Exploring auditory neglect: Anatomo-clinical correlations of auditory extinction

BackgroundThe key symptoms of auditory neglect include left extinction on tasks of dichotic and/or diotic listening and rightward shift in locating sounds. The anatomical correlates of the latter are relatively well understood, but no systematic studies have examined auditory extinction. Here, we performed a systematic study of anatomo-clinical correlates of extinction by using dichotic and/or diotic listening tasks.MethodsIn total, 20 patients with right hemispheric damage (RHD) and 19 with left hemispheric damage (LHD) performed dichotic and diotic listening tasks. Either task consists of the simultaneous presentation of word pairs; in the dichotic task, 1 word is presented to each ear, and in the diotic task, each word is lateralized by means of interaural time differences and presented to one side.Results and conclusionRHD was associated with exclusively contralesional extinction in dichotic or diotic listening, whereas in selected cases, LHD led to contra- or ipsilesional extinction. Bilateral symmetrical extinction occurred in RHD or LHD, with dichotic or diotic listening. The anatomical correlates of these extinction profiles offer an insight into the organisation of the auditory and attentional systems. First, left extinction in dichotic versus diotic listening involves different parts of the right hemisphere, which explains the double dissociation between these 2 neglect symptoms. Second, contralesional extinction in the dichotic task relies on homologous regions in either hemisphere. Third, ipsilesional extinction in dichotic listening after LHD was associated with lesions of the intrahemispheric white matter, interrupting callosal fibres outside their midsagittal or periventricular trajectory. Fourth, bilateral symmetrical extinction was associated with large parieto-fronto-temporal LHD or smaller parieto-temporal RHD, which suggests that divided attention, supported by the right hemisphere, and auditory streaming, supported by the left, likely play a critical role.     

Sensorimotor tongue representation in individuals with unilateral upper limb amelia

The purpose of the present study was to examine the impact of the congenital absence of one hand on cortical organization of the sensorimotor cortex (S1/M1). We investigated the tongue representation in S1/M1 in nine participants with normally developed limbs, comprising the control group, and in eight persons with a congenitally completely missing hand (i.e. unilateral hand amelia). All participants were examined by fMRI while performing horizontal tongue movements. The significantly activated clusters covering S1/M1 in both hemispheres were analyzed with respect to the number and intensity of activated voxels, as well as the location of the activation. In the right-handed control group, the number of activated voxels was significantly higher in the left as compared to the right hemisphere demonstrating a clear left hemispheric motor dominance for horizontal tongue movements. In the amelic individuals, no such hemispheric lateralization effect was observed. The neural activation pattern underlying tongue movement, however, was enlarged and displaced in the hemisphere contralateral to the missing limb when compared to the respective motor non-dominant, right hemisphere of the control group participants. The present findings suggest that congenital absence of one hand leads to an appreciably altered topological organization of S1/M1 consisting of an enlargement of the tongue representation and a shift towards the "hand" area which, however, had never received any input from a hand.     

Controlling for individual differences in fMRI brain activation to tones, syllables, and words

Previous neuroimaging studies have consistently reported bilateral activation to speech stimuli in the superior temporal gyrus (STG) and have identified an anteroventral stream of speech processing along the superior temporal sulcus (STS). However, little attention has been devoted to the possible confound of individual differences in hemispheric dominance for speech. The present study was designed to test for speech-selective activation while controlling for inter-individual variance in auditory laterality, by using only subjects with at least 10% right ear advantage (REA) on the dichotic listening test. Eighteen right-handed, healthy male volunteers (median age 26) participated in the study. The stimuli were words, syllables, and sine wave tones (220-2600 Hz), presented in a block design. Comparing words > tones and syllables > tones yielded activation in the left posterior MTG and the lateral STG (upper bank of STS). In the right temporal lobe, the activation was located in the MTG/STS (lower bank). Comparing left and right temporal lobe cluster sizes from the words > tones and syllables > tones contrasts on single-subject level demonstrated a statistically significant left lateralization for speech sound processing in the STS/MTG area. The asymmetry analyses suggest that dichotic listening may be a suitable method for selecting a homogenous group of subjects with respect to left hemisphere language dominance.     

Auditory processing in spinal cord injury: a preliminary investigation from a sensory deprivation perspective

Research on sensory deprivation suggests that the loss of somatosensory input to the central nervous system may have an impact on cortical reactivity and subsequent cognitive task efficiency. Individuals with spinal cord injury have a permanent loss of such input to varying degrees. However, there have been few investigations of cognitive processing in spinal cord injury. In this study, six outpatients with quadriplegia and 12 able-bodied controls were administered a dichotic listening task while auditory evoked response data and auditory threshold data were recorded. There were no differences between groups in terms of auditory threshold or auditory evoked responses. However, the outpatient quadriplegic group was more successful than the able-bodied controls in performing the dichotic listening task at one but not all levels of complexity. Results suggest that differences in cognitive processing ability between spinal cord injured and able-bodied individuals may reflect higher level motivational attention-concentration differences rather than more basic auditory and neurophysiologic processing differences.     

Laterality of tinnitus: relationship to functional assymetries

Tinnitus is a sensation of sound generated by the auditory system due to pathology, without any external acoustic or electrical stimulation. Clinical reports have indicated that tinnitus affects the left ear more frequently than the right one. Previous data suggest that the asymmetrical distribution of tinnitus is linked to handedness or other lateral signs, but no studies have heretofore examined lateral preferences in addressing this relationship. The literature concerning the laterality (localisation) of tinnitus is reviewed. The data confirm an asymmetrical distribution of tinnitus. Results of 7 studies (altogether 4634 patients) demonstrate that tinnitus occurs more often bilaterally (48.8%) than on the left side (28.0%) or the right (23.2%). There is no general predominance of the left ear. Handedness, eyedness, footedness, earedness and dichotic listening are examined in our own sample of 58 patients (23 men and 35 women) with acute, subacute or chronic tinnitus. A right sided preference was found for hand, foot, eye, ear preference and dichotic listening among 91%, 86%, 78%, 69% and 85% of the sample, respectively. Sixty per cent of the sample heard tinnitus only in the left ear, 21% only in the right ear and 19% in both ears. There is a higher correlation between localisation of tinnitus and dichotic listening than between other lateralities. Our investigation shows a significant relationship between localisation of tinnitus and laterality of dichotic listening, suggesting a possible link between tinnitus and hemisphere dominance. The result suggests a "functional" asymmetry of tinnitus.     

Abnormalities of language networks in temporal lobe epilepsy

Functional magnetic resonance imaging (fMRI) in patients with temporal lobe epilepsy (TLE) has demonstrated reorganisation of language functions with greater involvement of the non-dominant hemisphere. The structural brain connections supporting this atypical language dominance have not previously been identified. We performed fMRI of language functions and imaging of white matter connections using MR tractography in 14 patients with unilateral TLE and hippocampal sclerosis and 10 controls. Verb generation and reading comprehension paradigms were used to define functional regions which were used to generate starting regions for tractography. Controls and right TLE patients had a left-lateralised pattern of both language-related activations and the associated structural connections. Left TLE patients showed more symmetrical language activations, along with reduced left hemisphere and increased right hemisphere structural connections. Subjects with more lateralised functional activation had also more highly lateralised connecting pathways. We provide evidence for structural reorganisation of white matter tracts that reflects the altered functional language lateralisation in left TLE patients. The combination of fMRI and tractography offers a promising tool for studying the reorganisation of language functions in many neurological conditions and may prove useful in predicting language deficits following temporal lobe surgery.     

Effects of unilateral brain damage on contralateral and ipsilateral upper extremity function in hemiplegia

This article describes the long-term effects of unilateral penetrating hemispheric lesions on contralateral and ipsilateral upper extremity motor performance and functional outcome. Activities-of-daily-living skill and gross motor performance contralateral to the lesions were compared among 32 left-sided and 19 right-sided hemiplegic subjects using analysis of variance and chi-square techniques. Ipsilateral to the damaged hemisphere, fine motor tasks of simple visual motor reaction time, grip and pinch strength, finger tapping, and Purdue Pegboard performance were tested. Analysis of covariance compared each ipsilateral task to performance in the corresponding hand of 70 matched controls. Results indicate similar long-term functional ADL outcome in right and left hemisphere-damaged subjects, despite more severe contralateral functional motor deficits following lesions of the left hemisphere. Right hemisphere lesions led to ipsilateral decrements in reaction time, and lesions of either hemisphere diminished grip or pinch strength, finger tapping, and pegboard performance ipsilaterally. These results demonstrate that unilateral brain damage involving the motor areas of either hemisphere has detrimental effects on ipsilateral upper extremity motor function. Findings are discussed and related to the concept that the left hemisphere is specialized or has greater neuronal representation for bilateral motor processes. Physical therapists involved in the treatment of patients with hemiplegia should be aware that motor functions of the ipsilateral, nonparetic upper extremity may also be affected adversely by unilateral brain lesions.     

Asymmetry in the human primary somatosensory cortex and handedness

Brain asymmetry is a phenomenon well known for handedness and language specialization and has also been studied in motor cortex. Less is known about hemispheric asymmetries in the somatosensory cortex. In the present study, we systematically investigated the representation of somatosensory function analyzing early subcortical and cortical somatosensory-evoked potentials (SEP) after electrical stimulation of the right and left median nerve. In 16 subjects, we compared thresholds, the peripheral neurogram at Erb point, and, using MRI-based EEG source analysis, the P14 brainstem component as well as N20 and P22, the earliest cortical responses from the primary sensorimotor cortex. Handedness was documented using the Edinburgh Inventory and a dichotic listening test was performed as a measure for language dominance. Whereas thresholds, Erb potential, and P14 were symmetrical, amplitudes of the cortical N20 showed significant hemispheric asymmetry. In the left hemisphere, the N20 amplitude was higher, its generator was located further medial, and it had a stronger dipole moment. There was no difference in dipole orientation. As a possible morphological correlate, the size of the left postcentral gyrus exceeded that of the right. The cortical P22 component showed a lower amplitude and a trend toward weaker dipole strength in the left hemisphere. Across subjects, there were no significant correlations between laterality indices of N20, the size of the postcentral gyrus, handedness, or ear advantage. These data show that asymmetry of median nerve SEP occurs at the cortical level, only. However, both functional and morphological cortical asymmetry of somatosensory representation appears to vary independently of motor and language functions.     

Functional MR imaging in assessment of language dominance in epileptic patients

The value of functional MR Imaging (fMRI) in assessing language lateralization in epileptic patients candidate for surgical treatment is increasingly recognized. However few data are available for left-handed patients. Moreover determining factors for atypical dominance in patients investigated with contemporary imaging have not been reported. We studied 20 patients (14 males, 6 females; 9 right handed, 11 left handed) aged from 9 to 48 years, investigated for intractable partial epilepsy. Epileptic focus location was temporal in 14 cases, extratemporal in 6, and lateralized in the left hemisphere in 11/20. Hemispheric dominance for language was evaluated by both Wada test and fMRI using a silent word generation paradigm in all patients. Furthermore, a postictal speech test was performed in 15 patients. An fMRI language lateralization index was calculated from the number of activated pixels (Student's t test, P < 0.0001) in the right and left hemispheres. The Wada test showed a right hemispheric dominance in 8 patients (6 were left handed and 2 right handed) and a left hemispheric dominance in 12 patients (5 were left handed and 7 right handed). These results were concordant with clinical postictal examination in 11/15 patients (73%). Clinical status did not allow a conclusion about hemispheric dominance for the remaining 4 patients. FMRI was concordant with the Wada test in 19/20 cases. For one left-handed patient, fMRI showed bilateral activation, whereas the Wada test demonstrated a right hemispheric dominance. Right language lateralization was significantly correlated with left lateralized epilepsy (P < 0.05) but was not correlated with age at epilepsy onset, early brain injury (before 6 years), and lobar localization of epileptogenic focus. However the lack of a significant relationship between these factors and atypical language lateralization may be related to the small sample size.     

An experimental study of attention, labelling and memory in people suffering from chronic pain.

Cognitive-behavioural approaches to treatment have become an important part of the clinical management of chronic pain. More recent developments in cognitive-behavioural theory, based on recent developments in the understanding and treatment of health anxiety, have emphasized the importance of catastrophizing appraisals, which drive both attentional processes and behavioural responses, which in turn are believed to be crucial for the maintenance of chronic pain. The experiment conducted here investigated the responses of pain patients (n=39) and controls (n=71) to a behavioural task (prolonged squeezing a dynamometer). Subsequently, the impact of a cognitive task, which fully engaged participants' attention (dichotic listening) was examined. Participants were asked, firstly, to sustain an isometric muscle contraction task (squeezing); secondly, to learn an attentional demanding task (dichotic listening); thirdly, to recall the discomfort experienced in the squeezing task and lastly, to perform both squeezing and dichotic listening at the same time. The squeezing tasks were experimentally manipulated by attaching a more or less negative label ("pain tolerance test" vs. "muscle stamina and strength test"). Patients were found to be less able to sustain prolonged muscle tension than controls, but the effect was not evident once the distracting task was introduced; similar effects were found for discomfort. All participants subsequently recalled the squeezing task as being longer and associated with less discomfort than they had actually recorded it at the time. In the dichotic listening tasks, although patients detected the same number of words overall as controls did, they were less able to focus on the target channel (i.e. they detected more of the words included as distractors on the unattended channel).     

Productive and perceptive language reorganization in temporal lobe epilepsy

The aim of this work was to determine whether productive and perceptive language functions are differentially affected in homogeneous groups of epilepsy patients with right and left temporal lobe epilepsy (TLE). Eighteen patients with left TLE, 18 with right TLE, and 17 healthy volunteers were studied using fMRI during performance of three tasks assessing the productive and perceptive aspects of language (covert semantic verbal fluency, covert sentence repetition, and story listening). Hemispheric dominance for language was calculated in the frontal and temporal regions using laterality indices (LI). Atypical lateralization was defined as a right-sided LI (LI<-0.20) in the frontal lobes during the verbal fluency task or in the temporal lobes during the story listening task. Control subjects and right TLE patients demonstrated a strong left lateralization for language in the frontal lobes during the fluency task, whereas activation was less lateralized to the left hemisphere in left TLE patients, although the difference did not reach significance. In the story listening and the repetition tasks, activation was significantly more right sided in the temporal lobes of patients with left TLE. Atypical language representation was found in 19% of TLE patients (five left and two right TLE). The shift toward the right hemisphere was significantly larger in the temporal than the frontal lobes in patients with atypical language lateralization compared to TLE patients with a typical language lateralization. Neuropsychological performances of patients with atypical language patterns were better than those of patients with typical patterns, suggesting that this reorganization may represent a compensatory mechanism.     

Interindividual variability in the hemispheric organization for speech

A PET activation study was designed to investigate hemispheric specialization during speech comprehension and production in right- and left-handed subjects. Normalized regional cerebral blood flow (NrCBF) was repeatedly monitored while subjects either listened to factual stories (Story) or covertly generated verbs semantically related to heard nouns (Gener), using silent resting (Rest) as a common control condition. NrCBF variations in each task, as compared to Rest, as well as functional asymmetry indices (FAI = right minus left NrCBF variations), were computed in anatomical regions of interest (AROIs) defined on the single-subject MNI template. FAIs were predominantly leftward in all regions during both tasks, although larger FAIs were observed during Gener. Subjects were declared "typical" for language hemispheric specialization based on the presence of significant leftward asymmetries (FAI < 0) in the pars triangularis and opercularis of the inferior frontal gyrus during Gener, and in the middle and inferior temporal AROIs during Story. Six subjects (including five LH) showed an atypical language representation. Among them, one presented a right hemisphere specialization during both tasks, another a shift in hemispheric specialization from production to comprehension (left during Gener, right during Story). The group of 14 typical subjects showed significant positive correlation between homologous left and right AROIs NrCBF variations in temporal areas during Story, and in temporal and inferior frontal areas during Gener, almost all regions presenting a leftward FAI. Such correlations were also present in deactivated areas with strong leftward asymmetry (supramarginalis gyrus, inferior parietal region). These results suggest that entry into a language task translates into a hemispheric reconfiguration of lateral cortical areas with global NrCBF increase in the dominant hemisphere and decrease in the minor hemisphere. This can be considered as the setting up of a "language mode", under the control of a mechanism that operates at a perisylvian level. On top of this global organization, regional variations carry on the performance of the cognitive operations specific to the language task to be performed. Hemispheric relationships could be different in atypical subjects, with either between task hemispheric regulation differences or differences in regional specialization.     

BILATERAL ELECTRODERMAL ACTIVITY IN THE ACTIVE–ALERT HYPNOTIC INDUCTION

Shifts in hemispheric dominance were previously proposed to play a role in hypnosis. Participants (N = 32) were exposed to an active–alert hypnosis induction and a music-control condition while electrodermal activity was registered bilaterally, providing information on alterations in hemispheric dominance. The results suggest that highly hypnotizable participants show a shift to right-sided and low hypnotizable participants demonstrated a shift to left-sided electrodermal dominance in response to the induction, whereas no change in laterality is present in the control condition. Additionally, the authors found that self-reported hypnosis experiences were also associated with a shift in laterality. These results underline the importance of the shift to right hemispheric activity in hypnosis and underscore the importance of hemispheric changes in shaping subjective experience.     

Normal fMRI brain activation patterns in children performing a verb generation task

Although much is known concerning brain-language relations in adults, little is known about how these functions might be represented during the developmental period. We report results from 17 normal children, ages 7-18 years, who have successfully completed a word fluency paradigm during functional magnetic resonance imaging at 3 Tesla. Regions of activation replicate those reported for adult subjects. However, a statistically significant association between hemispheric lateralization of activation and age was found in the children. Specifically, although most subjects at all ages showed left hemisphere dominance for this task, the degree of lateralization increased with age. This study demonstrates that fMRI can reveal developmental shifts in the pattern of brain activation associated with semantic language function.     

Ipsilateral Deficits in 1-Handed Shoe Tying After Left or Right Hemisphere Stroke

Poole JL, Sadek J, Haaland KY. Ipsilateral deficits in 1-handed shoe tying after left or right hemisphere stroke.

Objective

To examine 1-handed shoe tying performance and whether cognitive deficits more associated with left or right hemisphere damage differentially affect it after unilateral stroke.

Design

Observational cohort comparing ipsilesional shoe tying, spatial and language skills, and limb praxis.

Setting

Primary care Veterans Affairs and private medical center.

Interventions

Not applicable.

Participants

Volunteer right-handed sample of adults with left or right hemisphere damage and healthy demographically matched adults.

Main Outcome Measure

The number of correct trials and the total time to complete 10 trials tying a shoe using the 1-handed method.

Results

Both stroke groups had fewer correct trials and were significantly slower tying the shoe than the control group. Spatial skills predicted accuracy and speed after right hemisphere damage. After left hemisphere damage, accuracy was predicted by spatial skills and limb praxis, while speed was predicted by limb praxis only.

Conclusions

Ipsilesional shoe tying is similarly impaired after left or right hemisphere damage, but for different reasons. Spatial deficits had a greater influence after right hemisphere damage, and limb apraxia had a greater influence after left hemisphere damage. Language deficits did not affect performance, indicating that aphasia does not preclude using this therapy approach. These results suggest that rehabilitation professionals should consider assessment of limb apraxia and ipsilesional skill training in the performance of everyday tasks.     

The neural bases underlying pitch processing difficulties

Normal listeners are often surprisingly poor at processing pitch changes. The neural bases of this difficulty were explored using magnetoencephalography (MEG) by comparing participants who obtained poor thresholds on a pitch-direction task with those who obtained good thresholds. Source-space projected data revealed that during an active listening task, the poor threshold group displayed greater activity in the left auditory cortical region when determining the direction of small pitch glides, whereas there was no difference in the good threshold group. In a passive listening task, a mismatch response (MMNm) was identified for pitch-glide direction deviants, with a tendency to be smaller in the poor listeners. The results imply that the difficulties in pitch processing are already apparent during automatic sound processing, and furthermore suggest that left hemisphere auditory regions are used by these listeners to consciously determine the direction of a pitch change. This is in line with evidence that the left hemisphere has a poor frequency resolution, and implies that normal listeners may use the sub-optimal hemisphere to process pitch changes.     

A common language network for comprehension and production: a contribution to the definition of language epicenters with PET

In this paper, we report on a PET activation study designed to assess whether functional neuroimaging would help to uncover essential language areas in normal volunteers and to provide a more accurate definition of their localization. Regional cerebral blood flow was repeatedly monitored in eight right-handed male volunteers, while performing a language comprehension task (listening to factual stories) and a language production task (covert generation of verbs semantically related to heard nouns), using silent resting as a control condition. The conjunction analysis, conducted with SPM, was used to uncover the network of activations common to both task that included three left hemisphere areas, namely (1) the pars opercularis and triangularis of the inferior frontal gyrus, (2) the posterior part of the superior temporal cortex centered around the superior temporal sulcus, extending to the planum temporale posterior part but sparing the supramarginalis and angular gyri, and (3) the most anterior part of the left inferior temporal gyrus at the junction with the anterior fusiform gyrus. The inferior and lateral parts of the right cerebellar cortex were also included in the conjunction network. Each of the three cortical areas, when they are site of lesion or electrical stimulation, elicit impairment in both language comprehension and production and can thus be considered as essential to language. Accordingly, the present results provide conservative anatomofunctional definitions of the Broca, Wernicke, and basal language areas. Interestingly, contralateral homologues of Broca's and Wernicke's areas also lighted up in the conjunction analysis that could be related to the interindividual variability of hemispheric language dominance.     

Callosal tracts and patterns of hemispheric dominance: a combined fMRI and DTI study

Left-hemispheric dominance for language and right-hemispheric dominance for spatial processing are distinctive characteristics of the human brain. However, variations of these hemispheric asymmetries have been observed, with a minority showing crowding of both functions to the same hemisphere or even a mirror reversal of the typical lateralization pattern. Here, we used diffusion tensor imaging and functional magnetic imaging to investigate the role of the corpus callosum in participants with atypical hemispheric dominance. The corpus callosum was segmented according to the projection site of the underlying fibre tracts. Analyses of the microstructure of the identified callosal segments revealed that atypical hemispheric dominance for language was associated with high anisotropic diffusion through the corpus callosum as a whole. This effect was most evident in participants with crowding of both functions to the right. The enhanced anisotropic diffusion in atypical hemispheric dominance implies that in these individuals the two hemispheres are more heavily interconnected.     

Dichotic listening reveals functional specificity in prefrontal cortex: an fMRI study

The present study used fMRI to investigate the relationship between stimulus presentation mode and attentional instruction in a free-report dichotic listening (DL) task with consonant-vowel (CV) syllables. Binaural and dichotic CV syllables were randomly presented to the subjects during four different instructional conditions: a passive listening instruction and three active instructions where subjects listened to both ears, right ear and left ear, respectively. The results showed that dichotic presentations activated areas in the superior temporal gyrus, middle and inferior frontal gyrus and the cingulate cortex to a larger extent than binaural presentations. Moreover, the results showed that increase of activation in these areas was differentially dependent on presentation mode and attentional instruction. Thus, it seems that speech perception, as studied with the DL procedure, involves a cortical network extending beyond primary speech perception areas in the brain, also including prefrontal cortex.     

磁源成像对中、英文语言功能区的研究

目的：探索通过中、英文单词刺激健康志愿者后用磁源成像（MSI）无创性测定语言功能区的位置。方法：作者使用脑磁图对8例右利健康志愿者进行语言接受功能区的功能成像，在此过程中，受试者进行分别听150对中、英文单词的文字识别任务。结果：MSI显示8例受试者中有7例左侧半球内的兴奋明显强于右侧半球，有1例双侧大脑半球内的兴奋大致相等；中、英文单词刺激的磁反应波峰的后期兴奋（刺激后300-600ms）的磁源均位于颞上回和颞中回的后部。结论：MSI是一项有发展前途的、无创伤性的检查方法，它不但可以判断语言优势半球，而且可以判定语言功能区的位置。