Stephanie Forkel

Publications

Displaying 1 - 17 of 17
  • Dulyan, L., Guzmán Chacón, E. G., & Forkel, S. J. (2025). Navigating neuroanatomy. In J. H. Grafman (Ed.), Encyclopedia of the human brain (2nd ed.). Amsterdam: Elsevier.

    Abstract

    This chapter introduces the origins and development of our current anatomical terminology. It scrutinizes the historical evolution and etymological significance of the over 1900 official anatomical terms in the current nomenclature, underscoring their impact on the contemporary comprehension of cognitive neuroanatomy. The chapter traces unification efforts from the Basel Nomina Anatomica in 1895 to the 1998 Terminologia Anatomica, noting challenges arising from outdated terminology in light of recent anatomical advancements.

    Highlighting the influence of terminologies on interpretations of brain anatomy, the chapter explores several anatomical mapping methods such as surface, sectional, connectional, and functional anatomy. It illuminates discrepancies and controversies, exemplified by divergent interpretations of the number of brain lobes and the definitions of 'Broca' and 'Wernicke' areas.

    The chapter explores anatomical terms' historical and cultural underpinnings, encompassing mythonyms, eponyms, and cultural influences on nomenclature. It critically examines the implications of these terminologies on contemporary research and shows that Large Language Models mirror these discrepancies. It underscores the need for more inclusive and culturally sensitive approaches in anatomical education.

    Lastly, we advocate for updating anatomical nomenclature, suggesting that a deeper understanding of these terminologies could provide insights and aid in resolving ongoing debates in the field. This examination sheds light on historical knowledge and emphasizes the dynamic interplay between language, culture, and anatomy in shaping our comprehension of the neurobiology of the brain and how we navigate neuroanatomy in the 21st century.
  • Dulyan, L., Bortolami, C., & Forkel, S. J. (2025). Asymmetries in the human brain. In C. Papagno, & P. Corballis (Eds.), Cerebral Asymmetries: Handbook of Clinical Neurology (pp. 15-36). Amsterdam: Elsevier.

    Abstract

    The human brain is an intricate network of cortical regions interconnected by white matter pathways, dynamically supporting cognitive functions. While cortical asymmetries have been consistently reported, the asymmetry of white matter connections remains less explored. This chapter provides a brief overview of asymmetries observed at the cortical, subcortical, cytoarchitectural, and receptor levels before exploring the detailed connectional anatomy of the human brain. It thoroughly examines the lateralization and interindividual variability of 56 distinct white matter tracts, offering a comprehensive review of their structural characteristics and interindividual variability. Additionally, we provide an extensive update on the asymmetry of a wide range of white matter tracts using high-resolution data from the Human Connectome Project (7T HCP www.humanconnectome.org). Future research and advanced quantitative analyses are crucial to understanding fully how asymmetry contributes to interindividual variability. This comprehensive exploration enhances our understanding of white matter organization and its potential implications for brain function.
  • Forkel, S. J., Bortolami, C., Dulyan, L., Barrett, R. L. C., & Beyh, A. (2025). Dissecting white matter pathways: A neuroanatomical approach. In F. Dell'Acqua, M. Descoteaux, & A. Leemans (Eds.), Handbook of Diffusion MR Tractography (pp. 397-421). Amsterdam: Elsevier.

    Abstract

    The brain is the most magnificent structure, and we are only at the cusp of unraveling some of its complexity. Neuroanatomy is the best tool to map the brain's structural complexity. As such, neuroanatomy is not just an academic exercise; it serves our fundamental understanding of the neurobiology of cognition and improves clinical practice. A deepened anatomical understanding has advanced our conceptual grasp of the evolution of the brain, interindividual variability of cognition in health and disease, and the conceptual shift toward the emergence of cognition. For the past 20 years, diffusion imaging tractography has dramatically facilitated these advances by enabling the study of the delicate networks that orchestrate brain processes (for review, see Thiebaut de Schotten and Forkel, 2022). Several steps are consistent across all studied populations and brain states (health/disease) when analyzing tractography data. We discuss various considerations for dissections across populations and give practical tips on common pitfalls and features to improve the visualization of the dissections. We briefly discuss specific considerations for manual dissections in nonhuman primates. Lastly, we provide an atlas of regions of interest (ROIs) for the most commonly delineated white matter connections in the human brain.
  • Satoer, D., Dulyan, L., & Forkel, S. J. (2025). Oncology: Brain asymmetries in language-relevant brain tumors. In C. Papagno, & P. Corballis (Eds.), Cerebral Asymmetries: Handbook of Clinical Neurology (pp. 65-87). Amsterdam: Elsevier.

    Abstract

    Brain tumors are classified as rare diseases, with an annual occurrence of 300,000 cases and account for an annual loss of 241,000 lives, highlighting their devastating nature. Recent advancements in diagnosis and treatment have significantly improved the management and care of brain tumors. This chapter provides an overview of the common types of primary brain tumors affecting language functions—gliomas and meningiomas. Techniques for identifying and mapping critical language areas, including the white matter language system, such as awake brain tumor surgery and diffusion-weighted tractography, are pivotal for understanding language localization and informing personalized treatment approaches. Numerous studies have demonstrated that gliomas in the dominant hemisphere can lead to (often subtle) impairments across various cognitive domains, with a particular emphasis on language. Recently, increased attention has been directed toward (nonverbal) cognitive deficits in patients with gliomas in the nondominant hemisphere, as well as cognitive outcomes in patients with meningiomas, a group historically overlooked. A patient-tailored approach to language and cognitive functions across the pre-, intra-, and postoperative phases is mandatory for brain tumor patients to preserve quality of life. Continued follow-up studies, in conjunction with advanced imaging techniques, are crucial for understanding the brain's potential for neuroplasticity and optimizing patient outcomes.
  • Nozais, V., Forkel, S. J., Petit, L., Talozzi, L., Corbetta, M., Thiebaut de Schotten, M., & Joliot, M. (2023). Atlasing white matter and grey matter joint contributions to resting-state networks in the human brain. Communications Biology, 6: 726. doi:10.1038/s42003-023-05107-3.

    Abstract

    Over the past two decades, the study of resting-state functional magnetic resonance imaging has revealed that functional connectivity within and between networks is linked to cognitive states and pathologies. However, the white matter connections supporting this connectivity remain only partially described. We developed a method to jointly map the white and grey matter contributing to each resting-state network (RSN). Using the Human Connectome Project, we generated an atlas of 30 RSNs. The method also highlighted the overlap between networks, which revealed that most of the brain’s white matter (89%) is shared between multiple RSNs, with 16% shared by at least 7 RSNs. These overlaps, especially the existence of regions shared by numerous networks, suggest that white matter lesions in these areas might strongly impact the communication within networks. We provide an atlas and an open-source software to explore the joint contribution of white and grey matter to RSNs and facilitate the study of the impact of white matter damage to these networks. In a first application of the software with clinical data, we were able to link stroke patients and impacted RSNs, showing that their symptoms aligned well with the estimated functions of the networks.
  • Parlatini, V., Itahashi, T., Lee, Y., Liu, S., Nguyen, T. T., Aoki, Y. Y., Forkel, S. J., Catani, M., Rubia, K., Zhou, J. H., Murphy, D. G., & Cortese, S. (2023). White matter alterations in Attention-Deficit/Hyperactivity Disorder (ADHD): a systematic review of 129 diffusion imaging studies with meta-analysis. Molecular Psychiatry, 28, 4098-4123. doi:10.1038/s41380-023-02173-1.

    Abstract

    Aberrant anatomical brain connections in attention-deficit/hyperactivity disorder (ADHD) are reported inconsistently across
    diffusion weighted imaging (DWI) studies. Based on a pre-registered protocol (Prospero: CRD42021259192), we searched PubMed,
    Ovid, and Web of Knowledge until 26/03/2022 to conduct a systematic review of DWI studies. We performed a quality assessment
    based on imaging acquisition, preprocessing, and analysis. Using signed differential mapping, we meta-analyzed a subset of the
    retrieved studies amenable to quantitative evidence synthesis, i.e., tract-based spatial statistics (TBSS) studies, in individuals of any
    age and, separately, in children, adults, and high-quality datasets. Finally, we conducted meta-regressions to test the effect of age,
    sex, and medication-naïvety. We included 129 studies (6739 ADHD participants and 6476 controls), of which 25 TBSS studies
    provided peak coordinates for case-control differences in fractional anisotropy (FA)(32 datasets) and 18 in mean diffusivity (MD)(23
    datasets). The systematic review highlighted white matter alterations (especially reduced FA) in projection, commissural and
    association pathways of individuals with ADHD, which were associated with symptom severity and cognitive deficits. The meta-
    analysis showed a consistent reduced FA in the splenium and body of the corpus callosum, extending to the cingulum. Lower FA
    was related to older age, and case-control differences did not survive in the pediatric meta-analysis. About 68% of studies were of
    low quality, mainly due to acquisitions with non-isotropic voxels or lack of motion correction; and the sensitivity analysis in high-
    quality datasets yielded no significant results. Findings suggest prominent alterations in posterior interhemispheric connections
    subserving cognitive and motor functions affected in ADHD, although these might be influenced by non-optimal acquisition
    parameters/preprocessing. Absence of findings in children may be related to the late development of callosal fibers, which may
    enhance case-control differences in adulthood. Clinicodemographic and methodological differences were major barriers to
    consistency and comparability among studies, and should be addressed in future investigations.
  • Akeret, K., Forkel, S. J., Buzzi, R. M., Vasella, F., Amrein, I., Colacicco, G., Regli, L., Serra, C., & Krayenbühl, N. (2022). Multimodal anatomy of the human forniceal commissure. Communications Biology, 5: 742. doi:10.1038/s42003-022-03692-3.

    Abstract

    Ambiguity surrounds the existence and morphology of the human forniceal commissure. We combine advanced in-vivo tractography, multidirectional ex-vivo fiber dissection, and multiplanar histological analysis to characterize this structure’s anatomy. Across all 178 subjects, in-vivo fiber dissection based on the Human Connectome Project 7 T MRI data identifies no interhemispheric connections between the crura fornicis. Multidirectional ex-vivo fiber dissection under the operating microscope demonstrates the psalterium as a thin soft-tissue membrane spanning between the right and left crus fornicis, but exposes no commissural fibers. Multiplanar histological analysis with myelin and Bielchowsky silver staining, however, visualizes delicate cruciform fibers extending between the crura fornicis, enclosed by connective tissue, the psalterium. The human forniceal commissure is therefore much more delicate than previously described and presented in anatomical textbooks. This finding is consistent with the observed phylogenetic trend of a reduction of the forniceal commissure in non-human primates compared to non-primate eutherian mammals.

    Additional information

    supplementary material
  • Alves, P. N., Forkel, S. J., Corbetta, M., & Thiebaut de Schotten, M. (2022). The subcortical and neurochemical organization of the ventral and dorsal attention networks. Communications Biology, 5: 1343. doi:10.1038/s42003-022-04281-0.

    Abstract

    Attention is a core cognitive function that filters and selects behaviourally relevant information in the environment. The cortical mapping of attentional systems identified two segregated networks that mediate stimulus-driven and goal-driven processes, the Ventral and the Dorsal Attention Networks (VAN, DAN). Deep brain electrophysiological recordings, behavioral data from phylogenetic distant species, and observations from human brain pathologies challenge purely corticocentric models. Here, we used advanced methods of functional alignment applied to resting-state functional connectivity analyses to map the subcortical architecture of the Ventral and Dorsal Attention Networks. Our investigations revealed the involvement of the pulvinar, the superior colliculi, the head of caudate nuclei, and a cluster of brainstem nuclei relevant to both networks. These nuclei are densely connected structural network hubs, as revealed by diffusion-weighted imaging tractography. Their projections establish interrelations with the acetylcholine nicotinic receptor as well as dopamine and serotonin transporters, as demonstrated in a spatial correlation analysis with a normative atlas of neurotransmitter systems. This convergence of functional, structural, and neurochemical evidence provides a comprehensive framework to understand the neural basis of attention across different species and brain diseases.
  • Boraud, T., & Forkel, S. J. (2022). Paul Broca: from fame to shame? Brain, 145(3), 801-804. doi:10.1093/brain/awab444.

    Abstract

    In 2016, the University of Bordeaux ran a competition within the local neuroscience community to find a
    name for its new neuroscience building. The name of Paul Broca, who was born nearby in 1824, was chosen
    in honour of his origins and his contributions to neuroscience. Recently, however, a debate has been ignited
    about the appropriateness of this choice, given Broca’s endorsement of physiological anthropology. At a time
    when academic institutions worldwide are revising their curricula to better reflect the contributions of pre-
    viously overlooked groups, how should we respond when the views of the ‘founding fathers’ of neurology
    clash with those of society today?

    Additional information

    supplementary figure
  • Dulyan, L., Talozzi, L., Pacella, V., Corbetta, M., Forkel, S. J., & Thiebaut de Schotten, M. (2022). Longitudinal prediction of motor dysfunction after stroke: a disconnectome study. Brain Structure and Function, 227, 3085-3098. doi:10.1007/s00429-022-02589-5.

    Abstract

    Motricity is the most commonly affected ability after a stroke. While many clinical studies attempt to predict motor symptoms at different chronic time points after a stroke, longitudinal acute-to-chronic studies remain scarce. Taking advantage of recent advances in mapping brain disconnections, we predict motor outcomes in 62 patients assessed longitudinally two weeks, three months, and one year after their stroke. Results indicate that brain disconnection patterns accurately predict motor impairments. However, disconnection patterns leading to impairment differ between the three-time points and between left and right motor impairments. These results were cross-validated using resampling techniques. In sum, we demonstrated that while some neuroplasticity mechanisms exist changing the structure–function relationship, disconnection patterns prevail when predicting motor impairment at different time points after stroke.

    Additional information

    supplementary file
  • Forkel, S. J., Labache, L., Nachev, P., Thiebaut de Schotten, M., & Hesling, I. (2022). Stroke disconnectome decodes reading networks. Brain Structure and Function, 227, 2897-2908. doi:10.1007/s00429-022-02575-x.

    Abstract

    Cognitive functional neuroimaging has been around for over 30 years and has shed light on the brain areas relevant for reading. However, new methodological developments enable mapping the interaction between functional imaging and the underlying white matter networks. In this study, we used such a novel method, called the disconnectome, to decode the reading circuitry in the brain. We used the resulting disconnection patterns to predict a typical lesion that would lead to reading deficits after brain damage. Our results suggest that white matter connections critical for reading include fronto-parietal U-shaped fibres and the vertical occipital fasciculus (VOF). The lesion most predictive of a reading deficit would impinge on the left temporal, occipital, and inferior parietal gyri. This novel framework can systematically be applied to bridge the gap between the neuropathology of language and cognitive neuroscience.
  • Forkel, S. J. (2022). Lesion-Symptom Mapping: From Single Cases to the Human Disconnectome. In S. Della Salla (Ed.), Encyclopedia of Behavioral Neuroscience (2nd edition, pp. 142-154). Elsevier. doi:10.1016/B978-0-12-819641-0.00056-6.

    Abstract

    Lesion symptom mapping has revolutionized our understanding of the functioning of the human brain. Associating damaged voxels in the brain with loss of function has created a map of the brain that identifies critical areas. While these methods have significantly advanced our understanding, recent improvements have identified the need for multivariate and multimodal methods to map hidden lesions and damage to white matter networks beyond the lesion voxels. This article reviews the evolution of lesion-symptom mapping from single case studies to the human disconnectome.
  • Forkel, S. J., Friedrich, P., Thiebaut de Schotten, M., & Howells, H. (2022). White matter variability, cognition, and disorders: a systematic review. Brain Structure & Function, 227, 529-544. doi:10.1007/s00429-021-02382-w.

    Abstract

    Inter-individual differences can inform treatment procedures and—if accounted for—have the potential to significantly improve patient outcomes. However, when studying brain anatomy, these inter-individual variations are commonly unaccounted for, despite reports of differences in gross anatomical features, cross-sectional, and connectional anatomy. Brain connections are essential to facilitate functional organization and, when severed, cause impairments or complete loss of function. Hence, the study of cerebral white matter may be an ideal compromise to capture inter-individual variability in structure and function. We reviewed the wealth of studies that associate cognitive functions and clinical symptoms with individual tracts using diffusion tractography. Our systematic review indicates that tractography has proven to be a sensitive method in neurology, psychiatry, and healthy populations to identify variability and its functional correlates. However, the literature may be biased, as the most commonly studied tracts are not necessarily those with the highest sensitivity to cognitive functions and pathologies. Additionally, the hemisphere of the studied tract is often unreported, thus neglecting functional laterality and asymmetries. Finally, we demonstrate that tracts, as we define them, are not correlated with one, but multiple cognitive domains or pathologies. While our systematic review identified some methodological caveats, it also suggests that tract–function correlations might still be a promising tool in identifying biomarkers for precision medicine. They can characterize variations in brain anatomy, differences in functional organization, and predicts resilience and recovery in patients.

    Additional information

    supplementary file
  • Forkel, S. J., Friedrich, P., Thiebaut de Schotten, M., & Howells, H. (2022). White matter variability, cognition, and disorders. In S. Della Sala (Ed.), Encyclopedia of Behavioral Neuroscience (2nd ed., pp. 233-241). Amsterdam: Elsevier.

    Abstract

    Inter-individual differences can inform treatment procedures and - if accounted for - can improve patient outcomes. However, when studying brain anatomy, these variations are largely unaccounted for. Brain connections are essential to mediate brain functional organization and, when severed, cause functional impairments. Here we reviewed the wealth of studies that associate functions and clinical symptoms with connections using tractography. Our results indicate that tractography is a sensitive method in healthy and clinical conditions to identify variability and its functional correlates. While our review identified some methodological caveats, it also suggests that tract-function correlations might be a promising biomarker for precision medicine.
  • Genon, S., & Forkel, S. J. (2022). How do different parts of brain white matter develop after birth in humans? Neuron, 110(23), 3860-3863. doi:10.1016/j.neuron.2022.11.011.

    Abstract

    Understanding human white matter development is vital to characterize typical brain organization and developmental neurocognitive disorders. In this issue of Neuron, Nazeri and colleagues1 identify different parts of white matter in the neonatal brain and show their maturational trajectories in line with microstructural feature development.
  • Mekki, Y., Guillemot, V., Lemaître, H., Carrión-Castillo, A., Forkel, S. J., Frouin, V., & Philippe, C. (2022). The genetic architecture of language functional connectivity. NeuroImage, 249: 118795. doi:10.1016/j.neuroimage.2021.118795.

    Abstract

    Language is a unique trait of the human species, of which the genetic architecture remains largely unknown. Through language disorders studies, many candidate genes were identified. However, such complex and multifactorial trait is unlikely to be driven by only few genes and case-control studies, suffering from a lack of power, struggle to uncover significant variants. In parallel, neuroimaging has significantly contributed to the understanding of structural and functional aspects of language in the human brain and the recent availability of large scale cohorts like UK Biobank have made possible to study language via image-derived endophenotypes in the general population. Because of its strong relationship with task-based fMRI (tbfMRI) activations and its easiness of acquisition, resting-state functional MRI (rsfMRI) have been more popularised, making it a good surrogate of functional neuronal processes. Taking advantage of such a synergistic system by aggregating effects across spatially distributed traits, we performed a multivariate genome-wide association study (mvGWAS) between genetic variations and resting-state functional connectivity (FC) of classical brain language areas in the inferior frontal (pars opercularis, triangularis and orbitalis), temporal and inferior parietal lobes (angular and supramarginal gyri), in 32,186 participants from UK Biobank. Twenty genomic loci were found associated with language FCs, out of which three were replicated in an independent replication sample. A locus in 3p11.1, regulating EPHA3 gene expression, is found associated with FCs of the semantic component of the language network, while a locus in 15q14, regulating THBS1 gene expression is found associated with FCs of the perceptual-motor language processing, bringing novel insights into the neurobiology of language.
  • Thiebaut de Schotten, M., & Forkel, S. J. (2022). The emergent properties of the connected brain. Science, 378(6619), 505-510. doi:10.1126/science.abq2591.

    Abstract

    There is more to brain connections than the mere transfer of signals between brain regions. Behavior and cognition emerge through cortical area interaction. This requires integration between local and distant areas orchestrated by densely connected networks. Brain connections determine the brain’s functional organization. The imaging of connections in the living brain has provided an opportunity to identify the driving factors behind the neurobiology of cognition. Connectivity differences between species and among humans have furthered the understanding of brain evolution and of diverging cognitive profiles. Brain pathologies amplify this variability through disconnections and, consequently, the disintegration of cognitive functions. The prediction of long-term symptoms is now preferentially based on brain disconnections. This paradigm shift will reshape our brain maps and challenge current brain models.

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