“The Mute Who Can Sing”: a cortical stimulation study on singing

Clinical article

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In an attempt to identify cortical areas involved in singing in addition to language areas, the authors used a singing task during direct cortical mapping in 5 patients who were amateur singers and had undergone surgery for brain tumors. The organization of the cortical areas involved in language and singing was analyzed in relation with these surgical data.


One left-handed and 4 right-handed patients with brain tumors in left (2 cases) and right (3 cases) hemispheres and no significant language or singing deficits underwent surgery with the “awake surgery” technique. All patients had a special interest in singing and were involved in amateur singing activities. They were tested using naming, reading, and singing tasks.


Outside primary sensorimotor areas, singing interferences were rare and were exclusively localized in small cortical areas (< 1 cm2). A clear distinction was found between speech and singing in the Broca region. In the Broca region, no singing interference was found in areas in which interference in naming and reading tasks were detected. Conversely, a specific singing interference was found in nondominant middle frontal gyri in one patient. This interference consisted of abrupt singing arrest without apparent face, mouth, and tongue contraction. Finally, nonspecific singing interferences were found in the right and left precentral gyri in all patients (probably by interference in final articulatory mechanisms of singing).


Dissociations between speech and singing found outside primary sensorimotor areas showed that these 2 functions use, in some cortical stages, different cerebral pathways.

Abbreviation used in this paper: fMR = functional MR.

Article Information

Address correspondence to: Franck-Emmanuel Roux, M.D., Ph.D., Institut National de la Santé Et de la Recherche Médicale 825 et Service de Neurochirurgie, Hôpital Purpan, F-31059 Toulouse, France. email: franck.roux@club-internet.fr.

© AANS, except where prohibited by US copyright law.



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    Schematic representation of the localization of the singing interference and language (naming and reading tasks) found in the left and right hemispheres in our 5 patients. The dotted line denotes the area of craniotomy. The numbers in the upper left of each panel denote the case number. F1 = superior frontal gyrus; F2 = middle frontal gyrus; F3 = inferior frontal gyrus; T1 = superior temporal gyrus.

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    Case 1. Illustration of preserved singing during direct brain mapping in the Broca area and the supramarginal gyrus where speech was impaired. The bilingual right-handed French/Rwandan 37-year-old patient had a low-grade astrocytoma in the postcentral gyrus for which he had previously undergone surgery at another institution. Although the patient spoke rather slowly, no preoperative language impairment was noted. A and B: Intraoperative images showing naming mappings in French and Rwandan. Naming interferences (L) in both languages were found in common (Broca region) or distinct areas (supramarginal gyrus). To improve the understanding of the intraoperative pictures, cortical sites that did not produce a naming impairment were not systematically labeled by a sterile ticket. The blue thread indicates the rolandic sulcus. Naming “motor” interferences were found in primary sensorimotor areas. C: Intraoperative photograph showing singing mapping in French and Rwandan. No singing interference was found (N) in the regions (supramarginal and opercular ramus) where the patient had a typical “speech arrest” during naming and reading tasks. Singing interference was only found in the primary sensorimotor area. D: Diagram showing the French and Rwandan naming and singing interference found in this patient. Outside the sensorimotor areas, no singing interference was detected.

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    Case 3. Example of impaired singing in the right hemisphere in a right-handed 70-year-old patient with a metastasis close the right precentral gyrus. Two specific singing interferences (S) were found in the nondominant middle frontal gyrus. No naming or reading interference were found in this region. A: Three-dimensional intraoperative reconstructions of the patient's brain with brain mapping findings. B: Corresponding intraoperative picture. The black line indicates the rolandic sulcus. C and D: Photographs of the patient's face during singing interference. Once stimulation was applied in nondominant middle frontal gyrus, the patient stopped singing suddenly. Note that there is no contraction of the face, lips, or tongue. F = face motor areas within the precentral gyrus; H = hand areas (contraction of the fingers during stimulation of these 2 areas); P = face or hand paresthesia areas found in the postcentral gyrus.


  • 1

    Alexander MPBenson DFStuss DT: The frontal lobe and language. Brain Lang 37:6566911989

  • 2

    Broca P: Remarques sur le siège de la faculté du langage articulé suivis d'une observation d'aphémie. Bull Soc Anat Paris 1861 36:3303571

    • Search Google Scholar
    • Export Citation
  • 3

    Brown SMartinez MJHodges DAFox PTParsons LM: The song system of the human brain. Brain Res Cogn Brain Res 20:3633752004

  • 4

    Cadalbert ALandis TRegard MGraves R: Singing with and without words: hemispheric asymmetries in motor control. J Clin Exp Neuropsychol 16:6646701994

    • Search Google Scholar
    • Export Citation
  • 5

    Calvin WHOjemann GA: Inside the Brain: Mapping the Cortex Exploring the Neuron New YorkNew American Library2000

  • 6

    Darwin C: Descent of Man LondonMurray1871

  • 7

    Epstein CMMeador KJLoring DWWright RJWeissman JDSheppard S: Localization and characterization of speech arrest during transcranial magnetic stimulation. Clin Neurophysiol 110:107310791999

    • Search Google Scholar
    • Export Citation
  • 8

    Geschwind NQuadfasel FASegarra JM: Isolation of speech area. Neuropsychologia 6:3273401968

  • 9

    Gordon HWBogen JE: Hemispheric lateralization of singing after intracarotid sodium amylobarbitone. J Neurol Neurosurg Psychiatry 37:7277381974

    • Search Google Scholar
    • Export Citation
  • 10

    Gott PS: Language after dominant hemispherectomy. J Neurol Neurosurg Psychiatry 36:108210881973

  • 11

    Gowers WR: On a case of simultaneous embolism of central retinal and middle cerebral arteries. Lancet 2:7947961875

  • 12

    Hebert SRacette AGagnon LPeretz I: Revisiting the dissociation between singing and speaking in expressive aphasia. Brain 126:183818502003

    • Search Google Scholar
    • Export Citation
  • 13

    Henschen SE: Clinical and anatomical contributions on brain pathology. Arch Neurol 13:2262491925

  • 14

    Jackson JH: Singing by speechless (aphasic) children. Lancet 2:4304311871

  • 15

    Jespersen O: Language: Its Nature Development and Origin LondonAllen and Unwin1922

  • 16

    Jossman P: Die Beziehungen der motorischen Amusie zu den apraktischen Störungen. Mschr Psychiat Neurol 63:2392571927

  • 17

    Kilmer ATinney S: Old Babylonian music instruction texts. JCS 48:49561996

  • 18

    Kleist K: Gehirnpathologie LeipzigBarth1934

  • 19

    Lordat J: Analyse de la parole pour servir à la théorie de divers cas d'alalie et de parlalie. J Soc Med Prat (Montpellier) 7:3333534174331843

    • Search Google Scholar
    • Export Citation
  • 20

    Mann L: Casuistische Beiträge zur Hirnchirurgie und Hirnlokalisation. Mschr Psychiat Neurol 4:3691898

  • 21

    Milner BALaterality effects in audition. Mountcastle V: Interhemispheric Relations and Cerebral Dominance BaltimoreJohns Hopkins Press1962. 177195

    • Search Google Scholar
    • Export Citation
  • 22

    Ojemann GOjemann JLettich EBerger M: Cortical language localization in left, dominant hemisphere. J Neurosurg 71:3163261989

  • 23

    Perry DWZatorre RJPetrides MAlivisatos BMeyer EEvans AC: Localization of cerebral activity during simple singing. Neuroreport 10:397939841999

    • Search Google Scholar
    • Export Citation
  • 24

    Popp AJ: Music, musicians, and the brain: an exploration of musical genius. J Neurosurg 101:8959032004

  • 25

    Pouratian NCannestra AFBookheimer SYMartin NAToga AW: Variability of intraoperative electrocortical stimulation mapping parameters across and within individuals. J Neurosurg 101:4584662004

    • Search Google Scholar
    • Export Citation
  • 26

    Prins RBastiaanse R: The early history of aphasiology: from the Egyptian surgeons (c. 1700 bc) to Broca (1861). Aphasiology 20:7627912006

    • Search Google Scholar
    • Export Citation
  • 27

    Roux FELubrano VLauwers-Cances VMascott Demonet JF: Category-specific cortical mapping: color-naming areas. J Neurosurg 104:27372006

    • Search Google Scholar
    • Export Citation
  • 28

    Schmidt MFAshmore RCVu ET: Bilateral control and interhemispheric coordination in the avian song motor system. Ann N Y Acad Sci 1016:1711862004

    • Search Google Scholar
    • Export Citation
  • 29

    Smith A: Speech and other functions after left hemispherectomy. J Neurol Neurosurg Psychiatry 29:4674711966

  • 30

    Stewart LWalsh VFrith URothwell J: Transcranial magnetic stimulation produces speech arrest but not song arrest. Ann N Y Acad Sci 930:4334352001

    • Search Google Scholar
    • Export Citation
  • 31

    Taylor MDBernstein M: Awake craniotomy with brain mapping as the routine surgical approach to treating patients with supratentorial intraaxial tumors: a prospective trial of 200 cases. J Neurosurg 90:35411999

    • Search Google Scholar
    • Export Citation
  • 32

    Wildgruber DAckerman HKlose UKardatzki BGrodd W: Functional lateralization of speech production at primary motor cortex: a fMRI study. Neuroreport 7:279127951996

    • Search Google Scholar
    • Export Citation
  • 33

    Wildgruber DRiecker AHertrich IErb MGrodd WEthofer T: Identification of emotional intonation evaluated by fMRI. Neuroimage 24:123312412005

    • Search Google Scholar
    • Export Citation
  • 34

    Yamadori AOsumi YMasuhara SOkubo M: Preservation of singing in Broca's aphasia. J Neurol Neurosurg Psychiatry 40:2212241977




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