Advanced lesion symptom mapping analyses and implementation asBCBtoolkit

Background Patients with brain lesions provide a unique opportunity to understand the functioning of the human mind. However, even when focal, brain lesions have local and remote effects that impact functionally and structurally connected circuits. Similarly, function emerges from the interaction between brain areas rather than their sole activity. For instance, category fluency requires the association between executive, semantic and language production functions. Findings Here we provide, for the first time, a set of complementary solutions to measure the impact of a given lesion upon the neuronal circuits. Our methods, which were applied to 37 patients with a focal frontal brain lesion, revealed a large set of directly and indirectly disconnected brain regions that had significantly impacted category fluency performance. The directly disconnected regions corresponded to areas that are classically considered as functionally engaged in verbal fluency and categorization tasks. These regions were also organized into larger directly and indirectly disconnected functional networks, including the left ventral fronto-parietal network, whose cortical thickness correlated with performance on category fluency. Conclusions The combination of structural and functional connectivity together with cortical thickness estimates reveals the remote effects of brain lesions, provide for the identification of the affected networks and strengthen our understanding of their relationship with cognitive and behavioural measures. The methods presented are available and freely accessible in the BCBtoolkit as supplementary software [1].