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Structural and functional mechanisms of reorganization for language compensation in patients with diffuse low grade gliomas in the left hemisphere
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Poster D10 in Poster Session D, Wednesday, October 25, 4:45 - 6:30 pm CEST, Espace Vieux-Port
Lucía Manso-Ortega1, Santiago Gil-Robles3,4,5, Iñigo Pomposo4,5, Garazi Bermudez4,5, Lucía Amoruso1,6, Manuel Carreiras1,2,6, Ileana Quiñones1; 1Basque Center on Cognition, Brain and Language (BCBL), 2University of the Basque Country (UPV/EHU), 3Universitary Hospital Quironsalud Madrid, 4Biocruces Research Institute, 5Universitary Hospital Cruces, 6IKERBASQUE. Basque foundation for science
Diffuse low grade gliomas (DLGGs) within the left hemisphere can significantly disrupt language functions. Emerging research suggests that the brain may have the ability to compensate for some of the loss of language function through neural plasticity. However, there is a lack of studies exploring structural and functional mechanisms of plasticity in the same sample of patients from a longitudinal approach. This study aims to fill this gap by investigating structural and functional plastic changes before and after surgery in a cohort of 15 patients with left DLGGs. Our goal is to track changes in the structural and functional dynamic of the language network in order to cope with the lesion and maintain language functions. First, to account for cognitive state and the optimal behavioral performance after surgery, patients completed cognitive evaluations both before and after surgery, encompassing assessments of general cognitive state (MMSE), intelligence measures (KBIT) and language ability (BEST). Then, to evaluate changes in structural plasticity, we measured grey matter volume before and after the surgical intervention through voxel-based morphometry analysis (VBM) on high-resolution MRI T1-weighted images. As per functional changes, we estimated the BOLD response associated with language production during a picture naming task (MULTIMAP) that included objects and verbs. To specifically disentangle longitudinal effects related to language processing, we focused our analysis in 10 brain regions known to subserve language production and comprehension: pars orbitalis, pars opercularis, pars triangularis, middle frontal gyrus, middle temporal gyrus, middle part of the temporal pole, superior temporal gyrus, superior temporal lobe, supramarginal gyrus, angular gyrus. For this spatial constraint, we parcellated the brain following the automatic labeling atlas (AAL). Behaviorally, we observed no differences within patients after comparing cognitive performance pre and post surgery. Patients demonstrate intact neurological and behavioral functioning in the post-surgical stage. This persistent behavioral pattern after the surgical intervention provides evidence of language compensation mechanisms after resection. Structurally, we found that volume decreased in areas located throughout the brain, including ipsilesional and contralesional areas. Moreover, activation patterns seem to be dependent on the lesion location. Despite differences across patients, longitudinal contrasts (post- vs. pre- surgery) as tested in individual GLM analysis showed a spread of activation including the recruitment of perilesional, ipsilesional, and contralesional areas. Overall, we find both structural and functional evidence of reorganization in order to cope with the lesion that enables patients to maintain language function. These results provide valuable insights into the compensatory mechanisms for language impairment in patients with left DLGGs. A deeper understanding would allow us to respect the structural and functional changes that are emerging to sustain cognitive abilities during treatment and the surgical intervention, resulting in a better prognosis for these patients.
Topic Areas: Language Production,