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The "crowding" effect (CE), wherein verbal functions are preserved presumably at the expense of nonverbal functions, which diminish following inter-hemispheric transfer of language functions, is recognized as a specific aspect of functional reorganization, offering an insight about neural plasticity in children with neural insult to the dominant hemisphere. CE is hypothesized as a marker for language preservation or improvement after left-hemispheric injury, yet it remains challenging to fully discern it in preoperative evaluation. We present a novel DWI connectome (DWIC) approach to predict the presence of CE in 24 drug-resistant epilepsy (DRE) patients with a left-hemispheric focus and 29 young healthy controls. Psychometry-driven DWIC analysis was applied to create verbal and non-verbal modular networks. Local efficiency (LE) was assessed at individual regions of the two networks and its Z-score was compared to predict the presence of CE. Compared with a traditional organization (TO) group, wherein verbal functions are adversely affected, while non-verbal functions are preserved, the CE group showed significantly higher Z-scores in verbal network and significantly lower Z-scores in non-verbal network, corresponding to network reorganization in CE. A larger number of antiseizure drugs was significantly associated with more decreased Z-score in the right non-verbal network of the CE group and left verbal network of the TO group. These findings hold great potential to identify DRE patients whose verbal/language skills may over time be preserved due to effective inter-hemispheric reorganization and identify those whose verbal/language impairments may persist due to lack of inter-hemispheric reorganization., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

This retrospective cohort study investigated 53 patients with drug-resistant focal epilepsy and identified factors predictive of long-term satisfaction of patients and families following extraoperative intracranial EEG (iEEG) recording. The mixed model analysis assessed the utility of intracranial EEG (iEEG) predictor variables, including the seizure-onset zone (SOZ), modulation index (MI), and naming-related high-gamma activity. Modulation index, quantifying the coupling between high-frequency activity at >80 Hz and local slow wave at 3-4 Hz, effectively functions as a surrogate marker of the burden of interictal spike-and-slow-wave discharges. The mixed model specifically incorporated 'subtraction-MI', defined as the subtraction of mean z-score normalized MI across all preserved sites from that across all resected sites. Auditory naming-related high-gamma activity at 70-110 Hz is a biomarker to characterize the underlying language and speech function. The model incorporated 'maximum resected high-gamma', defined as the high-gamma percent change largest among sites included in the resected language-dominant hemispheric region. The model also incorporated the clinical and imaging profiles of given patients. The analysis revealed that complete removal of SOZ (p = 0.003) and younger patient age (p = 0.040) were independently associated with greater satisfaction. Neither 'subtraction-MI' nor 'maximum naming-related high-gamma' showed a significant and independent association with long-term satisfaction in our patient cohort. The observed impact of complete resection of SOZ and early surgery can be considered when counseling candidates for epilepsy surgery., Competing Interests: Declaration of Competing Interest None of the authors has any conflict of interest to disclose. We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Purpose: Focal epilepsy is a risk factor for language impairment in children. We investigated whether the current state-of-the-art deep learning network on diffusion tractography connectome can accurately predict expressive and receptive language scores of children with epilepsy., Methods: We studied 37 children with a diagnosis of drug-resistant focal epilepsy (age: 11.8 ± 3.1 years) using 3 T MRI and diffusion tractography connectome: G = (S, Ω), where S is an adjacency matrix of edges representing the connectivity strength (number of white-matter tract streamlines) between each pair of brain regions, and Ω reflects a set of brain regions. A convolutional neural network (CNN) was trained to learn the nonlinear relationship between 'S (input)' and 'language score (output)'. Repeated hold-out validation was then employed to measure the Pearson correlation and mean absolute error (MAE) between CNN-predicted and actual language scores., Results: We found that CNN-predicted and actual scores were significantly correlated (i.e., Pearson's R/p-value: 0.82/<0.001 and 0.75/<0.001), yielding MAE: 7.77 and 7.40 for expressive and receptive scores, respectively. Specifically, sparse connectivity not only within the left cortico-cortical network but also involving the right subcortical structures was predictive of language impairment of expressive or receptive domain. Subsequent subgroup analyses inferred that the effectiveness of diffusion tractography-based prediction of language outcome was independent of clinical variables. Intrinsic diffusion tractography connectome properties may be useful for predicting the severity of baseline language dysfunction and possibly provide a better understanding of the biological mechanisms of epilepsy-related language impairment in children., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Interictal spike activity arising from an epileptic focus may cause transient subclinical changes in language function. We retrospectively studied four patients with a seizure focus of the left frontal lobe who underwent language mapping via electrocorticography. In three patients, we could group language task trials into 'spike' and 'non-spike' trials, based upon occurrence of spikes arising from the seizure onset zone during presentation of question stimuli. In one patient, we demonstrated a reduction in language-related gamma activity (80-100Hz) at one dorsal superior frontal site outside the seizure onset zone; reduction in mean peak amplitude of 58.4% of baseline reference (95% C.I.: 31.6% to 85.1%). This site was located near the seizure onset zone and was associated with the greatest spike rate among sites of similar function. This is the first preliminary study to show an effect of interictal spikes upon language-related gamma activity of the lateral frontal lobe., (Copyright © 2012 Elsevier Inc. All rights reserved.)

In 1954, Penfield and Jasper briefly described that percepts of unpleasant odor were elicited by intraoperative electrical stimulation of the olfactory bulb in patients with epilepsy. Since then, few peer-reviewed studies have reported such phenomena elicited by stimulation mapping via subdural electrodes implanted on the ventral surface of the frontal lobe. Here, we determined what types of olfactory hallucinations could be reproduced by such stimulation in children with focal epilepsy. This study included 16 children (age range: 5 to 17 years) who underwent implantation of subdural electrodes to localize the presumed epileptogenic zone and eloquent areas. Pairs of electrodes were electrically stimulated, and clinical responses were observed. In case a patient reported a perception, she/he was asked to describe its nature. We also described the stimulus parameters to elicit a given symptom. Eleven patients reported a perception of smell in response to electrical stimulation while the remaining five did not. Nine patients perceived an unpleasant smell (like bitterness, smoke, or garbage) while two perceived a pleasant smell (like strawberry or good food). Such olfactory hallucinations were induced by stimulation proximal to the olfactory bulb or tract on either hemisphere but not by that of orbitofrontal gyri lateral to the medial orbital sulci. The range of stimulus parameters employed to elicit olfactory hallucinations was comparable to those for other sensorimotor symptoms. Our systematic study of children with epilepsy replicated stimulation-induced olfactory hallucinations. We failed to provide evidence that a positive olfactory perception could be elicited by conventional stimulation of secondary olfactory cortex alone., (Copyright © 2012 Elsevier Inc. All rights reserved.)

We determined the spatio-temporal dynamics of intracranially-recorded gamma-oscillations modulated by spontaneous cooing and babbling, which are considered to embody pre-linguistic language behaviors during infancy. Electrocorticographic (ECoG) signals were recorded from 110 cortical sites in the right hemisphere of a 10-month-old girl with focal epilepsy. Electrocorticographic signals were time-locked to the onset of cooing or babbling. The amplitudes of gamma-oscillations during vocalizations were compared to those during preceding silent reference periods. Cooing and babbling elicited significant gamma-augmentation at 30-100 Hz at distinct sites of the inferior Rolandic region, whereas both forms of vocalizations elicited gamma-augmentation at an identical superior temporal site. The spatial, temporal and spectral characteristics of gamma-augmentation elicited by cooing and babbling were similar to those elicited by phoneme vocalization in older children and adults. Differential activation within the right inferior Rolandic region during cooing and babbling may reflect the mechanical or developmental difference between these two forms of vocalizations. The right superior temporal gyrus may participate in an auditory feedback system during vocalization., (Copyright © 2012 Elsevier Inc. All rights reserved.)

We determined how visuomotor tasks modulated gamma-oscillations on electrocorticography in epileptic patients who underwent epilepsy surgery. Each visual-cue consisted of either a sentence or hand gesture instructing the subject to press or not to press the button. Regardless of the recorded hemisphere, viewing sentence and gesture cues elicited gamma-augmentation sequentially in the lateral-polar occipital and inferior occipital-temporal areas; subsequently, button-press movement elicited gamma-augmentation in the Rolandic area. The magnitudes of gamma-augmentation in the Rolandic and inferior occipital-temporal areas were larger when the hand contralateral to the recorded hemisphere was used for motor responses. A double dissociation was found in the left inferior occipital-temporal cortex in one subject; the lateral portion had greater gamma-augmentation elicited by a sentence-cue, whereas the medial portion had greater gamma-augmentation elicited by a gesture-cue. The present study has increased our understanding of the physiology of the human visuomotor system., (Copyright 2010 Elsevier Inc. All rights reserved.)

Recent studies have suggested that cortical activation can be measured using event-related augmentation of gamma oscillations in humans. We determined how commonly and differentially gamma oscillations (50-150Hz) were modulated by three distinct word-association tasks during extraoperative electrocorticography monitoring in a patient with focal epilepsy who underwent epilepsy surgery. He was auditorily presented names of common foods (e.g., apple) during each task. He was instructed to overtly verbalize the color (e.g., red) of each given food during the first association task, the taste (e.g., sweet) during the second task, and the texture (e.g., crunchy) during the third task. All three word-association tasks commonly elicited significant augmentation of gamma oscillations in the superior temporal gyrus, the middle temporal gyrus, and the inferior frontal gyrus, as well as the pre- and postcentral gyri. The food-texture association task specifically elicited significant gamma augmentation in the supramarginal gyrus. This preliminary study generated the hypothesis that word-association tasks may supplement functional language mapping using electrical stimulation. Differential gamma augmentation in the supramarginal gyrus might be attributed to a larger workload required in the food-texture association task compared with the remaining two tasks., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)

A 7-year-old girl presented with a cluster of seizures occurring in one day and followed by the development of paranoid delusions. Her electroencephalogram (EEG) revealed a psychomotor variant. Cranial MRI was normal, but the 2-deoxy-2-[(18)F]fluoro-D-glucose (FDG) positron emission tomography (PET) scan showed hypometabolism in the left inferior frontal cortex. Her psychotic symptoms occurred episodically. Three years later, she developed hypermotor seizures associated with a fearful look. Video/EEG monitoring captured seizures of left frontotemporal onset. Her seizures became drug resistant and she underwent epilepsy surgery. Intracranial electrocorticography captured spontaneous and electrically induced seizures with onset in the left inferior frontal region, which was resected. She became seizure-free and her psychosis resolved. This case illustrates that frontal lobe epilepsy can present solely with psychotic symptoms, which may delay the diagnosis of epilepsy. We suggest that these cases may be underdiagnosed. When epilepsy is suspected and if MRI fails to demonstrate an abnormality, FDG PET scanning and video/EEG monitoring should be considered.