Search

Objective To investigate the functional connectivity of the hypothalamus in chronic migraine compared to interictal episodic migraine in order to improve our understanding of migraine chronification. Methods Using task-free fMRI and ROI-to-ROI analysis, we compared anterior hypothalamus intrinsic connectivity with the spinal trigeminal nucleus in patients with chronic migraine (n = 25) to age- and sex-matched patients with episodic migraine in the interictal phase (n = 22). We also conducted a seed-to-voxel analysis with anterior hypothalamus as a seed. Results All patients with chronic migraine had medication overuse. We found a significant connectivity (T = 2.08, p = 0.024) between anterior hypothalamus and spinal trigeminal nucleus in the chronic group, whereas these two regions were not connected in the episodic group. The strength of connectivity was not correlated with pain intensity (rho: 0.09, p = 0.655). In the seed-to-voxel analysis, three regions were more connected with the anterior hypothalamus in the chronic group: The spinal trigeminal nuclei (MNI coordinate x = 2, y = −44, z = −62), the right dorsal anterior insula (MNI coordinate x = 10, y = 10, z = 18), and the right caudate (MNI coordinate x = 12, y = 28, z = 6). However, these correlations were no longer significant after whole brain FWE correction. Conclusion An increased functional connectivity between the anterior hypothalamus and the spinal trigeminal nucleus, as previously reported in preictal episodic migraine, was demonstrated in chronic migraine with medication overuse. This finding confirms a major role of the anterior hypothalamus in migraine and suggests that chronic migraineurs are locked in the preictal phase.

BACKGROUND AND OBJECTIVES: Patients with Prader–Willi syndrome (PWS) display poor feeding and social skills as infants and fewer hypothalamic oxytocin (OXT)-producing neurons were documented in adults. Animal data demonstrated that early treatment with OXT restores sucking after birth. Our aim is to reproduce these data in infants with PWS. METHODS: We conducted a phase 2 escalating dose study of a short course (7 days) of intranasal OXT administration. We enrolled 18 infants with PWS under 6 months old (6 infants in each step) who received 4 IU of OXT either every other day, daily, or twice daily. We investigated the tolerance and the effects on feeding and social skills and changes in circulating ghrelin and brain connectivity by functional MRI. RESULTS: No adverse events were reported. No dose effect was observed. Sucking assessed by the Neonatal Oral-Motor Scale was abnormal in all infants at baseline and normalized in 88% after treatment. The scores of Neonatal Oral-Motor Scale and videofluoroscopy of swallowing significantly decreased from 16 to 9 (P < .001) and from 18 to 12.5 (P < .001), respectively. Significant improvements in Clinical Global Impression scale scores, social withdrawal behavior, and mother–infant interactions were observed. We documented a significant increase in acylated ghrelin and connectivity of the right superior orbitofrontal network that correlated with changes in sucking and behavior. CONCLUSIONS: OXT is well tolerated in infants with PWS and improves feeding and social skills. These results open perspectives for early treatment in neurodevelopment diseases with feeding problems.

International audience; Objectives: To determine the optimal CBCT settings for an automatic edge-detection-based endodontic segmentation procedure by assessing the accuracy of the root canal measurements. Methods: 12 intact teeth with closed apexes were cut perpendicular to the root axis, at predetermined levels to the reference plane (the first section made before acquisition). Acquisitions of each specimen were performed with Kodak 9000 ® 3D (76 mm, 14 bits; Kodak Carestream Health, Trophy, France) by using different combinations of milliamperes and kilovolts. Three-dimensional images were displayed and root canals were segmented with the MeVisLab software (edge-detection-based method; MeVis Research, Bremen, Germany). Histological root canal sections were then digitized with a 0.5-to 1.0-mm resolution and compared with equivalent two-dimensional cone-beam reconstructions for each pair of settings using the Pearson correlation coefficient, regression analysis and Bland–Altman method for the canal area and Feret's diameter. After a ranking process, a Wilcoxon paired test was carried out to compare the pair of settings. Results: The best pair of acquisition settings was 3.2 mA/60 kV. Significant differences were found between 3.2 mA/60 kV and other settings (p , 0.05) for the root canal area and for Feret's diameter. Conclusions: The quantitative analyses of the root canal system with the edge-detection-based method could depend on acquisition parameters. Improvements in segmentation still need to be carried out to ensure the quality of the reconstructions when we have to deal with closer outlines and because of the low spatial resolution. Cite this article as: Michetti J, Georgelin-Gurgel M, Mallet J-P, Diemer F, Boulanouar K. Influence of CBCT parameters on the output of an automatic edge-detection-based endodontic segmentation.

Functional magnetic resonance imaging (fMRI) using paced auditory serial addition test (PASAT) as paradigm was used to study the functional connectivity in 18 patients at the very early stage of multiple sclerosis (MS) compared with 18 controls, to determine the existence of circuitry disturbance inside the working memory network and its relationship with white matter abnormalities assessed by conventional MRI and magnetization transfer ratio (MTR) imaging. The left BA 45/46 was selected as the seed region to compute correlation maps with other brain regions. After obtaining the correlation map for each subject, between-group comparisons were performed using random effect procedure. Compared with controls, patients did not show any greater functional connectivity between left BA 45/46 and other regions during PASAT. In contrast, decrease in functional connectivity was observed in patients between left BA 45/46 and left BA 9, right BA 3, and the anterior cingulate cortex (BA 24). In patients, no correlations were found between altered functional connectivity and clinical data. However, functional connectivity observed between left BA 45/46 and BA 24 in patients was correlated with the MTR of normal appearing white matter, and with brain T2 lesion load. Altered functional connectivity is present inside the working memory network of patients at the very early stage of MS and is related to the extent of diffuse white matter changes.

OBJECTIVE: The aim of this study was to analyze the usefulness of preoperative language lunctional magnetic resonance imaging (IMRI), by correlating (MR) data with intraoperative cortical stimulation results for patients with brain tumors. METHODS: Naming and verb generation tasks were used, separately or in combination, for 14 right-handed patients with tumors in the left hemisphere, (MR) data obtained were analyzed with SPM soitware, with two standact analysis thresholds (P < 0.005 and then P < 0.05). The (MR) data were then registered in a frameless stereotactic neuronavigational device and correlated with direct brain mapping results. We used a statistical model with the (MR) information as a predictor, spatially correlating each intraoperatively mapped cortical site with (MR) data integrated in the neuronavigational system (site-by-site correlation). Fight patients were also studied with language (MR) postoperatively, with the same acquisition protocol. RESULTS: We observed high variability in signal extents and locations among patients with both tasks The activated arcas were located mainly in the left hemisphere in the middle and inferior frontal gyri (F2 and F3), the superior and middle temporal gyri (T1 and T2), and the supramarginal and angular gyri. A total of 426 cortical sites were tested for each task among the 14 patients. In frontal and temporoparietal areas, poor sensitivity of the (MR) technique was observed for the naming and verts generation takss (22 and 36%, respectively) with P < 0.005 as the analysis threshold. Although not perfect, the specificity of the (MR) technique was good in all conditions (97% for the naming task and 98% for the verb generation task). Better correlation (sensitivity, 59%; specificity, 97%) was achieved by combining the two (MR) tasks. Variation of the analysis threshold to P < 0.05 increased the sensitivity to 66% while decreasing the speciticity to 91 %. Postoperative (MR) data (for the cortical brain areas studied intraoperatively) werein accordance with brain mapping results for six of eight patients. Complete agreement between pre- and postoperative (MR) studies and direct brain mapping results was observed for only three of eight patients. CONCLUSION: With the paradigms and analysis thresholds used in this study, language (MR) data obtained with naming or verb generation tasks, before and after surgery, were imperfectly correlated with intraoperative brain mapping results. A better correlation could be obtained by combining the (MR) tasks. The overall results of this study demonstrated that language (MR) could not be used to make critical surgical decisions in the absence of direct brain mapping. Other acquisition protocols are required for evaluation of the potential role of language (MR) in the accurate detection of essential cortical language areas.

The aim of the current study was to assess the reproducibility of functional magnetic resonance imaging (fMRI) brain activation signals in a sensorimotor task in healthy subjects. Because random or systematic changes are likely to happen when movements are repeated over time, the authors searched for time-dependent changes in the fMRI signal intensity and the extent of activation within and between sessions. Reproducibility was studied on a sensorimotor task called “the active task” that includes a motor output and a sensory feedback, and also on a sensory stimulation called “the passive task” that assessed the sensory input alone. The active task consisted of flexion and extension of the right hand. The subjects had performed it several times before fMRI scanning so that it was well learned. The passive task consisted of a calibrated passive flexion and extension of the right wrist. Tasks were 1 Hz-paced. The control state was rest. Subjects naïve to the MRI environment and non–MRI-naïve subjects were studied. Twelve MRI-naïve subjects underwent 3 fMRI sessions separated by 5 hours and 49 days, respectively. During MRI scanning, they performed the active task. Six MRI-naïve subjects underwent 2 fMRI sessions with the passive task 1 month apart. Three non–MRI-naïve subjects performed twice an active 2-Hz self-paced task. The data were analyzed with SPM96 software. For within-session comparison, for active or passive tasks, good reproducibility of fMRI signal activation was found within a session (intra-and interrun reproducibility) whether it was the first, second, or third session. Therefore, no within-session habituation was found with a passive or a well-learned active task. For between-session comparison, for MRI-naïve or non–MRI-naïve subjects, and with the active or the passive task, activation was increased in the contralateral premotor cortex and in ispsilateral anterior cerebellar cortex but was decreased in the primary sensorimotor cortex, parietal cortex, and posterior supplementary motor area at the second session. The lower cortical signal was characterized by reduced activated areas with no change in maximum peak intensity in most cases. Changes were partially reversed at the third session. Part of the test–retest effect may come from habituation of the MRI experiment context. Less attention and stress at the second and third sessions may be components of the inhibition of cortical activity. Because the changes became reversed, the authors suggest that, beyond the habituation process, a learning process occurred that had nothing to do with procedural learning, because the tasks were well learned or passive. A long-term memory representation of the sensorimotor task, not only with its characteristics (for example, amplitude, frequency) but also with its context (fMRI), can become integrated into the motor system along the sessions. Furthermore, the pattern observed in the fMRI signal changes might evoke a consolidation process.

OBJECTIVE—To support the hypothesis about the potential compensatory role of ipsilateral corticofugal pathways when the contralateral pathways are impaired by brain tumours. METHODS—Retrospective analysis was carried out on the results of functional MRI (fMRI) of a selected group of five paretic patients with Rolandic brain tumours who exhibited an abnormally high ipsilateral/contralateral ratio of activation—that is, movements of the paretic hand activated predominately the ipsilateral cortex. Brain activation was achieved with a flexion extension of the fingers. Statistical parametric activation was obtained using a t test and a threshold of p

Using functional MRI (fMRI), we have studied the changes induced by the performance of a complex sequential motor task in the cortical areas of six akinetic patients with Parkinson's disease and six normal subjects. Compared with the normal subjects, the patients with Parkinson's disease exhibited a relatively decreased fMRI signal in the rostral part of the supplementary motor area (SMA) and in the right dorsolateral prefrontal cortex, as previously shown in PET studies. Concomitantly, the same patients exhibited a significant bilateral relative increase in fMRI signal in the primary sensorimotor cortex, lateral premotor cortex, inferior parietal cortex, caudal part of the SMA and anterior cingulate cortex. These fMRI data confirm that the frontal hypoactivation observed in patients with Parkinson's disease is restricted to the rostral part of the SMA and to the dorsolateral prefrontal cortex. These results also show that, apart from the lateral premotor and parietal cortices, increased fMRI signals can be found in other cortical motor areas of these patients, including the posterior SMA, the anterior cingulate cortex and the primary sensorimotor cortices, which are then likely to participate in the same putative attempt by the dopamine-denervated brain to recruit parallel motor circuits in order to overcome the functional deficit of the striatocortical motor loops.

To address the question of the existence of a phonetic module for speech perception, event-related potentials were recorded using a 32 channel system in subjects performing a detection task where the target was the ambiguous, noise-like phoneme /f/ presented either among syllables (speech context) or among environmental sounds (non-speech context). Significant context effects were observed on the N2/P3 complex elicited by the target. In particular, a well localized N2b (250-280 ms) appeared at the left temporoparietal sites on the difference wave between contexts as the result of an enhanced negativity when the target was presented among non-speech stimuli. These findings suggest the involvement of the left temporoparietal region in autonomous, modular processes of speech perception.

The purpose of this prospective, double-blind study was to correlate motor functional MRI (fMRI) with cortical brain mapping by intraoperative stimulation using 3D reconstructed images of the surface of the brain, and to validate the spatial data of fMRI in patients with brain tumors.Fourteen patients with tumors of the rolandic region underwent functional MR mapping of the hand region and subsequently cortical mapping before tumor resection. Data obtained with fMRI and brain mapping were not known previously by the neurosurgeon and by the neuroradiologist, respectively (double-blind study).In each case, the results of direct cortical mapping matched those obtained with fMRI, both positively and negatively, although the extent of the functional activations was larger than the area required to elicit the corresponding movement during intraoperative brain mapping.fMRI can be used before surgery to assess motor functional area in patients with rolandic tumors. More studies are needed to validate during surgery the real extent of fMRI activations.

It is suggested that resting state networks reflecting correlated neural regional activities participate significantly in brain functioning. A fundamental issue is to understand how these networks interact and how their activities change during behavioral transitions. Our aim was to understand better with functional MRI connectivity how the brain switched from a “resting” to a movement-related state by exploring the transitory readiness state for an intended movement of the right hand. Our study does not address movement preparation occurring in a time scale of milliseconds before movement which has been widely studied but movement-readiness which can last longer. At rest, in the absence of overt goal-directed behavior, a “default-mode” network, whose main areas are the posterior cingulate cortex and precuneus (PCC/Pcu), shows high activity interpreted as day dreaming, free association, stream of consciousness, and inner rehearsal. We found that, during rest, the “default-mode” network and the sensorimotor network were not functionally correlated. During movement-readiness, the two networks were functionally correlated through an interaction between the PCC/Pcu and the medial superior parietal cortex in the upper precuneus. The complex PCC/Pcu has been shown to be involved in retrieval and/or setting up spatial attributes for motor imagery, and thus, would be a key region in the movement-readiness phase. It might functionally connect to the medial superior parietal cortex to initiate the movement programming through retrieval of suited movement parameters. The anterior cingulum, functionally correlated to the primary sensorimotor cortex during movement-readiness would have a motivational role or could generate predictions about the movement.

Neuroimaging studies of reading converge to suggest that linguistically elementary stimuli are confined to the activation of bilateral posterior regions, whereas linguistically complex stimuli additionally recruit left hemispheric anterior regions, raising the hypotheses of a gradual bilateral-to-left and a posterior-to-anterior recruitment of reading related areas. Here, we tested these two hypotheses by contrasting a repertoire of eight categories of stimuli ranging from simple orthographic-like characters to words and pseudowords in a single experiment, and by measuring BOLD signal changes and connectivity while 16 fluent readers passively viewed the stimuli. Our results confirm the existence of a bilateral-to-left and posterior-to-anterior recruitment of reading related areas, straightforwardly resulting from the increase in stimuli's linguistic processing load, which reflects reading processes: visual analysis, orthographic encoding and phonological decoding. Connectivity analyses strengthened the validity of these observations and additionally revealed an enhancement of the left parieto-frontal information trafficking for higher linguistic processing. Our findings clearly establish the notion of a gradual spatio-functional recruitment of reading areas and demonstrate, to the best of our knowledge, the first evidence of a robust and staged link between the level of linguistic processing, the spatial distribution of brain activity and its information trafficking.

fMRI and structural equation modeling (SEM) were used to study effective connectivity inside the working memory network in patients at the earliest stage of multiple sclerosis (MS), while performing paced auditory serial addition test (PASAT), a sensitive task to reveal subtle cognitive impairments related to working memory and information speed processing. The path model used for SEM included bilateral connections between left and right BA 46, left and right BA 40, left and right anterior cingulate cortex (ACC), left BA 44 and left BA 40, right BA 44 and right BA 40, and unidirectional ipsilateral connections from BA 46 to BA 44, from ACC to BA 46, and from ACC to BA 44. Experimental data from the two groups fit accurately the working memory model, in patients [chi20(2) = 13, P = 0.877] as well as in controls [chi20(2) = 13.54, P = 0.853]. The omnibus test indicated a significant difference of model fits in patients and in controls [chi40(2) = 160.07, P < 0.0001]. Connectivity strengths from right BA 46 to left BA 46, from left ACC to left BA 46 were lower in patients than in controls, and higher from right ACC to right BA 46, from left to right and from right to left ACC (stacked model). Effective connectivity inside the working memory network appears altered in patients at the earliest stage of MS. Modulation of effective connectivity is present in patients inside the executive subsystems of working memory, and could be related to adaptive cognitive control processes that may limit the clinical manifestation of MS.

Little is known about the neural counterparts of speech therapy in aphasic patients. An fMRI experiment was performed before and after a specific and intensive speech output therapy in RC, a patient with long-lasting speech output deficit following a left-sided ischemic lesion. Overt picture naming and picture/word rhyming were used as activation tasks in RC and 6 control subjects. The naming task concerned the output lexicon deficit to be rehabilitated while rhyming referred to preserved levels of processing and was used to control for repetition effect. The speech therapy program improved naming performance. By comparison to the pattern observed before therapy, the naming task after therapy induced a pattern of activation close to that observed in control subjects, involving left-sided language areas surrounding the lesion. Speech therapy effect was associated with activations in Broca's area and the left supra-marginal gyrus, which might reflect a therapy-induced phonological compensatory strategy for naming.

Since serotonin (5-HT) stimulates motor function, pharmacological potentiation of 5-HT neurotransmission may improve motor function in healthy subjects and, possibly, recovery in post-stroke patients. Indeed, fluoxetine, a selective serotonin reuptake inhibitor (SSRI), increased activation in executive motor areas of healthy subjects as fenozolone, a releaser of monoamines (including noradrenaline, dopamine, and serotonin) from intracellular stores. This study is intended to test the hypothesis that paroxetine can likewise modulate brain motor activity in a dose-dependent manner in healthy subjects. In a double-blind counterbalanced study, six subjects underwent functional MRI examinations on three sessions 1 week apart (E1, E2, and E3) at the time of peak plasma concentrations (5 h after drug intake, i.e., either 20 or 60 mg of paroxetine or placebo) with a complex sequential opposition task. Rest and activation alternated in a block design. During activation, subjects performed, with the right hand, a 1-Hz-paced task that alternated two fist closings with a sequential opposition task. Paroxetine elicited effects similar to those reported for fluoxetine; notable changes were hyperactivation in the contralateral S1/M1, and posterior SMA and widespread hypoactivation of basal ganglia and cerebellum. There was an inverse correlation between dose and effect: significantly greater effects were observed with the 20-mg dose compared with 60 mg. Paroxetine dose-dependently modulates activation of the entire motor pathway in a way that favors motor output. Thus, a single dose of the SSRI paroxetine reorganized motor processing.

Objective To try to correlate subjective photophobic symptoms with visual pathway modifications (from the retinal image to the visual cortex) after refractive surgery by exploring brain activation on photic stimulation. Design Noncomparative case series. Participants Four subjects reporting discomfort produced by luminance (glare, halos, starbursts, or a combination thereof) in one eye after laser in situ keratomileusis (LASIK) were enrolled. The contralateral myopic eye (control) had no visual impairment and had undergone LASIK without complications or had not had previous surgery. Methods Functional magnetic resonance imaging was performed during photic stimulation, delivered by an optical fiber, of the affected and unaffected eyes. Results Functional magnetic resonance imaging provided evidence that most subjective visual symptoms correlated with anatomic flap abnormalities are associated with a higher signal increase in the visual association cortices compared with a nonsymptomatic eye. Conclusions Functional magnetic resonance imaging of the visual cortex may help in exploring the mechanisms involved in glare effects after refractive surgery.

Event-related fMRI was used to investigate brain activation during a visual go/no-go categorization task based on colored photographs of natural scenes, similar to a previous ERP study by Thorpe et al. (1996, Nature 381: 520-522). Subjects had to press a key when an animal was present in the display. Stimuli were flashed for 33 ms using an intertrial interval of 5 s and a design that carefully balanced targets and distractors in a pseudo-random sequence. Activation produced by targets and distractors was compared with two different techniques, one based on correlations with the stimulation pattern, the other using simple t score statistics to compare selected scans. The contralateral primary motor cortex and the ipsilateral cerebellum were both more active following target trials than following distractors, thus confirming the sensitivity of the method. Differential activity was also seen in the posterior cingulate cortex, the fusiform, and the parahippocampic gyri. Activity in such structures could underlie the differential evoked-potentials reported previously in the same task. Surprisingly, in these visual structures, the signal was stronger following distractor trials than target ones. This result could be due to more prolonged processing on distractor trials. Alternatively, it could be that target detection induces strong activation of a small proportion of neurons, which, because of competitive inhibitory mechanisms, could result in a decrease in activity for the population as a whole. We suggest that this kind of mechanism could also account for the decreases in signal observed in perceptual priming experiments.

The indications for surgery of slow growing tumours like low grade astrocytomas in eloquent areas are difficult. The timing and the benefit/risk ratio of the surgery must be evaluated, taking into account the potential post operative deficit. The purpose of this study was: a) to validate the data obtained with functional MRI (FMRI) by direct cortical stimulation in patients who are candidate for surgery; b) to demonstrate the usefulness of FMRI coupled with cortical brain mapping and 3D reconstructions of the surfaces of the brain in low grade astrocytoma. FMRI of the hand-motor cortex was performed in 8 patients with low grade astrocytomas. They subsenquently underwent direct cortical mapping to correlate the results of FMRI and resective surgery sparing the functional area. In the 8 cases, the results of direct cortical mapping in the precentral region matched accurately those obtained from FMRI. When surgical resection of low grade astrocytoma in the motor areas is considered, FMRI used with intra-operative cortical mapping can help the surgeon to spare functional areas during tumour removal.

Using a habituation-recovery paradigm adapted to functional magnetic resonance imaging, we investigated the brain responses to syllables and tones in six right-handed male subjects. We opposed a standard condition (STD) in which the subjects were listening to homogeneous sequences of four identical stimuli, to a deviant condition (DEV) in which the fourth stimulus of the sequence differed in pitch or spectral content for tones and in the initial stop consonant for syllables. The corresponding runs alternated four rest periods with two STD and two DEV conditions. In addition to a marked rightward asymmetry in the primary and secondary auditory cortex for tones and a right inferior frontal activation for the tone condition where the deviant had increased spectral content, the experiment revealed differential activations in the left posterior superior temporal gyrus and in the left supramarginal gyrus. Activations within the left posterior superior temporal gyrus were observed for the DEV condition with tones and for the STD and DEV conditions with syllables. Activation within the inferior part of the left supramarginal gyrus was only observed for the DEV condition with syllables. The analysis of the decreases and increases in the BOLD signal across the STD, DEV, and rest conditions suggests that the left posterior superior temporal gyrus is implicated in the preattentive change detection of acoustic changes in speech as well as nonspeech stimuli, whereas the left supramarginal gyrus is more specifically engaged in the detection of changes in phonological units.

Activations in the temporal lobes previously observed using positron emission tomography and auditory stimuli were partially reproduced with functional MRI and echo-planar imaging at 1.5 T in six volunteers performing tone and phoneme monitoring tasks. Verbal processing compared to a tone recognition task significantly activated a cortical area located in the left anterior temporal region (P < 0.02).

In order to improve the performance of the instrumental variable method (IVM) in calculating regional cerebral blood flow (rCBF) using Single Photon Emission Computed Tomography (SPELT), and inert diffusible tracer such as 133Xe, we use Learning Algorithms for Multivariate Data Analysis (LAMDA) to classify the voxels of the images of local concentrations in the brain. The LAMDA method correctly distinguished between extra and intra-cerebral voxels. However the topography of the intra-cerebral classes did not match the Regions Of Interest (ROI) defined on an anatomical basis. Provided that all the intra-cerebral classes contaminated by bone and air passage artefact were rejected, the results given by the NM are in good agreement with those derived by the bolus distribution principle. We thus conclude that LAMDA methods can improve the reliability of images of CBF estimates.

To evaluate the capabilities and the limitations of motor functional magnetic resonance imaging (fMRI) in the presurgical evaluation of the cerebral tumors located in or near the motor homunculus. To correlate each type of activation with the histologic characteristics of each tumor.fMRI was performed in 17 patients (14 adults and 3 children), without any motor deficit, presenting with various intracerebral tumors. Three fMRI activation paradigms were used: contralateral to the lesion: ballistic opposition of the fingers, flexion-extension of the foot and click of the tongue. Four patients, without motor deficit, with cerebral tumors far from the motor homunculus were used as control group to look for nonspecific activations. In all cases, the histopathology of the tumor was known accurately.In 11 patients with infiltrating tumors, the activated areas were clearly displaced. They were often intratumoral and scattered in correlation with the degree of infiltration. Two patients with noninfiltrating tumors (meningioma) showed extratumoral shift of the activated areas. Four patients presenting cerebral tumors far from the homunculus motor did not show intratumoral activation. The supplementary motor area and the ipsilateral primary motor cortex were also reproducibly activated during the motor tasks. The task of the tongue was often artifacted, probably because of the head motion.These preliminary results suggest that the histopathologic characteristics of a tumor, and especially its microscopic structure, play a role in the organization of the motor functional area. In a small number of cases, fMRI could be used intraoperatively with a neuronavigation system.

Functional neuroimaging studies have suggested a specific role of the extrastriate cortex in letter string and visual word form processing. However, this region has been shown to be involved in object recognition and its specificity for the processing of linguistic stimuli may be questioned. The authors used an event-related functional magnetic resonance imaging design with category priming to record the response elicited by the passive viewing of single letters, geometric figures, and of the categorically ambiguous stimulus “O” that pertains to both sets of familiar symbols. Bilateral activations in the extrastriate cortex were found, with a left predominance particularly pronounced for the ambiguous stimulus. Individual analysis of spatial extent and signal intensity showed a priming × stimulus × hemisphere interaction. When primed by the congruous categoric set, a bilateral decrease in activation was observed for letters and geometric figures. The ambiguous stimulus behaved as a letter for the left hemisphere, with decreased activation when primed by letters, whereas in the right hemisphere, an adaptation effect occurred when primed by geometric figures. These priming effects suggest that, for the ambiguous stimulus, letter processing was systematically involved in the left extrastriate cortex. The current results support the existence of a neural substrate for the abstract category of letters.

Event-related haemodynamic responses (EHRs) were recorded in subjects performing phonological tasks to test whether distinguishable temporal involvement of corresponding neural components would show through. A sequence of activation leading from primary auditory cortices to premotor regions emerged in the fast repetition and the phoneme monitoring tasks used. EHRs peaked significantly earlier in Wernicke's area (phonological decoding) than in Broca's area, the left supramarginal gyrus and the precentral gyrus (phonological rehearsal). Moreover, the sensitivity of within cluster temporal gradients to the nature of the tasks indicated either sensory to association cortex synchronization for fast repetition or delayed analysis for phoneme monitoring. These results are consistent with previous findings on working memory and show that fMRI permits temporal tracking of cognitive activations.

We report the case of a 30-year-old man (S.B.) who developed visual agnosia following a meningoencephalitis at the age of 3 years. MRI disclosed extensive bilateral lesions of the occipital temporal visual pathway (ventral stream) and lesions in the right dorsal pathway, sparing primary visual cortices. S.B. showed a severe visual recognition deficit (texture, colour, objects, faces and words), although movement and space perception were largely preserved. His remaining visual capacities illustrate the competence of an isolated dorsal system which essentially functions on the sole basis of magnocellular afferents (low spatial resolution, high sensitivity to low contrast and moving stimuli). Patient S.B. also shows remarkable visuomotor competences, despite his perceptual limitations. It is suggested that his perceptual capacities correspond to the visual processing limitations of the dorsal visual stream, which in this patient have become accessible to perceptual awareness.

Cortical areas responsive to proprioceptive stimulation were assessed by ERP technique in normals and in selected patients with stroke and were compared to fMRI data. Repetitive extension of right and left forefinger elicited a P1/N1/P2 complex wave pattern. This pattern was absent in patient with complete sensory loss and present but spatially modified in patient with recovered sensory deficit. Source localization with a simple model showed three sources starting in the contralateral rolandic area (SI), then involving the inferior parietal lobe unilaterally and the supplementary motor area (10 to 134 ms). It was followed by a bilaterally distributed pattern of two sources located in the ipsilateral parietal region and in the contralateral insula. Right and left stimulation led to very symmetrical patterns. Comparison to fMRI obtained from passive extension of the wrist in normals showed very compatible data. We described in this paper, a sequential processing of proprioceptive inputs after passive movements involving primary and secondary sensory motor areas.