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From the Department of Neurology (Drs. Gaillard and Mott), Children’s National Medical Center, Washington, DC; Epilepsy Research Branch (Drs. Gaillard and Theodore), National Institute of Neurologic Disorders and Stroke, NIH, Bethesda, MD; Diagnostic Radiology (Drs. Hertz–Pannier and LeBihan), Clinical Center, NIH, Bethesda, MD; and Neuroimaging Branch (Dr. Barnett), National Institute of Neurologic Disorders and Stroke, NIH, Bethesda, MD.
Address correspondence and reprint requests to Dr. William Davis Gaillard, Department of Neurology, Children’s National Medical Center, 111 Michigan Ave NW, Washington, DC 20010; e-mail: gaillardw{at}ninds.nih.gov
OBJECTIVE: To identify age-dependent activation patterns of verbal fluency with functional MRI (fMRI).
BACKGROUND: Few fMRI language studies have been performed in children, and none provide comparison data to adult studies. Normative data are important for interpretation of similar studies in patients with epilepsy.
METHODS: A total of 10 normal children (5 boys, 5 girls; mean age, 10.7 years; range, 8.1 to 13.1 years) and 10 normal adults (5 men, 5 women; mean age, 28.7 years; range, 19.3 to 48 years) were studied on a 1.5-T Signa MRI scanner using BOLD echo planar imaging of the frontal lobes with a verbal fluency paradigm, covert word generation to letters. Studies were analyzed with a cross-correlation algorithm (r = 0.7). A region-of-interest analysis was used to determine the extent, magnitude, and laterality of brain activation.
RESULTS: Children and adults activated similar regions, predominantly in left inferior frontal cortex (Broca’s area) and left middle frontal gyrus (dorsolateral prefrontal cortex). Children had, on average, 60% greater extent of activation than adults, with a trend for greater magnitude of activation. Children also had significantly more right hemisphere and inferior frontal gyrus activation than adults.
CONCLUSIONS: In a test of verbal fluency, children tended to activate cortex more widely than adults, but activation patterns for fluency appear to be established by middle childhood. Thus, functional MRI using verbal fluency paradigms may be applied to pediatric patient populations for determining language dominance in anterior brain regions. The greater activation found in children, including the right inferior frontal gyrus, may reflect developmental plasticity for the ongoing organization of neural networks, which underlie language capacity.
Key words: Functional MRI—Language—Verbal fluency—Children—Dominance
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