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Cerebral lateralization

Relationship of language and ideomotor praxis

From the Departments of Neurology (Drs. Meador, Loring, K. Lee, Hughes, and Nichols) and Psychiatry (Dr. G. Lee), Medical College of Georgia, Augusta, GA; and the Department of Neurology (Dr. Heilman), University of Florida, Gainesville, FL.

Address correspondence and reprint requests to Dr. Kimford J. Meador, Department of Neurology, Medical College of Georgia, 1120 15th Street (Room BAA335), Augusta, GA 30912.

OBJECTIVE: To determine the relationship of language lateralization and hand preference to praxis performance following left and right hemispheric amobarbital-induced inactivations.

BACKGROUND: Patients who are aphasic from left cerebral dysfunction also frequently exhibit ideomotor apraxia in which they make temporal, spatial, and postural errors of learned skilled movements. However, hemispheric lateralization of the systems mediating ideomotor praxis in patients with atypical cerebral language dominance (i.e., bilateral or right hemispheric language function) remains uncertain.

METHODS: Subjects included 90 patients with intractable seizures who were undergoing the intracarotid amobarbital procedure (IAP) as part of their preoperative evaluation for epilepsy surgery. Hand preference was determined by the Benton Handedness Questionnaire. Praxis was assessed by the subject’s performance when pantomiming the use of four pictured tools.

RESULTS: During left IAP, patients with typical language dominance made more ideomotor apraxic errors than did patients with atypical language dominance. During right IAP, patients with atypical language dominance made more ideomotor apraxic errors than did patients with typical language dominance. Overall, patients with atypical language dominance made fewer ideomotor apraxic errors than did patients with typical language dominance. These relationships were present irrespective of hand preference.

CONCLUSIONS: Language dominance is more closely associated with the laterality of temporal and spatial movement representations (i.e., ideomotor praxis dominance) than is hand preference. Patients with atypical language dominance exhibit more bilateral cerebral distribution of both language and praxis function.

Key words: Apraxia—Aphasia—Lateralization—Wada test.

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