Regular articleThe role of dominant premotor cortex in language: a study using intraoperative functional mapping in awake patients
Introduction
The human premotor cortex (PMC) was delineated by Fulton (Fulton, 1935) as the frontal agranular cortex (area 6) rostral to the primary motor cortex (area 4). This structure was divided into two subregions (Freund, 1996):
the ventral PMC, i.e., the ventral compartment of area 6 (area 6aα) (Vogt and Vogt, 1919) covering the anterior part of the precentral gyrus;
the dorsal PMC, i.e., the dorsal part of area 6 (area 6aβ) (Vogt and Vogt, 1919), covering the posterior part of the superior and middle frontal gyri, in front of the precentral sulcus.
Although many lesion Freund and Hummelsheim 1985, Halsband and Freund 1990, stimulation Foerster 1936, Lüders et al 1995, and functional neuroimaging Colebatch et al 1991, Deiber et al 1991, Seitz and Roland 1992 human studies allowed better clarification of the implication of the PMC in motor function, the participation of this area in language remains poorly understood. Some authors nevertheless advocated the involvement of dominant PMC in writing and reading Dehaene et al 2001, Exner 1881, Ritaccio et al 1992 and in speech production Alexander et al 1989, Cohen et al 1993, Fox et al 2001, Luria 1966. Moreover, recent works using positron emission tomography (PET) or fMRI found PMC activation during naming Chao and Martin 2000, Grabowski et al 1998, Grafton et al 1997, Martin et al 1996 and speech (Wise et al., 1999).
The present work reports a series of 25 patients harboring a cerebral low-grade glioma near or within the left dominant PMC, operated on under local anesthesia with intraoperative sensorimotor and language mappings using electrical stimulations. On the basis of the functional findings collected during surgery, the role of the left PMC in language is discussed and the therapeutic implications are considered.
Section snippets
Subjects
Among a series of 200 patients operated on for a brain lesion in functional areas in our institution between November 1996 and April 2002, 25 right-handed patients harboring a low-grade glioma located near or within the left dominant PMC were studied. Speech functions were evaluated clinically by neurologist/speech therapist, testing verbal comprehension, spontaneous speech, naming (80 pictures), verbal fluency, narrative tasks, and repetition (20 words, plus items in loop the more quickly
Results
The clinical, radiological, and surgical characteristics of the 25 patients are summarized in Table 1.
Discussion
In 1881, Exner (Exner, 1881) postulated the existence of an area controlling handwriting at the foot of the second frontal convolution and therefore immediately above Broca’s speech area: this is the first report which suggested the role of the PMC in language. Since this description of agraphia in association with lesions of the PMC, other lesional studies showed the likely implication of this region in different components of language. Indeed, Anderson et al. (Anderson et al., 1990) described
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