Mapping the Melting Pot: Approaches from Clinical Cross-Cultural Neuropsychology

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The following abstract was presented at the February 2019 meeting of the International Neuropsychological Society at a symposium titled “Biopsychosocial Considerations in the Functional Brain Mapping of Epilepsy Patients: An Intradisciplinary Approach.” See the news item about the presentation of this abstract.

Functional brain mapping is considered a vital part of the surgical planning process aimed at minimizing adverse neuropsychological consequences. Most commonly, mapping is used to identify eloquent cortex in expressive and receptive language areas, as well as structures related to sensorimotor functioning. While the success of brain mapping relies on the careful selection of tests based on putative cortical and subcortical networks and pre-operative neurocognitive assessments, equally as important is consideration of individual patient demographics. This is particularly evident in “special populations,” such as those with reduced educational attainment, low SES, physical disabilities, and uncommon ages for this procedure (i.e., pediatric and geriatric). Membership within these groups carries their own unique experiences which have the potential to shape the functional distribution within neuroanatomical structures (e.g., shared and unique expressive language areas in bilinguals). For example, supplemental procedures should be considered when mapping territories within Heschl’s gyrus due to its importance in pitch perception in patients who speak tonal languages, such as Thai, in which prosodic changes can confer different word meanings. In an English-language analogy, the difference between preSENT vs. PREsent may have a dramatic impact on post-operative comprehension difficulties in the patient’s dominant language.

Despite the clear necessity for modified mapping procedures to suit the needs of individual patient-based considerations, a unified approach among neuropsychologists has yet to be agreed upon. Thus, the viability of coordinated research efforts and the development of gold-standard clinical practice guidelines is limited. Guiding, foundational principles with intra-disciplinary applicability throughout neuropsychology will be discussed.

Authors: 
Jessica Spat-Lemus, Ph.D., David Sabsevitz, Ph.D., ABPP-CN, Marla Hamberger, Ph.D., Fedor Panov, M.D., Heidi Bender, Ph.D., ABPP-CN