimulation instruments

ObjectivesTranscranial magnetic stimulation (TMS) has been employed in patients with an implanted deep brain stimulation (DBS) device. We investigated the safety of TMS using simulation models with an implanted DBS device.MethodsThe DBS lead was inserted into plastic phantoms filled with dilute gelatin showing impedance similar to that of human brain. TMS was performed with three different types of magnetic coil. During TMS (1) electrode movement, (2) temperature change around the lead, and (3) TMS-induced current in various situations were observed. The amplitude and area of each evoked current were measured to calculate charge density of the evoked current.ResultsThere was no movement or temperature increase during 0.2 Hz repetitive TMS with 100% stimulus intensity for 1 h. The size of evoked current linearly increased with TMS intensity. The maximum charge density exceeded the safety limit of 30 μC/cm²/phase during stimulation above the loops of the lead with intensity over 50% using a figure-eight coil.ConclusionsStrong TMS on the looped DBS leads should not be administered to avoid electrical tissue injury. Subcutaneous lead position should be paid enough attention for forthcoming situations during surgery.     

Responsive neurostimulation with low-frequency stimulation

Deep brain stimulation and responsive neurostimulation (RNS) use high-frequency stimulation (HFS) per the pivotal trials and manufacturer-recommended therapy protocols. However, not all patients respond to HFS. In this retrospective case series, 10 patients implanted with the RNS System were programmed with low-frequency stimulation (LFS) to treat their seizures; nine of these patients were previously treated with HFS (100 Hz or greater). LFS was defined as frequency < 10 Hz. Burst duration was increased to at least 1000 ms. With HFS, patients had a median seizure reduction (MSR) of 13% (interquartile range [IQR] = −67 to 54) after a median of 19 months (IQR = 8–49). In contrast, LFS was associated with a 67% MSR (IQR = 13–95) when compared to HFS and 76% MSR (IQR = 43–91) when compared to baseline prior to implantation. Charge delivered per hour and pulses per day were not significantly different between HFS and LFS, although time stimulated per day was longer for LFS (228 min) than for HFS (7 min). There were no LFS-specific adverse effects reported by any of the patients. LFS could represent an alternative, effective method for delivering stimulation in focal drug-resistant epilepsy patients treated with the RNS System.     

Microswitch-aided programs with contingent stimulation versus general stimulation programs for post-coma persons with multiple disabilities

Objective: Assessing the impact of microswitch-aided programs with contingent stimulation on response engagement (Study I) and post-session alertness (Study II) of post-coma participants with multiple disabilities.

Method: Study I included three participants whose scores on the Coma Recovery Scale-Revised (CRS-R) were 11 or 13. Study II included three participants whose CRS-R scores were 19, 13, and 14. In both studies, the participants received sessions with contingent stimulation (i.e., sessions in which activation of a microswitch with an eyelid or hand response produced 15?s of preferred stimulation) and sessions with general, non-contingent stimulation (i.e., stimulation lasted throughout the sessions).

Results: Study I showed an increase in response engagement/frequencies only during the contingent stimulation sessions. Study II showed that the participants’ level of vigilance after those sessions was higher than after non-contingent stimulation sessions.

Conclusion: Microswitch-aided programs with contingent stimulation would be more beneficial than programs with general/non-contingent stimulation.     

Noninvasive cortical stimulation with transcranial direct current stimulation in Parkinson's disease.

Electrical stimulation of deep brain structures, such as globus pallidus and subthalamic nucleus, is widely accepted as a therapeutic tool for patients with Parkinson's disease (PD). Cortical stimulation either with epidural implanted electrodes or repetitive transcranial magnetic stimulation can be associated with motor function enhancement in PD. We aimed to study the effects of another noninvasive technique of cortical brain stimulation, transcranial direct current stimulation (tDCS), on motor function and motor-evoked potential (MEP) characteristics of PD patients. We tested tDCS using different electrode montages [anodal stimulation of primary motor cortex (M1), cathodal stimulation of M1, anodal stimulation of dorsolateral prefrontal cortex (DLPFC), and sham-stimulation] and evaluated the effects on motor function--as indexed by Unified Parkinson's Disease Rating Scale (UPDRS), simple reaction time (sRT) and Purdue Pegboard test--and on corticospinal motor excitability (MEP characteristics). All experiments were performed in a double-blinded manner. Anodal stimulation of M1 was associated with a significant improvement of motor function compared to sham-stimulation in the UPDRS (P < 0.001) and sRT (P = 0.019). This effect was not observed for cathodal stimulation of M1 or anodal stimulation of DLPFC. Furthermore, whereas anodal stimulation of M1 significantly increased MEP amplitude and area, cathodal stimulation of M1 significantly decreased them. There was a trend toward a significant correlation between motor function improvement after M1 anodal-tDCS and MEP area increase. These results confirm and extend the notion that cortical brain stimulation might improve motor function in patients with PD.     

Focal stimulation of human peripheral nerve with the magnetic coil: a comparison with electrical stimulation

The hypothenar compound motor action potential (CMAP) response to ulnar nerve stimulation at the elbow was used as a test system in the human to compare excitations by a round magnetic coil (MC), 92 mm in outer diameter, and by electrical bipolar or tripolar stimulation. Optimal focality of excitation was obtained with the MC at 90 degrees to the extended arm and its plane parallel to the arm, i.e., an orthogonal-longitudinal orientation. Tangential orientation of the MC on the arm, i.e., laying it flat on the arm, powerfully excited additional structures. As expected from classical axonology, orthogonal-transverse orientations were the least effective. With orthogonal-longitudinal orientation and submaximal stimulation, the spread of excitation lateral to the median nerve at the wrist was of the order of 10-15 mm, the thickness of the MC being 12 mm. With the same orientation, the site of origin of the distally propagating impulse was estimated by comparing CMAP latencies to bipolar electrical (with cathode distal) and MC stimulation. Tripolar stimulation (with cathode intermediate) had no advantage over bipolar stimulation. The impulse originated 13-22 mm from the midpoint of the contacting edge. Rotating the MC through 180 degrees and thus reversing the field polarity did not significantly change the CMAP latency, indicating that the effective cathode and anode lay within a few mm of each other. Stimulating with a tilted MC resulted in a maximum CMAP when the orthogonal-longitudinal orientation failed to do so. A simple volume conductor model yielded a potential gradient of the right order of magnitude (35 mV/mm) when the MC stimulator output was 25% of maximum, i.e., a little above threshold for exciting ulnar motor axons.     

Focal stimulation of human cerebral cortex with the magnetic coil: a comparison with electrical stimulation

Percutaneous stimulation of human motor cortex electrically (focal anode) and with magnetic coils (MCs) of various designs is compared. The theoretical prediction was confirmed that positioning the standard round MC laterally and orientating it more towards the vertical induces an electric field appropriate for directly exciting corticospinal neurons (cf., the conventional tangential orientation at the vertex). Thus, during voluntary contraction, minimal latency compound motor action potentials (CMAPs) in contralateral arm were elicited both by focal anodic and appropriately orientated MC stimulation. Conduction time from motor cortex to motoneuron was estimated by subtracting peripheral conduction time and monosynaptic delay at the motoneuron from the overall CMAP latency, yielding an estimated corticospinal conduction velocity as high as 66 m/sec. Discontinuous latency variations observed in population CMAPs or individual motor units approximated mono- or polysynaptic cortical synaptic delays and, therefore, are attributed to the intervals between direct and early, or late indirect corticospinal discharges. A TV computer system was used to track movements of individual digits and the hand following MC stimulation. An appropriately orientated MC readily elicited movements predominantly of a single digit, implying focal activation of motor cortex. A double square and a small pointed MC proved especially convenient for eliciting reproducibly single digit movements. Stronger stimulation revealed a topographical gradient in the responses of the different digits. Responses to a given MC stimulus a little above threshold were variable in amplitude, which could not be explained by the relationship of stimulus to phase of the cardiac or respiratory cycle. Overall, our findings indicate the importance of appropriately orientating a standard round MC and using a specially designed MC to obtain the various types of motor response to stimulation of cerebral cortex.     

Language mapping with direct electrical stimulation

Language mapping with electrical stimulation in patients with lesions close to the language area aids surgery by identifying the language area in each individual. This method is quite important in a clinical setting, and is the most reliable for preventing persistent language deficits after resection. Furthermore, language mapping with electrical stimulation has revealed that the functional organization of the language area is more complex than previously suggested by functional MRI and other methods. The language-related sites where electrical stimulation induced abnormality during language tasks were spatially distinct and surprisingly varied amona patients. In addition, electrical stimulation revealed a mosaic of language function, in which sites even 5-10 mm apart were functionally distinct. Cortical sites specifically related to a language function e.g., repetition, were surrounded by sites related to another language function but not to repetition. These findings suggested that the "language area" is not spatially homogeneous over centimeters of the cortex, but consists of functional sub-regions of the cortex. Findings obtained using intraoperative electrical stimulation of the subcortical white matter have supported the dual language pathways-the dorsal and ventral pathways. Electrical stimulation of the arcuate fasciculus induced phonological paraphasia and that of the inferior occipitofrontal fasciculus induced semantic paraphasia. However, no language deficits were induced by stimulation of the inferior longitudinal fasciculus, thereby indicating the indirect role of this bundle in language function. Our current models of human language organization can be modified on the basis of language mapping with electrical stimulation.