Probabilistic electrical stimulation mapping of human medial frontal cortex
Open accessAbstract
The medial frontal cortex remains functionally ill-understood; this is reflected by the heterogeneity of behavioural outcomes following damage to the region. We aim to use the rich information provided by extraoperative direct electrical cortical stimulation to enhance our understanding of its functional anatomy. Examining a cohort of 38 epilepsy patients undergoing direct electrical cortical stimulation in the context of presurgical evaluation, we reviewed stimulation findings and classified them in a behavioural framework (positive motor, negative motor, somatosensory, speech disturbances, and "other"). The spatially discrete cortical stimulation-derived data points were then transformed into continuous probabilistic maps, thereby enabling the voxel-wise spatial inference widely used in the analysis of functional and structural imaging data. A functional map of stimulation findings of the medial wall emerged. Positive motor responses occurred in 141 stimulations (31.2%), anatomically located on the paracentral lobule (threshold at p<.05), extending no further than the vertical anterior commissure (VCA) line. Thirty negative motor responses were observed (6.6%), localised to the VCA line (at p < .001 uncorrected). In 43 stimulations (9.5%) a somatosensory response localised to the caudal cingulate zone (at p < .001 uncorrected), with a second region posterior to central sulcus. Speech disturbances were elicited in 38 stimulations (8.4%), more commonly but not exclusively from the language fMRI dominant side, just anterior to VCA (p < .001 uncorrected). In only 2 stimulations, the patient experienced a subjective "urge" to move in the absence of overt movement. Classifying motor behaviour along the dimensions of effector, and movement vs arrest, we derive a wholly data-driven stimulation map of the medial wall, powered by the largest number of stimulations of the region reported (n = 452) in patients imaged with MRI. This model and the underlying data provide a robust framework for understanding the architecture of the region through the joint analysis of disruptive and correlative anatomical maps.
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A recent study showed only null results in sensory phenomenology in a large cohort of 36 patients in whom various medial PFC regions were stimulated.
“These findings corroborate those of a recent study showing only null results in sensory phenomenology in a large cohort of 36 patients in whom various medial PFC regions were stimulated (compare Trevisi et al., 2018, their Fig. 2).”
From Does the Prefrontal Cortex Play an Essential Role in Consciousness? Insights from Intracranial Electrical Stimulation of the Human Brain (2021) · cites this paper as Trevisi et al., 2018
The Results section ('Somatosensory responses'; page not provided) reports sensory experiences in 43 stimulations, including paraesthesias, pain, and warmth. Although 'No response' was the most common outcome, the study did not find only null results in sensory phenomenology. (LLM, conf=0.91)
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Experimental — accuracy not yet measuredRecent work across dozens of patients, from the authors' own group and others, indicates only null results in anteromedial prefrontal regions.
“We are not aware of any past research that reports iESinduced phenomenal changes in these regions (Selimbeyoglu and Parvizi, 2010), and recent work across dozens of patients, from both our own group (Fox et al., 2020) and others (Trevisi et al., 2018), indicates only null results in these areas.”
From Does the Prefrontal Cortex Play an Essential Role in Consciousness? Insights from Intracranial Electrical Stimulation of the Human Brain (2021) · cites this paper as Trevisi et al., 2018
The Results ('No response'; page unavailable) report that no response was the commonest outcome and covered an extensive area well anterior to the VCA. The study included 38 patients, but 'only null results' is too absolute: Results ('Other'; page unavailable) also report rare subjective experiences from stimulation deeply rostral to the VCA, while cautioning that their localisation is uncertain. (LLM, conf=0.88)
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- Authors
- Trevisi, G., Eickhoff, S. B., Chowdhury, F., Jha, A., Rodionov, R., Nowell, M., Miserocchi, A., McEvoy, A. W., Nachev, P., & Diehl, B.
- Affiliations
- Agostino Gemelli University Polyclinic (IT)
- Forschungszentrum Jülich (DE)
- National Hospital for Neurology and Neurosurgery (GB)
- UCL Queen Square Institute of Neurology (GB)
- Corresponding author
- Diehl, Beate
- ORCID
- Venue
- Cortex
- Publisher
- Elsevier BV
- Published
- 2018-12
- Volume
- 109
- Pages
- 336-346
- ISSN
- 0010-9452 (ISSN-L)
- PMC
- PMC6259584
- OpenAlex
- W2863528049
- Cited by
- 30
- References
- 30
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 5 · 2023: 4 · 2022: 6 · 2021: 6 · 2020: 4 · 2019: 2
- FWCI
- 2.04
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Cortex (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- JuSER (Forschungszentrum Jülich) (submittedVersion, cc-by)
- Funders
- Wolfson Foundation
- National Institutes of Health
- Horizon 2020 (7202070)
- National Institute of Mental Health (R01-MH074457)
- UCLH Biomedical Research Centre
- National Institute of Neurological Disorders and Stroke (U01-NS090407)
- University College London Hospitals Biomedical Research Centre
- Department of Health and Social Care
- Wellcome Trust
- Topics
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neuroscience and Neural Engineering
- Keywords
- medial frontal cortex, probabilistic mapping, functional anatomy, epilepsy, preoperative assessment, paracentral lobule, somatosensory cortex, speech disturbance, motor response
- MeSH terms
- Drug Resistant Epilepsy, Adult, Brain Mapping, Electric Stimulation, Electroencephalography, Female, Frontal Lobe, Humans, Magnetic Resonance Imaging, Male, Young Adult, Neuroimaging
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