Inducing transient language disruptions by mapping of Broca's area with modified patterned repetitive transcranial magnetic stimulation protocol

Clinical article

Maja Rogić M.Sc., Ph.D.1, Vedran Deletis M.D., Ph.D.1,2, and Isabel Fernández-Conejero M.D.3
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  • 1 Laboratory for Human and Experimental Neurophysiology, School of Medicine, University of Split, Croatia;
  • | 2 Department for Intraoperative Neurophysiology, Roosevelt Hospital, New York, New York; and
  • | 3 Intraoperative Neurophysiology Unit, University Hospital Bellvitge, Barcelona, Spain
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Object

Until now there has been no reliable stimulation protocol for inducing transient language disruptions while mapping Broca's area. Despite the promising data of only a few studies in which speech arrest and language disturbances have been induced, certain concerns have been raised. The purpose of this study was to map Broca's area by using event-related navigated transcranial magnetic stimulation (nTMS) to generate a modified patterned nTMS protocol.

Methods

Eleven right-handed subjects underwent nTMS to Broca's area while engaged in a visual object-naming task. Navigated TMS was triggered 300 msec after picture presentation. The modified patterned nTMS protocol consists of 4 stimuli with an interstimulus interval of 6 msec; 8 or 16 of those bursts were repeated with a burst repetition rate of 12 Hz. Prior to mapping of Broca's area, the primary motor cortices (M1) for hand and laryngeal muscles were mapped. The Euclidian distance on MRI was measured between cortical points eliciting transient language disruptions and M1 for the laryngeal muscle.

Results

On stimulating Broca's area, transient language disruptions were induced in all subjects. The mean Euclidian distance between cortical spots inducing transient language disruptions and M1 for the laryngeal muscle was 17.23 ± 4.73 mm.

Conclusions

The stimulation paradigm with the modified patterned nTMS protocol was shown to be promising and might gain more widespread use in speech localization in clinical and research applications.

Abbreviations used in this paper:

APB = abductor pollicis brevis; CoMEP = corticobulbar motor evoked potential; DCS = direct cortical stimulation; fMRI = functional MRI; M1 = primary motor cortex; NBS = Navigated Brain Stimulation; nTMS = navigated transcranial magnetic stimulation; rTMS = repetitive TMS.

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