J Neurol Surg A Cent Eur Neurosurg 2020; 81(02): 130-137
DOI: 10.1055/s-0040-1701236
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Hemispheric Dominance for Language and Side Effects in Mapping the Inferior Frontal Junction Area with Transcranial Magnetic Stimulation

1   Department of Neurosurgery, Medical Faculty, RWTH Aachen University, Aachen, Germany
2   Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
Johanna Blume-Schnitzler
1   Department of Neurosurgery, Medical Faculty, RWTH Aachen University, Aachen, Germany
Grit Frankemölle
1   Department of Neurosurgery, Medical Faculty, RWTH Aachen University, Aachen, Germany
Vanessa Drews
1   Department of Neurosurgery, Medical Faculty, RWTH Aachen University, Aachen, Germany
Stefan Heim
2   Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
3   Research Centre Jülich, Institute of Neuroscience and Medicine (INM-1), Jülich, Germany
4   JARA – Translational Brain Medicine, Aachen, Germany
Klaus Willmes
5   Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany
Hans Clusmann
1   Department of Neurosurgery, Medical Faculty, RWTH Aachen University, Aachen, Germany
Georg Neuloh
1   Department of Neurosurgery, Medical Faculty, RWTH Aachen University, Aachen, Germany
› Author Affiliations
Further Information

Publication History

12 December 2018

30 October 2019

Publication Date:
11 February 2020 (online)


Background and Study Aims Language mapping by navigated transcranial magnetic stimulation (TMS) is commonly applied over the left language-dominant hemisphere to indicate the language-related cortex. Detailed language mapping of Broca's region including stimulation targets in the immediate vicinity to the premotor cortex may raise concern about confounding unspecific motor effects. We performed interhemispheric comparisons to delineate such possible unspecific effects from true TMS-induced language inhibition.

Material and Methods Fifteen healthy German speakers named object pictures during navigated TMS over a left- and right-hemispheric target array covering the left inferior frontal junction area. Six mapping repetitions were conducted per hemisphere. Order of stimulation side was randomized between participants. Self-rating of discomfort was assessed after each stimulation; language errors and motor side effects were evaluated offline.

Results Naming errors were observed significantly more frequently during left- than right-hemispheric stimulation. The same pattern was found for the most frequent error category of performance errors. Hierarchical cluster analyses of normalized ratings of error severity revealed a clear focus of TMS susceptibility for language inhibition in object naming at the dorsoposterior target sites only in the left hemisphere. We found no statistical difference in discomfort ratings between both hemispheres and also no interhemispheric difference in motor side effects, but we observed significantly stronger muscle contractions of the eyes as compared with the mouth.

Conclusion Our results of (1) unspecific pre-/motor effects similarly induced in both hemispheres, and (2) a specific focus of TMS susceptibility in the language-dominant hemisphere render any substantial contribution of nonlanguage-specific effects in TMS language mapping of the inferior frontal junction area highly unlikely.


An oral presentation of this work took place at the 15th Annual Meeting of the German Society of Neurosurgery (Deutsche Gesellschaft für Neurochirurgie); May 2017; Magdeburg, Germany.

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