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Mapping the brain


9 October 2014

Our publications editor Nicola Swanborough took part in a study to identify which parts of the brain are used for different language skills. Here she explains how research will benefit those undergoing epilepsy surgery.

'I love everything there is about language, from Shakespeare's sonnets to the confined characters of twitterspeak. Nothing is more satisfying than tracing a word back to its origins - Greek, Old English, Middle English, Old Norse. Yet I have rarely given much consideration as to how language is generated in our brains - until that is, I took part in a pilot study using MRI scans to identify which parts of the brain are used for different language skills.

The study is being carried out here, at Epilepsy Society's Chalfont Centre and is being led by our head of psychology Dr Pam Thompson. The aim of the project is to help psychologists, neurologists and surgeons make better predictions about the effects of brain surgery on language function for people with temporal lobe epilepsy. This in turn will enable those who are considering surgery for their epilepsy, to make the most informed decision possible.

I was taking part in the study  as a healthy control - someone without epilepsy. My brain scans and test results would then be compared with those of people with temporal lobe epilepsy.

Freedom from seizures

On the morning of my first scan - you have to undergo three in all over the space of a year - one of our supporters emailed me to say that she was going for a scan the next day in London to locate language function in her brain. She is hoping to have surgery for her epilepsy. She is hoping for a life free from seizures.

It was a huge reality check. Statistics around research are powerful - 1,000 people are identified in the UK each year as being suitable for epilepsy surgery, yet less than half choose to undergo the treatment, often fearing damage to the very functions that help to make us the people we are - memory, vision and language.

But there is nothing more compelling than a personal email to punch home the enormity of that decision to opt for surgery. I have come to know this particular supporter well over the years - she is a busy mum and wife, sister, aunt, active member of the community as well as being hugely creative. She has much to gain through surgery but potentially much to lose. Her story was at the forefront of my mind as I lay in the MRI scanner.

3T MRI scanner for epilepsy

Ironically, there was a lot at the forefront of my mind throughout the tests, in spite of my determination to concentrate. Lying inside what is one of the most powerful medical diagnostic tools of the 21st century , it was hard not to be overwhelmed by the sophistication of the machinery. It has a big wow factor.

Added to this, it was bizarre to know that the person sitting opposite the scanner, was looking at my brain on a computer screen. The curious and insecure in me wondered whether all looked well, reassuringly average and hopefully functional. The maverick in me wondered if I thought in French or German (both schoolgirl standard) or prayed silently in Gaelic (worse than schoolgirl standard), whether  neuroimaging researcher, Louis Van Graan would be able to spot this from my scan and rein me in.

I checked with him afterwards and it seems it doesn't matter what language you think or speak in, the same pathways of the brain will be activated.

There is nothing more compelling than a personal email to punch home the enormity of that decision to opt for surgery. 

Brain scan

But to the serious business of the tests. I disciplined myself to concentrate. The study aims to identify which parts of the brain are used for skills such as naming objects or listening to words. Some of the tests are auditory, some visual, some draw on word association and verbal fluency, others on category fluency.

It is astonishing how your mind can go blank when asked to name as many different flowers or colours as possible, yet when asked to rest, my mind would do anything but. The eternal question of 'what are we going to have for dinner tonight' seemed to bombard my brain from every angle. I wondered whether there might be a small baked potato shape lit up on my brain scan.

I worried that my inability to switch off and rest might spoil the study and that the worrying itself - even the baked potato - might be detrimental. Again Louis was reassuring. The resting brain is actually only  five per cent less active  than a brain that is up and doing. This is general, not just my brain.

The tests were followed by a high resolution structural MRI. Results from the scans and tests would be combined with a 30 minute language assessment outside of the MRI when your voice is recorded for analysis of speech patterns and intonation. Results could then be compared to those with temporal lobe epilepsy.

Communication skills

I cannot imagine moving to a foreign country and being unable to appreciate all the idiosyncrasies and nuances of the local language. Verbal communication is fundamental to the way we express our feelings and emotions, the way we share joy, clear the air with a thumping good row or sing in the bath. The pilot study into the localisation of language skills in the brain aims to safeguard all of these for anyone undergoing surgery.

I have yet to hear how our supporter who is contemplating surgery for her epilepsy, got on with her own scan. I have yet to hear whether the focal point of her seizures is close to critical areas for language skills and whether she will choose to go for surgery. I'm keeping my fingers crossed for good news.'

Find out more about our world leading epilepsy research centre.