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Dr Sommer and colleagues (2004) reported decreased language lateralisation measured with functional magnetic resonance imaging (fMRI) in 12 monozygotic twin pairs discordant for schizophrenia compared with 12 healthy monozygotic twin pairs. The authors did not find significant differences in language lateralisation between affected twins and their co-twins without schizophrenia. In the December 2003 issue of the Czech peer-reviewed psychiatric journal Psychiatrie, we published preliminary data from a study (supported by grant NF 6794-3/2001 from the Internal Grant Agency of the Czech Republic) that examined hemispheric dominance for language processing by means of fMRI in four monozygotic twin pairs discordant for schizophrenia. Although the activation paradigm (a verbal fluency task) differed from the one employed by Dr Sommer et al, the lateralisation index was calculated according to the same method within identical volumes of interest. The results indicated that language processing was significantly less lateralised in affected twins compared with their co-twins without schizophrenia (P<0.05, Wilcoxon signed ranks test, robustness assessed by analysis of 10 000 Monte Carlo permutations; mean laterality index 0.90 (s.d.=0.12) for unaffected twins and 0.73 (s.d.=17) for affected twins). There were no statistical differences in the laterality index during the verbal fluency paradigm between unaffected twins from the discordant monozygotic twin pairs and the four control monozygotic twin pairs (unpublished data). The explanation of the discrepancies could lie in the participants enrolled in our study. Since the aim of our work was to assess relative contribution of non-genetic factors in previously reported decreased language lateralisation in schizophrenia, the exclusion criterion was (in contrast to Dr Sommer's study) any family history of schizophrenia or other major psychiatric disorder. This particular study strategy allowed selection of an extreme population presumably represented by sporadic forms of the disease. In addition, stringent diagnostic criteria were used in that only participants with schizophrenia were enrolled in the study. The occurrence of psychiatric disorders in co-twins without schizophrenia and the fact that the participants were not controlled for family history of psychosis suggest a substantial degree of genetic predisposition for schizophrenia in unaffected co-twins expressed as overall decrease in language lateralisation within the discordant twin group studied by Dr Sommer and her colleagues.
EDITED BY KHALIDA ISMAIL