Title Prilog metodologiji prepoznavanja neurofizioloških biljega u mišićima grkljana izazvanih transkranijalnom magnetskom stimulacijom (TMS) motoričkih područja kore mozga za govor
Title (english) Contribution to the methodology of identification of neurophysiological markers in laryngeal muscles elicited by transcranial magnetic stimulation (TMS) of motor speech related cortical areas
Author Maja Rogić Vidaković
Mentor Vedran Deletis (mentor)
Committee member Zoran Đogaš (predsjednik povjerenstva)
Committee member Željko Dujić (član povjerenstva)
Committee member Darko Chudy (član povjerenstva)
Granter University of Split School of Medicine Split
Defense date and country 2012, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Basic Medical Sciences Neuroscience
Universal decimal classification (UDC ) 61 - Medical sciences
Abstract Uvod/problematika
Cilj ovog istraživanja je prepoznavanje neurofizioloških biljega u mišićima grkljana zdravih
ispitanika izazvanih navigacijskom transkranijalnom magnetskom stimulacijom (nTMS)
motoričkih područja kore mozga za govor, operkularnog dijela Brocine regije (op Broca) i
primarne motoričke regija (M1) za mišiće grkljana.
Specifični ciljevi bili su:
a) odrediti neurofiziološke parametre stimulacije i registracije odgovora kratke latencije
(OKL) u mišiću grkljana nakon nTMS primarne motoričke regije (M1) za mišiće grkljana
dominantne hemisfere,
b) odrediti neurofiziološke parametre stimulacije i registracije odgovora duge latencije (ODL)
u mišiću grkljana nakon nTMS op Brocine regije dominantne hemisfere,
c) izazivati pseudo prekid govora stimulacijom M1 za mišiće grkljana čijom stimulacijom je
prethodno izazvan OKL u mišiću grkljana, i
d) izazivati prekid govora stimulacijom op Brocine regije čijom stimulacijom je prethodno
izazvan ODL u mišiću grkljana.
Metodologija i rezultati
a) Kod svih 19 ispitanika stimuliran je M1 za mišiće grkljana te je registriran OKL u mišiću
grkljana s dvije aplicirane metodologije. Kod 11 ispitanika koristili smo metodologiju nTMS
s jednim stimulusom tijekom facilitacije (vokalizacija). Rezultati parametara stimulacije za
izazivanje OKL u mišiću grkljana su: intenzitet stimulacije 45.64±17.68 % maksimalnog
izlaza stimulatora i jakost električnog polja (EF) 99.91±23.58 V/m, a rezultati parametara
registriranog OKL u mišiću grkljana su: latencija OKL 11.90±1.27 ms i amplituda OKL
0.20±0.17 mV. Kod drugih 8 ispitanika i 2 ispitanika kod kojih je aplicirana prethodna
metodologija, koristili smo i novu metodologiju stimulacije kratkom serijom stimulusa
tijekom imenovanja vizualno prezentiranih objekata (VPO). Rezultati su pokazali
nepostojanje statistički značajnih razlika između dvije korištene metodologije.
b) Pomicanjem mjesta stimulacije ispred lokalizacije M1 za mišiće grkljana prema op dijelu
Brocine regije donjeg dijela frontalne vijuge izazvani su ODL u mišiću grkljana kod svih 10
zdravih ispitanika kod kojih smo koristili novu metodologiju stimulacije kratkom serijom
stimulusa tijekom imenovanja VPO. Parametri stimulacije za izazivanje ODL u mišiću
grkljana su: intenzitet stimulacije 36.34±4.94 % maksimalnog izlaza stimulatora i jakost
električnog polja (EF) 57.68±10.58 V/m, a latencija registriranog odgovora je 58.50±5.90 ms.
Osim parametra latencije ODL, mjereno je vrijeme u kojem se on izazivao u odnosu na
početak prikazivanja VPO. Rezultati su pokazali da nije bilo statistički značajne povezanosti
latencije ODL i razlike vremena početka pojavljivanja ODL i latencije imenovanja mjereno
prvom pojavom mikrofonskog odziva.
c) Kod svih 10 ispitanika kod kojih je stimuliran M1 za mišiće grkljana i izazvan OKL, ista
kortikalna lokalizacija je ponovno stimulirana serijom stimulusa te se izazivao pseudo prekid
govora kod zadatka brojenja i imenovanja VPO. Pseudo prekid govora je bio praćen
kontrakcijama mišića lica i usana.
d) Kod 10 ispitanika kod kojih je stimuliran op Brocine regije i izazvan ODL u mišiću
grkljana, ista kortikalna stimulacija je ponovno stimulirana serijom stimulusa te se kod jedne ispitanice izazvao pravi prekid govora kod zadatka brojenja i zadatka imenovanja VPO, a kod
tri ispitanika kvalitativni poremećaji govora (jezične naravi).
Zaključak
Po prvi puta su dobiveni neurofiziološki biljezi motoričkih područja kore mozga za govor
upotrebom nTMS: a) neurofiziološki biljeg M1 za mišiće grkljana je OKL registriran u mišiću
grkljana i b) neurofiziološki biljeg op Brocine regije je ODL također registriran u mišiću
grkljana.
Značaj
Razvijena je metodologija registracije neurofizioloških biljega u mišićima grkljana izazvanih
nTMS motoričkih područja kore mozga kod zdravih ispitanika. Ova metodologija je prilog
intraoperacijskoj metodologiji direktne i transkranijalne električne stimulacije u cilju
izazivanja odgovora u mišićima grkljana. Za očekivati je primjena ove metodologije u
preoperacijskom mapiranju motoričkih područja kore mozga za govor. Metodologija će
olakšati planiranje i izvođenje neurokirurških operacija u cilju očuvanja motoričkih područja
kore mozga za govor i sprečavanju postoperacijskih deficita u govoru. Rezultati ove studije su
doprinos temeljnom razumijevanju kognitivnih mehanizama odgovornih za obradu i
produkciju govora.
Abstract (english) Introduction and Background
The objective of this study is to identify neurophysiological markers generated in laryngeal
muscles by navigated transcranial magnetic stimulation (nTMS) of motor speech related
cortical areas, opercular part of Broca's region and primary motor region (M1) for laryngeal
muscles in healthy subjects.
The specific objectives were:
a) to determine the neurophysiological parameters of stimulation and registration of short
latency response (SLR) in the laryngeal muscle after nTMS of primary motor region (M1) for
the laryngeal muscles of the dominant hemisphere,
b) to determine the neurophysiological parameters of stimulation and registration of the long
latency response (LLR) in the laryngeal muscle after nTMS of opercular part of Broca’s
region of the dominant hemisphere,
c) to induce a pseudo speech arrest during stimulation of M1 for laryngeal muscle whose
stimulation has previously generated SLR in CTHY muscle, and
d) to induce speech arrest during stimulation of opercular part of Broca’s region whose
stimulation has previously generated the LLR in CTHY muscle.
Methodology and Results
a) In all 19 healthy subjects short latency response (SLR) was recorded from laryngeal muscle
by stimulation of M1 for laryngeal muscles with two applied methodologies (single stimulus
and train of stimuli). In 11 patients we used the nTMS methodology with single stimulus
during facilitation task (vocalization). The results of parameters of stimulation of SLR in
laryngeal muscle: stimulation intensity 45.64 ± 17.68% of the maximum stimulator output
and the intensity of the electric filed (EF) 23:58 ± 99.91 V / m, and the results of the
parameters of registration of SLR in laryngeal muscle: latency of SLR 11.90 ± 1.27 ms and
amplitude of SLR 0:20 ± 0.17 mV. In the other 8 subjects and 2 subjects who had applied the
previous methodology, we used a new methodology of train of stimuli during visual object
naming task (VON). Results showed no significant differences between two used
methodologies.
b) Moving the site of stimulation in front of the localization of M1 for laryngeal muscles
toward Broca’s region of inferior frontal gyrus, LLR was recorded in laryngeal muscle in all
10 healthy subjects in whom we used a new methodology of train of stimuli during VON. The
parameters of stimulation for eliciting LLR in laryngeal muscle were: stimulation intensity of
36.34 ± 4.94% of maximum stimulator output, the intensity of the electric field (EF) of 10:58
± 57.68 V / m. The latency of LLR in laryngeal muscle was 58.50 ± 5.90 ms. In addition to
the latency of LLR, we have measured the time in which LLR was induced in relation to the
beginning of visually presented object. The results showed that there was no statistically
significant difference in latency of LLR between the time difference in which LLR was
induced and naming latency of VPO measured with the first appearance of the microphone
onset.
c) In all 10 subjects in whom M1 for laryngeal muscles was stimulated generating SLR in
laryngeal muscle, the same location was again stimulated with a train of stimuli inducing the
pseudo speech arrest during counting task and naming of VPO. Pseudo speech arrest was
characterized by contractions of facial and lip muscles.
d) In 10 subjects in whom opercular part of Boca’s region was stimulated generating LLR in
laryngeal muscle, the same location was again stimulated with a train of stimuli inducing
speech arrest in one subject during counting task and naming of VPO. In three subjects
qualitative language disturbances were induced.
Conclusion
For the first time neurophysiologic markers of motor speech related cortical areas are
identified by names: a) neurophysiologic marker for M1 for laryngeal muscle is SLR recorded
in laryngeal muscle, and b) neurophysiologic marker for the opercular part of the Boca’s
region is LLR recorded in laryngeal muscle.
Significance
The methodology was developed for identification of neurophysiologic markers of motor
speech related cortical areas by names in healthy volunteers. This methodology is a direct
contribution to the methodology of intraoperative direct and transcranial electrical stimulation
for eliciting responses from laryngeal muscles.
It is expected that this methodology will be used in preoperative mapping of motor speech
related cortical areas to facilitate surgical planning, and mapping of motor speech related
cortical areas during neurosurgical operations, in order to preserve these areas from injuries
and to prevent postoperative speech deficits. The results of this study will contribute to our
understanding of the underlying cognitive mechanisms responsible for the processing and
production of speech.
Keywords
mapiranje mozga
transkranijalna magnetska stimulacija
grkljan
frontalni režanj
Keywords (english)
Brain Mapping
Transcranial Magnetic Stimulation
Larynx
Frontal Lobe
Language croatian
URN:NBN urn:nbn:hr:171:730173
Study programme Title: Obtaining a doctorate of science outside of doctoral studies Study programme type: university Study level: postgraduate Academic / professional title: doktor/doktorica znanosti (doktor/doktorica znanosti)
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Created on 2024-04-10 13:34:52