Reply: Where is the speech production area? Evidence from direct cortical electrical stimulation mapping.

Gajardo-Vidal et al.1 reported data from a sample of 134 stroke patients with relatively circumscribed damage to the left frontal lobe. Contrary to the received view, mapping lesion to deficit using an ecologically-valid measure of speech production (i.e. spontaneous connected speech elicited with a picture description task) revealed that, irrespective of lesion extent, damage to Broca’s area does not contribute to long-term speech production outcome, whereas damage to the white matter in the vicinity of the anterior part of the arcuate fasciculus (AF) is strongly implicated. Our results therefore address a matter of critical clinical importance: understanding the causes of inter-patient variability in speech production outcome post-stroke.