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Xiao L, Xiang S, Chen C, Zhu H, Zhou M, Tang Y, Feng L, Hu S. Association of synaptic density and cognitive performance in temporal lobe epilepsy: Humans and animals PET imaging study with [ 18F]SynVesT-1. Psychiatry Clin Neurosci 2024. [PMID: 38804583 DOI: 10.1111/pcn.13682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 04/08/2024] [Accepted: 05/03/2024] [Indexed: 05/29/2024]
Abstract
AIM Cognitive impairment is a common comorbidity in individuals with temporal lobe epilepsy (TLE), yet the underlying mechanisms remain unknown. This study explored the putative association between in vivo synaptic loss and cognitive outcomes in TLE patients by PET imaging of synaptic vesicle glycoprotein 2A (SV2A). METHODS We enrolled 16 TLE patients and 10 cognitively normal controls. All participants underwent SV2A PET imaging using [18F]SynVesT-1 and cognitive assessment. Lithium chloride-pilocarpine-induced rats with status epilepticus (n = 20) and controls (n = 6) rats received levetiracetam (LEV, specifically binds to SV2A), valproic acid (VPA), or saline for 14 days. Then, synaptic density was quantified by [18F]SynVesT-1 micro-PET/CT. The novel object recognition and Morris water maze tests evaluated TLE-related cognitive function. SV2A expression was examined and confirmed by immunohistochemistry. RESULTS Temporal lobe epilepsy patients showed significantly reduced synaptic density in hippocampus, which was associated with cognitive performance. In the rat model of TLE, the expression of SV2A and synaptic density decreased consistently in a wider range of brain regions, including the entorhinal cortex, insula, hippocampus, amygdala, thalamus, and cortex. We treated TLE animal models with LEV or VPA to explore whether synaptic loss contributes to cognitive deficits. It was found that LEV significantly exerted protective effects against brain synaptic deficits and cognitive impairment. CONCLUSION This is the first study to link synaptic loss to cognitive deficits in TLE, suggesting [18F]SynVesT-1 PET could be a promising biomarker for monitoring synaptic loss and cognitive dysfunction. LEV might help reverse synaptic deficits and ameliorate learning and memory impairments in TLE patients.
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Affiliation(s)
- Ling Xiao
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Shijun Xiang
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Chen Chen
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Haoyue Zhu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Ming Zhou
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Yongxiang Tang
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, China
| | - Shuo Hu
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Biological Nanotechnology of National Health Commission, Xiangya Hospital, Central South University, Changsha, China
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Jin Y, Mikhailova E, Lei M, Cowley SA, Sun T, Yang X, Zhang Y, Liu K, Catarino da Silva D, Campos Soares L, Bandiera S, Szele FG, Molnár Z, Zhou L, Bayley H. Integration of 3D-printed cerebral cortical tissue into an ex vivo lesioned brain slice. Nat Commun 2023; 14:5986. [PMID: 37794031 PMCID: PMC10551017 DOI: 10.1038/s41467-023-41356-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 09/01/2023] [Indexed: 10/06/2023] Open
Abstract
Engineering human tissue with diverse cell types and architectures remains challenging. The cerebral cortex, which has a layered cellular architecture composed of layer-specific neurons organised into vertical columns, delivers higher cognition through intricately wired neural circuits. However, current tissue engineering approaches cannot produce such structures. Here, we use a droplet printing technique to fabricate tissues comprising simplified cerebral cortical columns. Human induced pluripotent stem cells are differentiated into upper- and deep-layer neural progenitors, which are then printed to form cerebral cortical tissues with a two-layer organization. The tissues show layer-specific biomarker expression and develop a structurally integrated network of processes. Implantation of the printed cortical tissues into ex vivo mouse brain explants results in substantial structural implant-host integration across the tissue boundaries as demonstrated by the projection of processes and the migration of neurons, and leads to the appearance of correlated Ca2+ oscillations across the interface. The presented approach might be used for the evaluation of drugs and nutrients that promote tissue integration. Importantly, our methodology offers a technical reservoir for future personalized implantation treatments that use 3D tissues derived from a patient's own induced pluripotent stem cells.
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Affiliation(s)
- Yongcheng Jin
- Department of Chemistry, University of Oxford, Oxford, OX1 3TA, UK
| | | | - Ming Lei
- Department of Pharmacology, University of Oxford, Oxford, OX1 3QT, UK
| | - Sally A Cowley
- James and Lillian Martin Centre for Stem Cell Research, Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Tianyi Sun
- Department of Pharmacology, University of Oxford, Oxford, OX1 3QT, UK
| | - Xingyun Yang
- Department of Chemistry, University of Oxford, Oxford, OX1 3TA, UK
| | - Yujia Zhang
- Department of Chemistry, University of Oxford, Oxford, OX1 3TA, UK
| | - Kaili Liu
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, OX1 3PT, UK
| | | | - Luana Campos Soares
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, OX1 3PT, UK
| | - Sara Bandiera
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, OX1 3PT, UK
| | - Francis G Szele
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, OX1 3PT, UK.
| | - Zoltán Molnár
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, OX1 3PT, UK.
| | - Linna Zhou
- Department of Chemistry, University of Oxford, Oxford, OX1 3TA, UK.
- Ludwig Institute for Cancer Research, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7DQ, UK.
| | - Hagan Bayley
- Department of Chemistry, University of Oxford, Oxford, OX1 3TA, UK.
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Allison K, Stoeckel R, Olsen E, Tallman S, Iuzzini-Seigel J. Motor Speech Phenotypes in Children With Epilepsy: Preliminary Findings. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1912-1922. [PMID: 36827527 DOI: 10.1044/2022_ajslp-22-00176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE This exploratory study aimed to characterize motor speech impairments in a small sample of children with epilepsy, both with and without a known seizure etiology. A secondary aim was to evaluate the validity of the Profile for Childhood Apraxia of speech and Dysarthria (ProCAD), a newly developed tool for differential diagnosis of childhood apraxia of speech and dysarthria. METHOD Thirteen children with seizure disorders completed a comprehensive speech and language assessment. Three expert speech-language pathologists rated the presence of auditory-perceptual features of motor speech impairment using the ProCAD. Motor speech features, diagnoses, and standardized test scores were compared between children with a known seizure etiology and children with idiopathic epilepsy. RESULTS Nine of the 13 children exhibited motor speech impairment; dysarthria was the most common diagnosis. Most children (11/13) exhibited language impairment. Group comparisons showed that children with a known seizure etiology had more atypical motor speech features and lower language scores than children with idiopathic seizures. CONCLUSION These preliminary findings suggest a high rate of motor speech impairment among children with epilepsy.
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Affiliation(s)
| | - Ruth Stoeckel
- Division of Neurology, Department of Speech Pathology, Mayo Clinic (retired), Rochester, MN
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Jiang S, Lang L, Sun B, Wu D, Feng R, He J, Chen L, Hu J, Mao Y. Surgery for Epilepsy Involving Rolandic and Perirolandic Cortex: A Case Series Assessing Complications and Efficacy. Oper Neurosurg (Hagerstown) 2022; 23:287-297. [PMID: 35973401 DOI: 10.1227/ons.0000000000000324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/25/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Surgical removal of lesions around the rolandic cortex remains a challenge for neurosurgeons owing to the high risk of neurological deficits. Evaluating the risk factors associated with motor deficits after surgery in this region may help reduce the occurrence of motor deficits. OBJECTIVE To report our surgical experience in treating epileptic lesions involving the rolandic and perirolandic cortices. METHODS We performed a single-center retrospective review of patients undergoing epilepsy surgeries with lesions located in the rolandic and perirolandic cortices. Patients with detailed follow-up information were included. The lesion locations, resected regions, and invasive exploration techniques were studied to assess their relationship with postoperative motor deficits. RESULTS Forty-one patients were included. Twenty-three patients suffered from a transient motor deficit, and 2 had permanent disabilities after surgery. Six patients with lesions at the posterior bank of the precentral sulcus underwent resection, and 5 experienced short-term motor deficits. Two patients with lesions adjacent to the anterior part of the precentral gyrus, in whom the adjacent precentral gyrus was removed, experienced permanent motor deficits. Lesions located at the bottom of the central sulcus and invading the anterior bank of the central sulcus were observed in 3 patients. The patients did not experience permanent motor deficits after surgery. CONCLUSION The anterior bank of the central sulcus is indispensable for motor function, and destruction of this region would inevitably cause motor deficits. The anterior bank of the precentral gyrus can also be removed without motor impairment if there is a preexisting epileptogenic lesion.
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Affiliation(s)
- Shize Jiang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.,State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, China
| | - Liqin Lang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Bing Sun
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Dongyan Wu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Rui Feng
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Juanjuan He
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Liang Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.,State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, China
| | - Jie Hu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.,State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, China
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Marcelle M, You X, Fanto EJ, Sepeta LN, Gaillard WD, Berl MM. Impact of development and recent-onset epilepsy on language dominance. Epilepsia 2022; 63:2637-2649. [PMID: 36222084 PMCID: PMC9574909 DOI: 10.1111/epi.17383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/20/2022] [Accepted: 08/02/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Reorganization of the language network from typically left-lateralized frontotemporal regions to bilaterally distributed or right-lateralized networks occurs in anywhere from 25%-30% of patients with focal epilepsy. In patients who have been recently diagnosed with epilepsy, an important question remains as to whether it is the presence of seizures or the underlying epilepsy etiology that leads to atypical language representations. This question becomes even more interesting in pediatric samples, where the typical developmental processes of the language network may confer more variability and plasticity in the language network. We assessed a carefully selected cohort of children with recent-onset epilepsy to examine whether it is the effects of seizures or their underlying cause that leads to atypical language lateralization. METHODS We used functional magnetic resonance imaging (fMRI) to compare language laterality in children with recently diagnosed focal unaware epilepsy and age-matched controls. Age at epilepsy onset (age 4 to 6 years vs age 7 to 12 years) was also examined to determine if age at onset influenced laterality. RESULTS The majority of recent-onset patients and controls exhibited left-lateralized language. There was a significant interaction such that the relationship between epilepsy duration and laterality differed by age at onset. In children with onset after age 6, a longer duration of epilepsy was associated with less left-lateralized language dominance. In contrast, in children with onset between 4 and 6 years of age, a longer duration of epilepsy was not associated with less left language dominance. SIGNIFICANCE Our results demonstrate that although language remained largely left-lateralized in children recently diagnosed with epilepsy, the impact of seizure duration depended on age at onset, indicating that the timing of developmental and disease factors are important in determining language dominance.
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Affiliation(s)
- Madeline Marcelle
- Children’s National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, United States
- Interdisciplinary Program in Neuroscience, Georgetown University, 4000 Reservoir Road NW, Washington DC 20057, United States
| | - Xiaozhen You
- Children’s National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, United States
| | - Eleanor J. Fanto
- Children’s National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, United States
| | - Leigh N. Sepeta
- Children’s National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, United States
- George Washington University, 2300 I Street NW, Washington, DC 20037, United States
| | - William Davis Gaillard
- Children’s National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, United States
- George Washington University, 2300 I Street NW, Washington, DC 20037, United States
| | - Madison M. Berl
- Children’s National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, United States
- George Washington University, 2300 I Street NW, Washington, DC 20037, United States
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Conde-Blanco E, Pariente JC, Carreño M, Boget T, Pascual-Díaz S, Centeno M, Manzanares I, Donaire A, Pintor L, Rumià J, Roldán P, Setoain X, Bargalló N. Testing an Adapted Auditory Verbal Learning Test Paradigm for fMRI to Lateralize Verbal Memory in Patients with Epilepsy. AJNR Am J Neuroradiol 2022; 43:1445-1452. [PMID: 36137657 PMCID: PMC9575519 DOI: 10.3174/ajnr.a7622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 07/01/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE fMRI is a noninvasive tool for predicting postsurgical deficits in candidates with pharmacoresistant temporal lobe epilepsy. We aimed to test an adapted paradigm of the Rey Auditory Verbal Learning Test to evaluate differences in memory laterality indexes between patients and healthy controls and its association with neuropsychological scores. MATERIALS AND METHODS We performed a prospective study of 50 patients with temporal lobe epilepsy and 22 healthy controls. Participants underwent a block design language and memory fMRI. Laterality indexes and the hippocampal anterior-posterior index were calculated. Language and memory lateralization was organized into typical and atypical on the basis of laterality indexes. A neuropsychological assessment was performed with a median time from fMRI of 8 months and was compared with fMRI performance. RESULTS We studied 40 patients with left temporal lobe epilepsy and 10 with right temporal lobe epilepsy. Typical language occurred in 65.3% of patients and 90.9% of healthy controls (P = .04). The memory fMRI laterality index was obtained in all healthy controls and 92% of patients. The verbal memory laterality index was bilateral (24.3%) more frequently than the language laterality index (7.69%) in patients with left temporal lobe epilepsy. Atypical verbal memory was greater in patients with left temporal lobe epilepsy (56.8%) than in healthy controls (36.4%), and the proportion of bilateral laterality indexes (53.3%) was larger than right laterality indexes (46.7%). Atypical verbal memory might be associated with higher cognitive scores in patients. No relevant differences were seen in the hippocampal anterior-posterior index according to memory impairment. CONCLUSIONS The adapted Rey Auditory Verbal Learning Test paradigm fMRI might support verbal memory lateralization. Temporal lobe epilepsy laterality influences hippocampal memory laterality indexes. Left temporal lobe epilepsy has shown a higher proportion of atypical verbal memory compared with language, potentially to memory functional reorganization.
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Affiliation(s)
- E Conde-Blanco
- From the Departments of Neurology (E.C.-B., M. Carreño, M. Centeno, I.M., A.D.)
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (E.C.-B., M. Carreño, M. Centeno, A.D., T.B., L.P., J.R., P.R., X.S., N.B.), Barcelona, Spain
- EpiCARE: European Reference Network for Epilepsy (E.C.-B., M. Carreño, M. Centeno, A.D.), Dublin, Ireland
| | - J C Pariente
- Magnetic Resonance Imaging Core Facility (J.C.P., S.P.-D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - M Carreño
- From the Departments of Neurology (E.C.-B., M. Carreño, M. Centeno, I.M., A.D.)
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (E.C.-B., M. Carreño, M. Centeno, A.D., T.B., L.P., J.R., P.R., X.S., N.B.), Barcelona, Spain
- EpiCARE: European Reference Network for Epilepsy (E.C.-B., M. Carreño, M. Centeno, A.D.), Dublin, Ireland
| | - T Boget
- Neuropsychology (T.B.)
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (E.C.-B., M. Carreño, M. Centeno, A.D., T.B., L.P., J.R., P.R., X.S., N.B.), Barcelona, Spain
| | - S Pascual-Díaz
- Magnetic Resonance Imaging Core Facility (J.C.P., S.P.-D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - M Centeno
- From the Departments of Neurology (E.C.-B., M. Carreño, M. Centeno, I.M., A.D.)
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (E.C.-B., M. Carreño, M. Centeno, A.D., T.B., L.P., J.R., P.R., X.S., N.B.), Barcelona, Spain
- EpiCARE: European Reference Network for Epilepsy (E.C.-B., M. Carreño, M. Centeno, A.D.), Dublin, Ireland
| | - I Manzanares
- From the Departments of Neurology (E.C.-B., M. Carreño, M. Centeno, I.M., A.D.)
| | - A Donaire
- From the Departments of Neurology (E.C.-B., M. Carreño, M. Centeno, I.M., A.D.)
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (E.C.-B., M. Carreño, M. Centeno, A.D., T.B., L.P., J.R., P.R., X.S., N.B.), Barcelona, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (A.D., X.S.), Barcelona, Spain
- EpiCARE: European Reference Network for Epilepsy (E.C.-B., M. Carreño, M. Centeno, A.D.), Dublin, Ireland
| | - L Pintor
- Psychiatry (L.P.)
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (E.C.-B., M. Carreño, M. Centeno, A.D., T.B., L.P., J.R., P.R., X.S., N.B.), Barcelona, Spain
| | - J Rumià
- Neurosurgery (J.R., P.R.)
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (E.C.-B., M. Carreño, M. Centeno, A.D., T.B., L.P., J.R., P.R., X.S., N.B.), Barcelona, Spain
| | - P Roldán
- Neurosurgery (J.R., P.R.)
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (E.C.-B., M. Carreño, M. Centeno, A.D., T.B., L.P., J.R., P.R., X.S., N.B.), Barcelona, Spain
| | - X Setoain
- Nuclear Medicine (X.S.), Epilepsy Program, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (E.C.-B., M. Carreño, M. Centeno, A.D., T.B., L.P., J.R., P.R., X.S., N.B.), Barcelona, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (A.D., X.S.), Barcelona, Spain
| | - N Bargalló
- Radiology (N.B.)
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (E.C.-B., M. Carreño, M. Centeno, A.D., T.B., L.P., J.R., P.R., X.S., N.B.), Barcelona, Spain
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Pasquini L, Di Napoli A, Rossi-Espagnet MC, Visconti E, Napolitano A, Romano A, Bozzao A, Peck KK, Holodny AI. Understanding Language Reorganization With Neuroimaging: How Language Adapts to Different Focal Lesions and Insights Into Clinical Applications. Front Hum Neurosci 2022; 16:747215. [PMID: 35250510 PMCID: PMC8895248 DOI: 10.3389/fnhum.2022.747215] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/18/2022] [Indexed: 12/13/2022] Open
Abstract
When the language-dominant hemisphere is damaged by a focal lesion, the brain may reorganize the language network through functional and structural changes known as adaptive plasticity. Adaptive plasticity is documented for triggers including ischemic, tumoral, and epileptic focal lesions, with effects in clinical practice. Many questions remain regarding language plasticity. Different lesions may induce different patterns of reorganization depending on pathologic features, location in the brain, and timing of onset. Neuroimaging provides insights into language plasticity due to its non-invasiveness, ability to image the whole brain, and large-scale implementation. This review provides an overview of language plasticity on MRI with insights for patient care. First, we describe the structural and functional language network as depicted by neuroimaging. Second, we explore language reorganization triggered by stroke, brain tumors, and epileptic lesions and analyze applications in clinical diagnosis and treatment planning. By comparing different focal lesions, we investigate determinants of language plasticity including lesion location and timing of onset, longitudinal evolution of reorganization, and the relationship between structural and functional changes.
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Affiliation(s)
- Luca Pasquini
- Neuroradiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
| | - Alberto Di Napoli
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
- Radiology Department, Castelli Hospital, Rome, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | | | - Emiliano Visconti
- Neuroradiology Unit, Cesena Surgery and Trauma Department, M. Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Antonio Napolitano
- Medical Physics Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Andrea Romano
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
| | - Alessandro Bozzao
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
| | - Kyung K. Peck
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Andrei I. Holodny
- Neuroradiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Department of Radiology, Weill Medical College of Cornell University, New York, NY, United States
- Department of Neuroscience, Weill-Cornell Graduate School of the Medical Sciences, New York, NY, United States
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Resection of dominant fusiform gyrus is associated with decline of naming function when temporal lobe epilepsy manifests after the age of five: A voxel-based lesion-symptom mapping study. NEUROIMAGE: CLINICAL 2022; 35:103129. [PMID: 36002957 PMCID: PMC9421498 DOI: 10.1016/j.nicl.2022.103129] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/08/2022] [Accepted: 07/27/2022] [Indexed: 11/20/2022] Open
Abstract
Resection in the dominant fusiform gyrus is associated with an increased risk of postoperative decline in picture naming. More temporo-posterior resections in this area results in a greater degree of naming decline. Risk of significant naming decline after left temporal surgery increased by 5% with every year of later seizure onset.
Objective To determine patients’ characteristics and regions in the temporal lobe where resections lead to a decline in picture naming. Methods 311 patients with left hemispheric dominance for language were included who underwent epilepsy surgery at the Epilepsy Center of Erlangen and whose picture naming scores (Boston Naming Test, BNT) were available preoperatively and 6-months postoperatively. Surgical lesions were mapped to an averaged template based on preoperative and postoperative MRI using voxel-based lesion-symptom mapping (VBLSM). Postoperative brain shifts were corrected. The relationship between lesioned brain areas and the presence of a postoperative naming decline was examined voxel-wise while controlling for effects of overall lesion size at first in the total cohort and then restricted to temporal lobe resections. Results In VBLSM in the total sample, a decline in BNT score was significantly related to left temporal surgery. When only considering patients with left temporal lobe resections (n = 121), 40 (33.1%) significantly worsened in BNT postoperatively. VBLSM including all patients with left temporal resections generated no significant results within the temporal lobe. However, naming decline of patients with epilepsy onset after 5 years of age was significantly associated with resections in the left inferior temporal (extent of BNT decline range: 10.8− 14.4%) and fusiform gyrus (decline range: 12.1−18.4%). Significance Resections in the posterior part of the dominant fusiform and inferior temporal gyrus was associated with a risk of deterioration in naming performance at six months after surgery in patients with epilepsy onset after 5 years of age but not with earlier epilepsy onset.
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The Impact of Right Temporal Lobe Epilepsy On Nonverbal Memory: Meta-regression of Stimulus- and Task-related Moderators. Neuropsychol Rev 2021; 32:537-557. [PMID: 34559363 DOI: 10.1007/s11065-021-09514-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 05/24/2021] [Indexed: 11/08/2022]
Abstract
Nonverbal memory tests have great potential value for detecting the impact of lateralized pathology and predicting the risk of memory loss following right temporal lobe resection (TLR) for temporal lobe epilepsy (TLE) patients, but this potential has not been realized. Previous reviews suggest that stimulus type moderates the capacity of nonverbal memory tests to detect right-lateralized pathology (i.e., faces > designs), but the roles of other task-related factors have not been systematically explored. We address these limitations using mixed model meta-regression (k = 158) of right-lateralization effects (right worse than left TLE) testing the moderating effects of: 1) stimulus type (designs, faces, spatial), 2) learning format (single trial, repeated trials), 3) testing delay (immediate or long delay), and 4) testing format (recall, recognition) for three patient scenarios: 1) presurgical, 2) postsurgical, and 3) postsurgical change. Stimulus type significantly moderated the size of the right-lateralization effect (faces > designs) for postsurgical patients, test format moderated the size of the right-lateralization effect for presurgical-postsurgical change (recognition > recall) but learning format and test delay had no right-lateralization effect for either sample. For presurgical patients, none of the task-related factors significantly increased right-lateralization effects. This comprehensive review reveals the value of recognition testing in gauging the risk of nonverbal memory decline.
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Elsherif M, Esmael A. Hippocampal atrophy and quantitative EEG markers in mild cognitive impairment in temporal lobe epilepsy versus extra-temporal lobe epilepsy. Neurol Sci 2021; 43:1975-1986. [PMID: 34406537 DOI: 10.1007/s10072-021-05540-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/26/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Cognitive impairment in temporal lobe epilepsy is widely acknowledged as one of the most well-known comorbidities. This study aimed to explore cognitive impairment and to determine the potential clinical, radiological, and quantitative electroencephalography markers for cognitive impairment in temporal lobe epilepsy patients versus extra-temporal lobe epilepsy. METHODS Forty-five patients with temporal lobe epilepsy and forty-five patients with extra-temporal lobe epilepsy were recruited for an administered digit span test, verbal fluency test, mini-mental state examination, digital symbol test, and Montreal cognitive assessment. Also, they were subjected to magnetic resonance imaging assessment for hippocampal atrophy and a quantitative electroencephalography assessment for electroencephalography markers (median frequency, peak frequency, and the alpha-to-theta ratio). RESULTS Patients with extra-temporal lobe epilepsy showed non-significant higher epilepsy durations and a higher frequency of seizures. Temporal lobe epilepsy patients showed a more statistically significant family history of epilepsy (37.7%), more history of febrile convulsions (13.3%), higher hippocampal atrophy (17.8%), and lower cognitive scales, especially mini-mental state examination and Montreal cognitive assessment; lower digital symbol test, verbal fluency test, and backward memory of digit span test. Also, temporal lobe epilepsy patients had a strong negative correlation with electroencephalography markers: median frequency, peak frequency, and the alpha-to-theta ratio (r = - 0.68, P < 0.005 and r = - 0.64, P < 0.005 and r = - 0.66, P < 0.005 respectively). CONCLUSION Cognitive impairment in patients with temporal lobe epilepsy was correlated with hippocampal atrophy and quantitative electroencephalography abnormalities, especially peak frequency, median frequency, and alpha-to-theta ratio that could be used alone for the identification of early cognitive impairment. TRIAL REGISTRATION Clinicaltrials.gov: NCT04376671.
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Affiliation(s)
- Mohammed Elsherif
- Department of Neurology, Mansoura Faculty of Medicine, Mansoura University, Mansoura, 35516, Dakahlia, Egypt.
| | - Ahmed Esmael
- Department of Neurology, Mansoura Faculty of Medicine, Mansoura University, Mansoura, 35516, Dakahlia, Egypt
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Sharawat IK, Panda PK, Kasinathan A. Atypical handedness and its clinicoradiological predictors in children with focal epilepsy. Epilepsy Res 2021; 173:106622. [PMID: 33813361 DOI: 10.1016/j.eplepsyres.2021.106622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 03/09/2021] [Accepted: 03/20/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE Handedness has been strongly linked to cerebral lateralisation for language. Literature on atypical handedness and its association with focal epilepsy starting from early childhood is limited and needs exploration. METHODS In this cross-sectional study, the prevalence of atypical handedness (left-handedness and ambidexterity) was compared between children with left/right focal epilepsy aged 3-14 years without any definite motor deficit, between August 2019 and July 2020. Cognition, behavioral abnormalities, working memory, and executive function were also compared between the groups. Various clinical, demographic, and radiological variables were explored to determine any association with the presence of atypical handedness. RESULTS Of the total 79 children (45 boys, 57 % mean age 6.5 ± 2.3 years, 41-left focal epilepsy) with focal epilepsy enrolled for the study, the prevalence of atypical handedness was found to be 12.6 % (10/79). No association between atypical handedness and clinical/demographic variables including left/right focal epilepsy was observed in the study excepting neuroimaging abnormality (p = 0.0008 and 0.02 respectively). This increased prevalence of neuroimaging abnormality in patients with atypical handedness was significant in multivariate analysis, after adjusting for confounding variables. Similarly, intelligence quotient (full scale, verbal and non-verbal, as well as sub-domains), behavioral abnormality (internalizing and externalizing score on CBCL), scores on picture memory, simple copying, and missing scan task were not significantly different between children with left and right focal epilepsy or children with atypical handedness and right-handedness. CONCLUSION Atypical handedness is not more frequent in children with left focal epilepsy as compared to right focal epilepsy.
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Affiliation(s)
- Indar Kumar Sharawat
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Prateek Kumar Panda
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
| | - Ananthanarayanan Kasinathan
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, 605006, India
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Patterns and predictors of language representation and the influence of epilepsy surgery on language reorganization in children and young adults with focal lesional epilepsy. PLoS One 2020; 15:e0238389. [PMID: 32898166 PMCID: PMC7478845 DOI: 10.1371/journal.pone.0238389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 08/14/2020] [Indexed: 11/19/2022] Open
Abstract
Mapping brain functions is crucial for neurosurgical planning in patients with drug-resistant seizures. However, presurgical language mapping using either functional or structural networks can be challenging, especially in children. In fact, most of the evidence on this topic derives from cross-sectional or retrospective studies in adults submitted to anterior temporal lobectomy. In this prospective study, we used fMRI and DTI to explore patterns of language representation, their predictors and impact on cognitive performances in 29 children and young adults (mean age at surgery: 14.6 ± 4.5 years) with focal lesional epilepsy. In 20 of them, we also assessed the influence of epilepsy surgery on language lateralization. All patients were consecutively enrolled at a single epilepsy surgery center between 2009 and 2015 and assessed with preoperative structural and functional 3T brain MRI during three language tasks: Word Generation (WG), Rhyme Generation (RG) and a comprehension task. We also acquired DTI data on arcuate fasciculus in 24 patients. We first assessed patterns of language representation (relationship of activations with the epileptogenic lesion and Laterality Index (LI)) and then hypothesized a causal model to test whether selected clinical variables would influence the patterns of language representation and the ensuing impact of the latter on cognitive performances. Twenty out of 29 patients also underwent postoperative language fMRI. We analyzed possible changes of fMRI and DTI LIs and their clinical predictors. Preoperatively, we found atypical language lateralization in four patients during WG task, in one patient during RG task and in seven patients during the comprehension task. Diffuse interictal EEG abnormalities predicted a more atypical language representation on fMRI (p = 0.012), which in turn correlated with lower attention (p = 0.036) and IQ/GDQ scores (p = 0.014). Postoperative language reorganization implied shifting towards atypical language representation. Abnormal postoperative EEG (p = 0.003) and surgical failures (p = 0.015) were associated with more atypical language lateralization, in turn correlating with worsened fluency. Neither preoperative asymmetry nor postoperative DTI LI changes in the arcuate fasciculus were observed. Focal lesional epilepsy associated with diffuse EEG abnormalities may favor atypical language lateralization and worse cognitive performances, which are potentially reversible after successful surgery.
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Tedrus GMAS, Passos MLGA, Vargas LM, Menezes LEFJ. Cognition and epilepsy: Cognitive screening test. Dement Neuropsychol 2020; 14:186-193. [PMID: 32595889 PMCID: PMC7304275 DOI: 10.1590/1980-57642020dn14-020013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Cognitive deficits often occur in people with epilepsy (PWE). However, in Brazil, PWE might not undergo neurocognitive evaluation due to the low number of validated tests available and lack of multidisciplinary teams in general epilepsy outpatient clinics.
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Affiliation(s)
| | | | - Letícia Muniz Vargas
- Undergraduate Student - Faculty of Medicine, Pontifical Catholic University of Campinas, Campinas, SP, Brazil
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14
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Lopes TM, Campos BM, Zanão TA, Balthazar MLF, Yasuda CL, Cendes F. Hippocampal atrophy disrupts the language network but not hemispheric language lateralization. Epilepsia 2019; 60:744-755. [DOI: 10.1111/epi.14694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Tátila Martins Lopes
- Neuroimaging LaboratoryDepartment of NeurologyUniversity of Campinas Campinas SP Brazil
| | - Brunno Machado Campos
- Neuroimaging LaboratoryDepartment of NeurologyUniversity of Campinas Campinas SP Brazil
| | - Tamires Araújo Zanão
- Neuroimaging LaboratoryDepartment of NeurologyUniversity of Campinas Campinas SP Brazil
| | | | - Clarissa Lin Yasuda
- Neuroimaging LaboratoryDepartment of NeurologyUniversity of Campinas Campinas SP Brazil
| | - Fernando Cendes
- Neuroimaging LaboratoryDepartment of NeurologyUniversity of Campinas Campinas SP Brazil
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15
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Spectral entropy indicates electrophysiological and hemodynamic changes in drug-resistant epilepsy - A multimodal MREG study. NEUROIMAGE-CLINICAL 2019; 22:101763. [PMID: 30927607 PMCID: PMC6444290 DOI: 10.1016/j.nicl.2019.101763] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 02/01/2019] [Accepted: 03/10/2019] [Indexed: 12/20/2022]
Abstract
Objective Epilepsy causes measurable irregularity over a range of brain signal frequencies, as well as autonomic nervous system functions that modulate heart and respiratory rate variability. Imaging dynamic neuronal signals utilizing simultaneously acquired ultra-fast 10 Hz magnetic resonance encephalography (MREG), direct current electroencephalography (DC-EEG), and near-infrared spectroscopy (NIRS) can provide a more comprehensive picture of human brain function. Spectral entropy (SE) is a nonlinear method to summarize signal power irregularity over measured frequencies. SE was used as a joint measure to study whether spectral signal irregularity over a range of brain signal frequencies based on synchronous multimodal brain signals could provide new insights in the neural underpinnings of epileptiform activity. Methods Ten patients with focal drug-resistant epilepsy (DRE) and ten healthy controls (HC) were scanned with 10 Hz MREG sequence in combination with EEG, NIRS (measuring oxygenated, deoxygenated, and total hemoglobin: HbO, Hb, and HbT, respectively), and cardiorespiratory signals. After pre-processing, voxelwise SEMREG was estimated from MREG data. Different neurophysiological and physiological subfrequency band signals were further estimated from MREG, DC-EEG, and NIRS: fullband (0–5 Hz, FB), near FB (0.08–5 Hz, NFB), brain pulsations in very-low (0.009–0.08 Hz, VLFP), respiratory (0.12–0.4 Hz, RFP), and cardiac (0.7–1.6 Hz, CFP) frequency bands. Global dynamic fluctuations in MREG and NIRS were analyzed in windows of 2 min with 50% overlap. Results Right thalamus, cingulate gyrus, inferior frontal gyrus, and frontal pole showed significantly higher SEMREG in DRE patients compared to HC. In DRE patients, SE of cortical Hb was significantly reduced in FB (p = .045), NFB (p = .017), and CFP (p = .038), while both HbO and HbT were significantly reduced in RFP (p = .038, p = .045, respectively). Dynamic SE of HbT was reduced in DRE patients in RFP during minutes 2 to 6. Fitting to the frontal MREG and NIRS results, DRE patients showed a significant increase in SEEEG in FB in fronto-central and parieto-occipital regions, in VLFP in parieto-central region, accompanied with a significant decrease in RFP in frontal pole and parietal and occipital (O2, Oz) regions. Conclusion This is the first study to show altered spectral entropy from synchronous MREG, EEG, and NIRS in DRE patients. Higher SEMREG in DRE patients in anterior cingulate gyrus together with SEEEG and SENIRS results in 0.12–0.4 Hz can be linked to altered parasympathetic function and respiratory pulsations in the brain. Higher SEMREG in thalamus in DRE patients is connected to disturbances in anatomical and functional connections in epilepsy. Findings suggest that spectral irregularity of both electrophysiological and hemodynamic signals are altered in specific way depending on the physiological frequency range. Simultaneous imaging methods indicate spectral irregularity in neurovascular and electrophysiological brain pulsations in DRE. Altered spectral entropy in EEG, NIRS and BOLD indicate dysfunctional brain pulsations in respiratory frequency in epilepsy. Spectral irregularity (0-5 Hz) of BOLD in right thalamus supports previous structural and functional findings in epilepsy.
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Cano-López I, Calvo A, Boget T, Carreño M, Donaire A, Setoain X, Pintor L, Rumià J, González-Bono E, Junqué C, Bargalló N. Typical asymmetry in the hemispheric activation during an fMRI verbal comprehension paradigm is related to better performance in verbal and non-verbal tasks in patients with epilepsy. Neuroimage Clin 2018; 20:742-752. [PMID: 30238918 PMCID: PMC6154460 DOI: 10.1016/j.nicl.2018.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/05/2018] [Accepted: 09/14/2018] [Indexed: 01/28/2023]
Abstract
Chronic exposure to seizures in patients with left hemisphere (LH) epileptic focus could favor higher activation in the contralateral hemisphere during language processing, but the cognitive effects of this remain unclear. This study assesses the relationship between asymmetry in hemispheric activation during language fMRI and performance in verbal and non-verbal tasks. Whereas prior studies primarily used fMRI paradigms that favor frontal lobe activation and less prominent activation of the medial or superior temporal lobes, we used a verbal comprehension paradigm previously demonstrated to activate reliably receptive language areas. Forty-seven patients with drug-resistant epilepsy candidates for surgery underwent a multidisciplinary assessment, including a comprehensive neuropsychological evaluation and an fMRI verbal comprehension paradigm. Patients were distributed in two groups depending on laterality indexes (LI): typical hemispheric asymmetry (unilateral left activation preponderance; n = 23) and atypical hemispheric asymmetry (bilateral or unilateral right preponderance; n = 24). Right-handedness and right hemisphere (RH) focus were significant predictors of typical asymmetry. Patients with typical activation pattern presented better performance intelligence quotient and verbal learning than patients with atypical hemispheric asymmetry (for all, p < 0.014). Patients with LH focus had more frequently atypical hemispheric asymmetry than patients with RH focus (p = 0.05). Specifically, they showed lower LI and this was related to worse performance in verbal and non-verbal tasks. In conclusion, an increased activation of homologous RH areas for verbal comprehension processing could imply a competition of cognitive resources in the performance of the same task, disrupting cognitive performance.
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Affiliation(s)
- Irene Cano-López
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Valencia, Spain.
| | - Anna Calvo
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Teresa Boget
- Epilepsy Unit, Department of Psychiatry, Hospital Clínic, Barcelona, Spain
| | - Mar Carreño
- Epilepsy Unit, Department of Neurology, Hospital Clínic, Barcelona, Spain
| | - Antonio Donaire
- Epilepsy Unit, Department of Neurology, Hospital Clínic, Barcelona, Spain
| | - Xavier Setoain
- Epilepsy Unit, Department of Nuclear Medicine, Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona, Spain
| | - Luis Pintor
- Epilepsy Unit, Department of Psychiatry, Hospital Clínic, Barcelona, Spain
| | - Jordi Rumià
- Epilepsy Unit, Department of Neurosurgery, Hospital Clínic, Barcelona, Spain
| | - Esperanza González-Bono
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Valencia, Spain
| | - Carme Junqué
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain; Medical Psychology Unit, Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic, Barcelona, Spain
| | - Núria Bargalló
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain; Epilepsy Unit, Department of Radiology, Hospital Clínic, Barcelona, Spain
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Hartl E, Knoche T, Choupina H, Rémi J, Vollmar C, Cunha J, Noachtar S. Quantitative and qualitative analysis of ictal vocalization in focal epilepsy syndromes. Seizure 2018; 60:178-183. [DOI: 10.1016/j.seizure.2018.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/08/2018] [Accepted: 07/10/2018] [Indexed: 10/28/2022] Open
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Ozker M, Yoshor D, Beauchamp MS. Converging Evidence From Electrocorticography and BOLD fMRI for a Sharp Functional Boundary in Superior Temporal Gyrus Related to Multisensory Speech Processing. Front Hum Neurosci 2018; 12:141. [PMID: 29740294 PMCID: PMC5928751 DOI: 10.3389/fnhum.2018.00141] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/28/2018] [Indexed: 01/15/2023] Open
Abstract
Although humans can understand speech using the auditory modality alone, in noisy environments visual speech information from the talker’s mouth can rescue otherwise unintelligible auditory speech. To investigate the neural substrates of multisensory speech perception, we compared neural activity from the human superior temporal gyrus (STG) in two datasets. One dataset consisted of direct neural recordings (electrocorticography, ECoG) from surface electrodes implanted in epilepsy patients (this dataset has been previously published). The second dataset consisted of indirect measures of neural activity using blood oxygen level dependent functional magnetic resonance imaging (BOLD fMRI). Both ECoG and fMRI participants viewed the same clear and noisy audiovisual speech stimuli and performed the same speech recognition task. Both techniques demonstrated a sharp functional boundary in the STG, spatially coincident with an anatomical boundary defined by the posterior edge of Heschl’s gyrus. Cortex on the anterior side of the boundary responded more strongly to clear audiovisual speech than to noisy audiovisual speech while cortex on the posterior side of the boundary did not. For both ECoG and fMRI measurements, the transition between the functionally distinct regions happened within 10 mm of anterior-to-posterior distance along the STG. We relate this boundary to the multisensory neural code underlying speech perception and propose that it represents an important functional division within the human speech perception network.
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Affiliation(s)
- Muge Ozker
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Daniel Yoshor
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States.,Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - Michael S Beauchamp
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
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Chou N, Serafini S, Muh CR. Cortical Language Areas and Plasticity in Pediatric Patients With Epilepsy: A Review. Pediatr Neurol 2018; 78:3-12. [PMID: 29191650 DOI: 10.1016/j.pediatrneurol.2017.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 08/28/2017] [Accepted: 10/02/2017] [Indexed: 12/12/2022]
Abstract
Chronic injury to the brain from seizure activity is associated with decreased language skills in pediatric patients, as measured on neuropsychological tests for language function and academic achievement. This makes the study of language in patients with epilepsy clinically necessary. Functional magnetic resonance imaging and direct electrical cortical stimulation have been used to evaluate aspects of cortical language processing in healthy adults and in adults with epilepsy or other neurological insults. Results of these studies help to locate cortical language areas that are involved with modality-specific language processing (visual naming, auditory naming, sentence-completion, and repetition) and the neuroplasticity of language areas in the setting of neurological injury and reorganization. A better understanding of language processing contributes to a more efficient and efficacious electrical cortical stimulation mapping of language areas for patients with intractable epilepsy who are undergoing preresection evaluation. Most of the current literature on localization and reorganization of cortical language areas in the setting of epilepsy concerns the adult patient population, whereas the literature on pediatric patients is substantially lacking in comparison. This article reviews the conclusions drawn thus far from Wada, magnetoencephalography, functional magnetic resonance imaging, and electrical cortical stimulation language studies on types of language reorganization seen in pediatric patients with intractable temporal lobe epilepsy and the clinical factors associated with reorganization, and proposes future directions of research to further the academic and clinical understanding of language processing in pediatric patients.
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Affiliation(s)
- Naomi Chou
- Duke University School of Medicine, Durham, North Carolina
| | - Sandra Serafini
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Carrie R Muh
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina.
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20
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Multi-factorial modulation of hemispheric specialization and plasticity for language in healthy and pathological conditions: A review. Cortex 2017; 86:314-339. [DOI: 10.1016/j.cortex.2016.05.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/16/2016] [Accepted: 05/13/2016] [Indexed: 12/16/2022]
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Maulisova A, Korman B, Rey G, Bernal B, Duchowny M, Niederlova M, Krsek P, Novak V. Atypical language representation in children with intractable temporal lobe epilepsy. Epilepsy Behav 2016; 58:91-6. [PMID: 27064828 DOI: 10.1016/j.yebeh.2016.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 03/04/2016] [Accepted: 03/05/2016] [Indexed: 11/29/2022]
Abstract
This study evaluated language organization in children with intractable epilepsy caused by temporal lobe focal cortical dysplasia (FCD) alone or dual pathology (temporal lobe FCD and hippocampal sclerosis, HS). We analyzed clinical, neurological, fMRI, neuropsychological, and histopathologic data in 46 pediatric patients with temporal lobe lesions who underwent excisional epilepsy surgery. The frequency of atypical language representation was similar in both groups, but children with dual pathology were more likely to be left-handed. Atypical receptive language cortex correlated with lower intellectual capacity, verbal abstract conceptualization, receptive language abilities, verbal working memory, and a history of status epilepticus but did not correlate with higher seizure frequency or early seizure onset. Histopathologic substrate had only a minor influence on neuropsychological status. Greater verbal comprehension deficits were noted in children with atypical receptive language representation, a risk factor for cognitive morbidity.
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Affiliation(s)
- Alice Maulisova
- Charles University, Faculty of Arts, Department of Psychology, Prague, Czech Republic; Motol University Hospital, Prague, Czech Republic
| | - Brandon Korman
- Brain Institute, Nicklaus Children's Hospital, Miami, FL, United States.
| | - Gustavo Rey
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Byron Bernal
- Department of Radiology, Nicklaus Children's Hospital, Miami, FL, United States
| | - Michael Duchowny
- Brain Institute, Nicklaus Children's Hospital, Miami, FL, United States; Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Marketa Niederlova
- Charles University, Faculty of Arts, Department of Psychology, Prague, Czech Republic
| | - Pavel Krsek
- Charles University, 2nd Faculty of Medicine, Prague, Czech Republic; Motol University Hospital, Prague, Czech Republic
| | - Vilem Novak
- University of Ostrava, Faculty of Medicine, Ostrava, Czech Republic; Faculty Hospital Ostrava, Ostrava, Czech Republic
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22
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Korczyn AD, Schachter SC, Amlerova J, Bialer M, van Emde Boas W, Brázdil M, Brodtkorb E, Engel J, Gotman J, Komárek V, Leppik IE, Marusic P, Meletti S, Metternich B, Moulin CJA, Muhlert N, Mula M, Nakken KO, Picard F, Schulze-Bonhage A, Theodore W, Wolf P, Zeman A, Rektor I. Third International Congress on Epilepsy, Brain and Mind: Part 1. Epilepsy Behav 2015; 50:116-37. [PMID: 26276417 PMCID: PMC5256665 DOI: 10.1016/j.yebeh.2015.06.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 06/24/2015] [Indexed: 12/12/2022]
Abstract
Epilepsy is both a disease of the brain and the mind. Here, we present the first of two papers with extended summaries of selected presentations of the Third International Congress on Epilepsy, Brain and Mind (April 3-5, 2014; Brno, Czech Republic). Epilepsy in history and the arts and its relationships with religion were discussed, as were overviews of epilepsy and relevant aspects of social cognition, handedness, accelerated forgetting and autobiographical amnesia, and large-scale brain networks.
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Affiliation(s)
- Amos D Korczyn
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Steven C Schachter
- Consortia for Improving Medicine with Innovation and Technology, Harvard Medical School, Boston, MA, USA.
| | - Jana Amlerova
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Meir Bialer
- Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Walter van Emde Boas
- Department of EEG, Dutch Epilepsy Clinics Foundation (SEIN), Heemstede, The Netherlands; Epilepsy Monitoring Unit, Dutch Epilepsy Clinics Foundation (SEIN), Heemstede, The Netherlands
| | - Milan Brázdil
- Masaryk University, Brno Epilepsy Center, St. Anne's Hospital and School of Medicine, Brno, Czech Republic; Central European Institute of Technology (CEITEC), Brno, Czech Republic
| | - Eylert Brodtkorb
- Department of Neurology and Clinical Neurophysiology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Jean Gotman
- Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Vladmir Komárek
- Department of Paediatric Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Ilo E Leppik
- MINCEP Epilepsy Care, University of Minnesota, Minneapolis, MN, USA; College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Petr Marusic
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Chris J A Moulin
- Laboratory for the Study of Learning and Development, University of Bourgogne, Dijon, France
| | - Nils Muhlert
- School of Psychology and Cardiff University Brain Research Imaging Centre, Cardiff University, Cardiff, Wales, UK
| | - Marco Mula
- Epilepsy Group, Atkinson Morley Regional Neuroscience Centre, St. George's Hospital, London, UK; Institute of Medical and Biomedical Sciences, St. George's University of London, London, UK
| | - Karl O Nakken
- National Centre for Epilepsy, Oslo University Hospital, Norway
| | - Fabienne Picard
- Department of Neurology, University Hospital and Medical School of Geneva, Switzerland
| | | | - William Theodore
- Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Peter Wolf
- Danish Epilepsy Centre Filadelfia, Dianalund, Denmark; Department of Clinical Medicine, Neurological Service, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Adam Zeman
- University of Exeter Medical School, St. Luke's Campus, Exeter, UK
| | - Ivan Rektor
- Masaryk University, Brno Epilepsy Center, St. Anne's Hospital and School of Medicine, Brno, Czech Republic; Central European Institute of Technology (CEITEC), Brno, Czech Republic
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Jayalakshmi S, Vooturi S, Vadapalli R, Somayajula S, Madigubba S, Panigrahi M. Outcome of surgery for temporal lobe epilepsy in adults - A cohort study. Int J Surg 2015; 36:443-447. [PMID: 25979111 DOI: 10.1016/j.ijsu.2015.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 05/04/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The aim of the current study was to evaluate the factors associated with post-operative outcome in patients with temporal lobe epilepsy (TLE) undergoing Surgery. METHODS We analyzed data of 288 consecutive patients operated for drug-resistant TLE. All the patients had at least one year post surgery follow-up. Logistic regression model was used to evaluate the predictive value of different factors for outcome. RESULTS The mean age at onset of epilepsy of the study population was 15.51 ± 9.79 years; whereas the mean age at surgery was 32.16 ± 9.45 years, with 125 (43.4%) women. The age at surgery was significantly lower in the patients with favourable outcome (30.26 ± 9.05 vs. 34.06 ± 9.85 years; p = 0.007). The mean duration of epilepsy with age of onset below 12 years was higher than the rest (19.84 ± 7.30 vs. 13.00 ± 8.45 years; p < 0.001). The histopathology showed hippocampal sclerosis in 203 (70.4%) of the patients; isolated focal cortical dysplasia was associated with unfavourable outcome (9.3% vs.2.6%; p = 0.036). The duration of follow up ranged from 1 to 10.3 years. Three patients died late in the follow up. At the last follow 73% were seizure free and Engel's favourable outcome was noted in 82%. Duration of epilepsy greater than ten years (β = 6.997; 95%CI; 2.254-21.715; p = 0.01), younger age of onset of epilepsy (β = 1.07; 95%CI; 1.014-1.132; p = 0.015) and acute post operative seizures (APOS) (β = 4.761; 95%CI; 1.946-11.649; p = 0.001) were the predictors of unfavourable outcome. CONCLUSION Following surgery for TLE, 73% were seizure free and Engel's favourable outcome was noted in 82%. The predictors of unfavourable outcome were younger age of onset, pronged duration and of epilepsy and APOS.
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Affiliation(s)
- Sita Jayalakshmi
- Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad - 03, Telangana, India.
| | - Sudhindra Vooturi
- Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad - 03, Telangana, India
| | - Rammohan Vadapalli
- Department of Radiology, Vijaya Diagnostic Centre, Himayath Nagar, Hyderabad - 29, Telangana, India
| | - Shanmukhi Somayajula
- Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad - 03, Telangana, India
| | - Sailaja Madigubba
- Department of Pathology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad - 03, Telangana, India
| | - Manas Panigrahi
- Department of Neurosurgery, Krishna Institute of Medical Sciences, Minister Road, Secunderabad - 03, Telangana, India
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Rathore C, Alexander A, Sarma PS, Radhakrishnan K. Memory outcome following left anterior temporal lobectomy in patients with a failed Wada test. Epilepsy Behav 2015; 44:207-12. [PMID: 25768711 DOI: 10.1016/j.yebeh.2015.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 02/09/2015] [Accepted: 02/09/2015] [Indexed: 11/15/2022]
Abstract
PURPOSE This study aimed to compare the memory outcome following left anterior temporal lobectomy (ATL) between patients with a failed Wada test and patients who passed the Wada test. METHODS From 1996 to 2002, we performed the Wada test on all patients with unilateral left mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) and concordant electroclinical data before ATL. We used a 12-item recognition paradigm for memory testing and awarded a score of +1 for each correct response and -0.5 for each incorrect response. No patient was denied surgery on the basis of Wada scores. We assessed cognitive and memory functions using the Wechsler Adult Intelligence Scale and the Wechsler Memory Scale preoperatively and at one year after ATL. We compared the number of patients who showed decline in memory scores, as per the published reliable change indices, between the patients with a failed Wada test and the patients who passed the Wada test. RESULTS Out of the 116 eligible patients with left MTLE-HS, 88 underwent bilateral Wada test, while 28 underwent ipsilateral Wada test. None of them developed postoperative amnesia. Approximately, one-third of patients with a failed Wada memory test when the failure was defined as a contralateral score of <4, as an ipsilateral score of >8, and as an asymmetry score of <0. The patients with Wada memory failure had a longer pre-ATL duration of epilepsy (p<0.003). The memory and quality-of-life outcomes did not differ between the group with a failed Wada memory test and the group who passed the Wada memory test. The results remained the same when analyses were repeated at various other cutoff points. CONCLUSION The patients with left MTLE-HS with concordant electroclinical, MRI, and neuropsychological data should not be denied ATL solely on the basis of Wada memory test results.
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Affiliation(s)
- Chaturbhuj Rathore
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Aley Alexander
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - P Sankara Sarma
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Kurupath Radhakrishnan
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
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Eichstaedt KE, Soble JR, Kamper JE, Bozorg AM, Benbadis SR, Vale FL, Schoenberg MR. Sex differences in lateralization of semantic verbal fluency in temporal lobe epilepsy. BRAIN AND LANGUAGE 2015; 141:11-15. [PMID: 25522368 DOI: 10.1016/j.bandl.2014.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 11/07/2014] [Accepted: 11/23/2014] [Indexed: 06/04/2023]
Abstract
When differences exist, women tend to outperform men on measures of verbal fluency, possibly due to greater bilateral language representation. Patients with temporal lobe epilepsy (TLE) have a higher rate of atypical cortical language representation than the general population, making them a population of interest for the study of language. For the current study, 78 TLE patients (51% male, 51% left temporal focus) underwent pre-surgical neuropsychological evaluations. Retrospective data analyses investigated the impact of seizure laterality and sex on letter and semantic verbal fluency. Results indicated an interaction between sex and laterality for semantic, but not letter, verbal fluency. Males with left TLE exhibited significantly worse semantic fluency than males with right TLE, whereas females' semantic fluency did not differ by seizure focus. These data indicate that females with TLE may indeed engage in more bilateral hemispheric processing of semantic verbal fluency, whereas males may be more reliant on left temporal cortical function for this task.
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Affiliation(s)
- Katie E Eichstaedt
- University of South Florida, Morsani College of Medicine, 3515 East Fletcher Avenue, MDC Box 14, Tampa, FL 33613, USA.
| | - Jason R Soble
- South Texas Veterans Healthcare System, Psychology Service (116B), 7400 Merton Minter Blvd., San Antonio, TX 78229, USA.
| | - Joel E Kamper
- University of South Florida, Morsani College of Medicine, 3515 East Fletcher Avenue, MDC Box 14, Tampa, FL 33613, USA; James A. Haley Veterans Administration Medical Center, Department of Mental Health and Behavioral Sciences (116B), 13000 Bruce B. Downs Blvd., Tampa, FL 33602, USA.
| | - Ali M Bozorg
- University of South Florida, Morsani College of Medicine, 3515 East Fletcher Avenue, MDC Box 14, Tampa, FL 33613, USA.
| | - Selim R Benbadis
- University of South Florida, Morsani College of Medicine, 3515 East Fletcher Avenue, MDC Box 14, Tampa, FL 33613, USA.
| | - Fernando L Vale
- University of South Florida, Morsani College of Medicine, 3515 East Fletcher Avenue, MDC Box 14, Tampa, FL 33613, USA.
| | - Mike R Schoenberg
- University of South Florida, Morsani College of Medicine, 3515 East Fletcher Avenue, MDC Box 14, Tampa, FL 33613, USA.
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Połczyńska MM, Benjamin CFA, Moseley BD, Walshaw P, Eliashiv D, Vigil C, Jones M, Bookheimer SY. Role of the Wada test and functional magnetic resonance imaging in preoperative mapping of language and memory: two atypical cases. Neurocase 2015; 21:707-20. [PMID: 25372664 DOI: 10.1080/13554794.2014.977300] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The Wada test is an invasive procedure used to determine cerebral memory and language dominance as well as risk of cognitive deficits following neurosurgery. However, the potential risks of Wada testing have led some to consider foregoing Wada testing in candidates for resective epilepsy surgery with right hemispheric seizure onset. We present two atypical cases in which the Wada test showed unexpected memory and language lateralization. These cases underscore the importance of functional magnetic resonance in which imaging and Wada examination in right-handed individuals even when the lesion would not suggest atypical language representation.
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Affiliation(s)
- Monika M Połczyńska
- a Department of Psychiatry and Biobehavioral Sciences , University of California , Los Angeles , CA , USA
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Połczyńska M, Curtiss S, Walshaw P, Siddarth P, Benjamin C, Moseley BD, Vigil C, Jones M, Eliashiv D, Bookheimer S. Grammar tests increase the ability to lateralize language function in the Wada test. Epilepsy Res 2014; 108:1864-73. [DOI: 10.1016/j.eplepsyres.2014.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 08/12/2014] [Accepted: 09/13/2014] [Indexed: 10/24/2022]
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Skirrow C, Cross JH, Harrison S, Cormack F, Harkness W, Coleman R, Meierotto E, Gaiottino J, Vargha-Khadem F, Baldeweg T. Temporal lobe surgery in childhood and neuroanatomical predictors of long-term declarative memory outcome. ACTA ACUST UNITED AC 2014; 138:80-93. [PMID: 25392199 PMCID: PMC4285190 DOI: 10.1093/brain/awu313] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
See Berg (doi:10.1093/brain/awu320) for a scientific commentary on this article. In a long-term follow-up study of children who underwent temporal lobe surgery for treatment of epilepsy, Skirrow et al. identify no significant pre-to-post-surgery memory losses, but instead robust improvements in memory functions supported by the unoperated temporal lobe. The integrity of remaining temporal lobe structures places constraints on long-term memory outcomes. The temporal lobes play a prominent role in declarative memory function, including episodic memory (memory for events) and semantic memory (memory for facts and concepts). Surgical resection for medication-resistant and well-localized temporal lobe epilepsy has good prognosis for seizure freedom, but is linked to memory difficulties in adults, especially when the removal is on the left side. Children may benefit most from surgery, because brain plasticity may facilitate post-surgical reorganization, and seizure cessation may promote cognitive development. However, the long-term impact of this intervention in children is not known. We examined memory function in 53 children (25 males, 28 females) who were evaluated for epilepsy surgery: 42 underwent unilateral temporal lobe resections (25 left, 17 right, mean age at surgery 13.8 years), 11 were treated only pharmacologically. Average follow-up was 9 years (range 5–15). Post-surgical change in visual and verbal episodic memory, and semantic memory at follow-up were examined. Pre- and post-surgical T1-weighted MRI brain scans were analysed to extract hippocampal and resection volumes, and evaluate post-surgical temporal lobe integrity. Language lateralization indices were derived from functional magnetic resonance imaging. There were no significant pre- to postoperative decrements in memory associated with surgery. In contrast, gains in verbal episodic memory were seen after right temporal lobe surgery, and visual episodic memory improved after left temporal lobe surgery, indicating a functional release in the unoperated temporal lobe after seizure reduction or cessation. Pre- to post-surgical change in memory function was not associated with any indices of brain structure derived from MRI. However, better verbal memory at follow-up was linked to greater post-surgical residual hippocampal volumes, most robustly in left surgical participants. Better semantic memory at follow-up was associated with smaller resection volumes and greater temporal pole integrity after left temporal surgery. Results were independent of post-surgical intellectual function and language lateralization. Our findings indicate post-surgical, hemisphere-dependent material-specific improvement in memory functions in the intact temporal lobe. However, outcome was linked to the anatomical integrity of the temporal lobe memory system, indicating that compensatory mechanisms are constrained by the amount of tissue which remains in the operated temporal lobe. Careful tailoring of resections for children undergoing epilepsy surgery may enhance long-term memory outcome.
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Affiliation(s)
- Caroline Skirrow
- 1 Cognitive Neuroscience and Neuropsychiatry Section, Developmental Neurosciences Programme, Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK 2 Great Ormond Street Hospital NHS Trust, Great Ormond Street, WC1N 3JH, UK
| | - J Helen Cross
- 2 Great Ormond Street Hospital NHS Trust, Great Ormond Street, WC1N 3JH, UK 3 Clinical Neurosciences Section, Developmental Neurosciences Programme, Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Sue Harrison
- 1 Cognitive Neuroscience and Neuropsychiatry Section, Developmental Neurosciences Programme, Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK 2 Great Ormond Street Hospital NHS Trust, Great Ormond Street, WC1N 3JH, UK
| | - Francesca Cormack
- 4 Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge, CB2 7EF, UK
| | - William Harkness
- 2 Great Ormond Street Hospital NHS Trust, Great Ormond Street, WC1N 3JH, UK
| | - Rosie Coleman
- 1 Cognitive Neuroscience and Neuropsychiatry Section, Developmental Neurosciences Programme, Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK 2 Great Ormond Street Hospital NHS Trust, Great Ormond Street, WC1N 3JH, UK
| | - Ellen Meierotto
- 1 Cognitive Neuroscience and Neuropsychiatry Section, Developmental Neurosciences Programme, Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK 5 Abteilung für Psychiatrie und Psychotherapie, Universitätsklinik Freiburg, Hugstetter Strasse 55, 29106 Freiburg, Germany
| | - Johanna Gaiottino
- 1 Cognitive Neuroscience and Neuropsychiatry Section, Developmental Neurosciences Programme, Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Faraneh Vargha-Khadem
- 1 Cognitive Neuroscience and Neuropsychiatry Section, Developmental Neurosciences Programme, Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK 2 Great Ormond Street Hospital NHS Trust, Great Ormond Street, WC1N 3JH, UK
| | - Torsten Baldeweg
- 1 Cognitive Neuroscience and Neuropsychiatry Section, Developmental Neurosciences Programme, Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK 2 Great Ormond Street Hospital NHS Trust, Great Ormond Street, WC1N 3JH, UK
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Croft LJ, Baldeweg T, Sepeta L, Zimmaro L, Berl MM, Gaillard WD. Vulnerability of the ventral language network in children with focal epilepsy. ACTA ACUST UNITED AC 2014; 137:2245-57. [PMID: 24941948 PMCID: PMC4107744 DOI: 10.1093/brain/awu154] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Croft et al. present fMRI and functional connectivity analyses of the language network in children with epilepsy and healthy controls. In both groups, the network is organised into dorsal and ventral systems. Activation of the ventral network is reduced in children with epilepsy, in association with poorer language function. Children with focal epilepsy are at increased risk of language impairment, yet the neural substrate of this dysfunction is not yet known. Using functional magnetic resonance imaging we investigated the impact of focal epilepsy on the developing language system using measures of network topology (spatial organization of activation) and synchrony (functional connectivity). We studied healthy children (n = 48, 4–12 years, 24 females) and children with focal epilepsy (n = 21, 5–12 years, nine females) with left hemisphere language dominance. Participants performed an age-adjusted auditory description decision task during functional magnetic resonance imaging, to identify perisylvian language regions. Mean signal change was extracted from eight left perisylvian regions of interest and compared between groups. Paired region of interest functional connectivity analysis was performed on time course data from the same regions, to investigate left network synchrony. Two principal component analyses were performed to extract (i) patterns of activation (using mean signal change data); and (ii) patterns of synchronized regions (using functional connectivity data). For both principal component analyses two components (networks) were extracted, which mapped onto the functional anatomy of dorsal and ventral language systems. Associations among network variables, age, epilepsy-related factors and verbal ability were assessed. Activated networks were affected by age and epilepsy [F(2,60) = 3.74, P = 0.03]: post hoc analyses showed, for healthy children, activation in both ventral and dorsal networks decreased with age (P = 0.02). Regardless of age and task performance, children with epilepsy showed reduced activation of the ventral network (P < 0.001). They also showed a trend for increased activation of the dorsal network (P = 0.08) associated with improved task performance (r = 0.62, P = 0.008). Crucially, decreased activation of the ventral network in patients predicted poorer language outcome ( = 0.47, P = 0.002). This suggests childhood onset epilepsy preferentially alters maturation of the ventral language system, and this is related to poorer language ability.
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Affiliation(s)
- Louise J Croft
- 1 Institute of Child Health, University College London, London, UK
| | - Torsten Baldeweg
- 1 Institute of Child Health, University College London, London, UK
| | - Leigh Sepeta
- 1 Institute of Child Health, University College London, London, UK
| | - Lauren Zimmaro
- 1 Institute of Child Health, University College London, London, UK
| | - Madison M Berl
- 1 Institute of Child Health, University College London, London, UK1 Institute of Child Health, University College London, London, UK
| | - William D Gaillard
- 1 Institute of Child Health, University College London, London, UK1 Institute of Child Health, University College London, London, UK
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Miró J, Ripollés P, López-Barroso D, Vilà-Balló A, Juncadella M, de Diego-Balaguer R, Marco-Pallares J, Rodríguez-Fornells A, Falip M. Atypical language organization in temporal lobe epilepsy revealed by a passive semantic paradigm. BMC Neurol 2014; 14:98. [PMID: 24885511 PMCID: PMC4017227 DOI: 10.1186/1471-2377-14-98] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 03/17/2014] [Indexed: 11/12/2022] Open
Abstract
Background Mesial temporal lobe epilepsy (MTLE) is the most common type of focal epilepsy in adults and can be successfully cured by surgery. One of the main complications of this surgery however is a decline in language abilities. The magnitude of this decline is related to the degree of language lateralization to the left hemisphere. Most fMRI paradigms used to determine language dominance in epileptic populations have used active language tasks. Sometimes, these paradigms are too complex and may result in patient underperformance. Only a few studies have used purely passive tasks, such as listening to standard speech. Methods In the present study we characterized language lateralization in patients with MTLE using a rapid and passive semantic language task. We used functional magnetic resonance imaging (fMRI) to study 23 patients [12 with Left (LMTLE), 11 with Right mesial temporal lobe epilepsy (RMTLE)] and 19 healthy right-handed controls using a 6 minute long semantic task in which subjects passively listened to groups of sentences (SEN) and pseudo sentences (PSEN). A lateralization index (LI) was computed using a priori regions of interest of the temporal lobe. Results The LI for the significant contrasts produced activations for all participants in both temporal lobes. 81.8% of RMTLE patients and 79% of healthy individuals had a bilateral language representation for this particular task. However, 50% of LMTLE patients presented an atypical right hemispheric dominance in the LI. More importantly, the degree of right lateralization in LMTLE patients was correlated with the age of epilepsy onset. Conclusions The simple, rapid, non-collaboration dependent, passive task described in this study, produces a robust activation in the temporal lobe in both patients and controls and is capable of illustrating a pattern of atypical language organization for LMTLE patients. Furthermore, we observed that the atypical right-lateralization patterns in LMTLE patients was associated to earlier age at epilepsy onset. These results are in line with the idea that early onset of epileptic activity is associated to larger neuroplastic changes.
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Affiliation(s)
- Júlia Miró
- Cognition and Brain Plasticity Group [Bellvitge Biomedical Research Institute]- IDIBELL, L'Hospitalet de Llobregat, Barcelona 08907, Spain.
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Banerjee J, Chandra SP, Kurwale N, Tripathi M. Epileptogenic networks and drug-resistant epilepsy: Present and future perspectives of epilepsy research-Utility for the epileptologist and the epilepsy surgeon. Ann Indian Acad Neurol 2014; 17:S134-40. [PMID: 24791082 PMCID: PMC4001228 DOI: 10.4103/0972-2327.128688] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 01/09/2014] [Accepted: 01/15/2014] [Indexed: 11/30/2022] Open
Abstract
A multidisciplinary approach is required to understand the complex intricacies of drug-resistant epilepsy (DRE). A challenge that neurosurgeons across the world face is accurate localization of epileptogenic zone. A significant number of patients who have undergone resective brain surgery for epilepsy still continue to have seizures. The reason behind this therapy resistance still eludes us. Thus to develop a cure for the difficult to treat epilepsy, we need to comprehensively study epileptogenesis. Till date, most of the studies on DRE is focused on undermining the abnormal functioning of receptors involved in synaptic transmission and reduced levels of antiepileptic drugs around there targets. But recent advances in imaging and electrophysiological techniques have suggested the role epileptogenic networks in the process of epileptogenesis. According to this hypothesis, the local neurons recruit distant neurons through complex oscillatory circuits, which further recruit more distant neurons, thereby generating a hypersynchronus neuronal activity. The epileptogenic networks may be confined to the lesion or could propagate to distant focus. The success of surgery depends on the precision by which the epileptogenic network is determined while planning a surgical intervention. Here, we summarize various modalities of electrophysiological and imaging techniques to determine the functionally active epileptogenic networks. We also review evidence pertaining to the proposed role of epileptogenic network in abnormal synaptic transmission which is one of the major causes of epileptiform activity. Elucidation of current concepts in regulation of synaptic transmission by networks will help develop therapies for epilepsy cases that cannot be managed pharmacologically.
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Affiliation(s)
- Jyotirmoy Banerjee
- Centre of Excellence for Epilepsy Research (A NBRC-AIIMS Collaboration), New Delhi, India
| | - Sarat P Chandra
- Centre of Excellence for Epilepsy Research (A NBRC-AIIMS Collaboration), New Delhi, India ; Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Nilesh Kurwale
- Centre of Excellence for Epilepsy Research (A NBRC-AIIMS Collaboration), New Delhi, India ; Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Centre of Excellence for Epilepsy Research (A NBRC-AIIMS Collaboration), New Delhi, India ; Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Genetti M, Grouiller F, Vulliemoz S, Spinelli L, Seeck M, Michel CM, Schaller K. Noninvasive language mapping in patients with epilepsy or brain tumors. Neurosurgery 2013; 72:555-65; discussion 565. [PMID: 23511822 DOI: 10.1227/neu.0b013e318282cdad] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Functional magnetic resonance imaging (fMRI) has become part of routine brain mapping in patients with epilepsy or tumor undergoing resective surgery. However, robust localization of crucial functional areas is required. OBJECTIVE To establish a simple, short fMRI task that reliably localizes crucial language areas in individual patients who undergo respective surgery. METHODS fMRI was measured during an 8-minute auditory semantic decision task in 28 healthy controls and 35 consecutive patients who had focal epilepsy or a brain tumor. Nineteen underwent resective surgery. Group and individual analyses were performed. Results in patients were compared with postsurgical language outcome and electrocortical stimulation when available. RESULTS fMRI activations concordant with the anterior and posterior language areas were found in 96% and 89% of the controls, respectively. The anterior and posterior language areas were both activated in 93% of the patients. These results were concordant with electrocortical stimulation results in 5 patients. Transient postsurgical language deficits were found in 2 patients in whom surgery was performed in the vicinity of the fMRI activations or who had postsurgical complications implicating areas of fMRI activations. CONCLUSION The proposed fast fMRI language protocol reliably localized the most relevant language areas in individual subjects. It appears to be a valuable complementary tool for surgical planning of epileptogenic foci and of brain tumors.
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Affiliation(s)
- Melanie Genetti
- Department of Neurology and Fundamental Neurosciences, Geneva University Hospitals, Geneva, Switzerland
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Trujillo-Pozo I, Martín-Monzón I, Rodríguez-Romero R. Brain lateralization and neural plasticity for musical and cognitive abilities in an epileptic musician. Front Hum Neurosci 2013; 7:829. [PMID: 24367312 PMCID: PMC3853870 DOI: 10.3389/fnhum.2013.00829] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 11/17/2013] [Indexed: 11/13/2022] Open
Abstract
The use of intracarotid propofol procedure (IPP) when assessing musical lateralization has not been reported in literature up to now. This procedure (similar to Wada Test) has provided the opportunity to investigate not only lateralization of language and memory functions on epileptic patients but also offers a functional mapping approach with superior spatial and temporal resolution to analyze the lateralization of musical abilities. Findings in literature suggest that musical training modifies functional and structural brain organization. We studied hemispheric lateralization in a professional musician, a 33 years old woman with refractory left medial temporal lobe (MTL) epilepsy (TLE). A longitudinal neuropsychological study was performed over a period of 21 months. Before epilepsy surgery, musical abilities, language and memory were tested during IPP by means of a novel and exhaustive neuropsychological battery focusing on the processing of music. We used a selection of stimuli to analyze listening, score reading, and tempo discrimination. Our results suggested that IPP is an excellent method to determine not only language, semantic, and episodic memory, but also musical dominance in a professional musician who may be candidate for epilepsy surgery. Neuropsychological testing revealed that right hemisphere's patient is involved in semantic and episodic musical memory processes, whereas her score reading and tempo processing require contribution from both hemispheres. At one-year follow-up, outcome was excellent with respect to seizures and professional skills, meanwhile cognitive abilities improved. These findings indicate that IPP helps to predict who might be at risk for postoperative musical, language, and memory deficits after epilepsy surgery. Our research suggests that musical expertise and epilepsy critically modifies long-term memory processes and induces brain structural and functional plasticity.
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Affiliation(s)
- Isabel Trujillo-Pozo
- Laboratory of Psychobiology, Faculty of Psychology, Campus Santiago Ramón y Cajal, University of SevillaSevilla, Spain
| | - Isabel Martín-Monzón
- Laboratory of Psychobiology, Faculty of Psychology, Campus Santiago Ramón y Cajal, University of SevillaSevilla, Spain
| | - Rafael Rodríguez-Romero
- Neuroradiology Unit, Radiodiagnostic Department, Virgen del Rocío University HospitalSevilla, Spain
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Zhang X, Zhang G, Yu T, Ni D, Cai L, Qiao L, Du W, Li Y. Surgical treatment for epilepsy involving language cortices: A combined process of electrical cortical stimulation mapping and intra-operative continuous language assessment. Seizure 2013; 22:780-6. [DOI: 10.1016/j.seizure.2013.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 06/11/2013] [Accepted: 06/12/2013] [Indexed: 11/29/2022] Open
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Pahs G, Rankin P, Helen Cross J, Croft L, Northam GB, Liegeois F, Greenway S, Harrison S, Vargha-Khadem F, Baldeweg T. Asymmetry of planum temporale constrains interhemispheric language plasticity in children with focal epilepsy. ACTA ACUST UNITED AC 2013; 136:3163-75. [PMID: 24022474 PMCID: PMC4038779 DOI: 10.1093/brain/awt225] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Reorganization of eloquent cortex enables rescue of language functions in patients who sustain brain injury. Individuals with left-sided, early-onset focal epilepsy often show atypical (i.e. bilateral or right-sided) language dominance. Surprisingly, many patients fail to show such interhemispheric shift of language despite having major epileptogenic lesions in close proximity to eloquent cortex. Although a number of epilepsy-related factors may promote interhemispheric plasticity, it has remained unexplored if neuroanatomical asymmetries linked to human language dominance modify the likelihood of atypical lateralization. Here we examined the asymmetry of the planum temporale, one of the most striking asymmetries in the human brain, in relation to language lateralization in children with left-sided focal epilepsy. Language functional magnetic resonance imaging was performed in 51 children with focal epilepsy and left-sided lesions and 36 healthy control subjects. We examined the association of language laterality with a range of potential clinical predictors and the asymmetry of the length of the planum temporale. Using voxel-based methods, we sought to determine the effect of lesion location (in the affected left hemisphere) and grey matter density (in the unaffected right hemisphere) on language laterality. Atypical language lateralization was observed in 19 patients (38%) and in four controls (11%). Language laterality was increasingly right-sided in patients who showed atypical handedness, a left perisylvian ictal electroencephalographic focus, and a lesion in left anterior superior temporal or inferior frontal regions. Most striking was the relationship between rightward asymmetry of the planum temporale and atypical language (R = 0.70, P < 0.0001); patients with a longer planum temporale in the right (unaffected) hemisphere were more likely to have atypical language dominance. Voxel-based regression analysis confirmed that increased grey matter density in the right temporo-parietal junction was correlated with right hemisphere lateralization of language. The length of the planum temporale in the right hemisphere was the main predictor of language lateralization in the epilepsy group, accounting for 48% of variance, with handedness accounting for only a further 5%. There was no correlation between language lateralization and planum temporale asymmetry in the control group. We conclude that asymmetry of the planum temporale may be unrelated to language lateralization in healthy individuals, but the size of the right, contra-lesional planum temporale region may reflect a ‘reserve capacity’ for interhemispheric language reorganization in the presence of a seizure focus and lesions within left perisylvian regions.
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Affiliation(s)
- Gerald Pahs
- 1 Developmental Cognitive Neuroscience Unit, Institute of Child Health, University College London, London, WC1N 1EH, UK
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Rosazza C, Ghielmetti F, Minati L, Vitali P, Giovagnoli A, Deleo F, Didato G, Parente A, Marras C, Bruzzone M, D'Incerti L, Spreafico R, Villani F. Preoperative language lateralization in temporal lobe epilepsy (TLE) predicts peri-ictal, pre- and post-operative language performance: An fMRI study. Neuroimage Clin 2013; 3:73-83. [PMID: 24179851 PMCID: PMC3807502 DOI: 10.1016/j.nicl.2013.07.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 05/31/2013] [Accepted: 07/01/2013] [Indexed: 11/15/2022]
Abstract
In patients with temporal lobe epilepsy (TLE), assessment of language lateralization is important as anterior temporal lobectomy may lead to language impairments. Despite the widespread use of fMRI, evidence of its usefulness in predicting postsurgical language performance is scant. We investigated whether preoperative functional lateralization is related to the preoperative language performance, peri-ictal aphasia, and can predict language outcome one year post-surgery. We studied a total of 72 TLE patients (42 left, 30 right), by using three fMRI tasks: Naming, Verb Generation and Fluency. Functional lateralization indices were analyzed with neuropsychological scores and presence of peri-ictal aphasia. The key findings are:1)Both left and right TLE patients show decreased left lateralization compared to controls.2)Lateralization correlates with language performance before surgery. In left TLE, decreased left lateralization correlates with better fluency performance. In right TLE, increased left lateralization during the Naming task correlates with better naming.3)Left lateralization correlates with peri-ictal aphasia in left TLE patients.4)Lateralization correlates with language performance after surgery. In a subgroup of left TLE who underwent surgery (17 left), decreased left lateralization is predictive of better naming performance at 6 and 12 months after surgery. The present study highlights the clinical relevance of fMRI language lateralization in TLE, especially to predict language outcome one year post-surgery. We also underline the importance of using fMRI tasks eliciting frontal and anterior temporal activations, when studying left and right TLE patients.
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Affiliation(s)
- C. Rosazza
- Neuroradiology Dept., Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
- Scientific Dept., Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
| | - F. Ghielmetti
- Neuroradiology Dept., Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
- Health Dept., Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
| | - L. Minati
- Scientific Dept., Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
| | - P. Vitali
- Brain MRI 3T Mondino Research Center, Istituto Neurologico “C. Mondino”, Pavia, Italy
| | - A.R. Giovagnoli
- Neuropsychology Laboratory, Dept. of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
| | - F. Deleo
- Division of Clinical Epileptology and Experimental Neurophysiology, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
| | - G. Didato
- Division of Clinical Epileptology and Experimental Neurophysiology, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
| | - A. Parente
- Neuropsychology Laboratory, Dept. of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
| | - C. Marras
- Neurosurgery Dept., Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
- Dept. of Neuroscience Bambino Gesù Children Hospital, Rome, Italy
| | - M.G. Bruzzone
- Neuroradiology Dept., Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
| | - L. D'Incerti
- Neuroradiology Dept., Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
| | - R. Spreafico
- Division of Clinical Epileptology and Experimental Neurophysiology, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
| | - F. Villani
- Division of Clinical Epileptology and Experimental Neurophysiology, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
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Stretton J, Winston GP, Sidhu M, Bonelli S, Centeno M, Vollmar C, Cleary RA, Williams E, Symms MR, Koepp MJ, Thompson PJ, Duncan JS. Disrupted segregation of working memory networks in temporal lobe epilepsy. NEUROIMAGE-CLINICAL 2013; 2:273-81. [PMID: 24179782 PMCID: PMC3777779 DOI: 10.1016/j.nicl.2013.01.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 01/04/2013] [Accepted: 01/22/2013] [Indexed: 11/30/2022]
Abstract
Working memory is a critical building block for almost all cognitive tasks, and impairment can cause significant disruption to daily life routines. We investigated the functional connectivity (FC) of the visuo-spatial working memory network in temporal lobe epilepsy and its relationship to the underlying white matter tracts emanating from the hippocampus. Fifty-two patients with unilateral hippocampal sclerosis (HS) (30 left) and 30 healthy controls underwent working memory functional MRI (fMRI) and Diffusion Tensor Imaging (DTI). Six seed regions were identified for FC analysis; 4 within a task-positive network (left and right middle frontal gyri and superior parietal lobes), and 2 within a task-negative network (left and right hippocampi). FC maps were created by extracting the time-series of the fMRI signal in each region in each subject and were used as regressors of interest for additional GLM fMRI analyses. Structural connectivity (SC) corresponding to areas to which the left and right hippocampi were connected was determined using tractography, and a mean FA for each hippocampal SC map was calculated. Both left and right HS groups showed atypical FC between task-positive and task-negative networks compared to controls. This was characterised by co-activation of the task-positive superior parietal lobe ipsilateral to the typically task-negative sclerosed hippocampus. Correlational analysis revealed stronger FC between superior parietal lobe and ipsilateral hippocampus, was associated with worse performance in each patient group. The SC of the hippocampus was associated with the intra-hemispheric FC of the superior parietal lobe, in that greater SC was associated with weaker parieto-frontal FC. The findings suggest that the segregation of the task-positive and task-negative FC networks supporting working memory in TLE is disrupted, and is associated with abnormal structural connectivity of the sclerosed hippocampus. Co-activation of parieto-temporal regions was associated with poorer working memory and this may be associated with working memory dysfunction in TLE.
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Affiliation(s)
- J Stretton
- Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
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Masterton RA, Carney PW, Jackson GD. Cortical and thalamic resting-state functional connectivity is altered in childhood absence epilepsy. Epilepsy Res 2012; 99:327-34. [DOI: 10.1016/j.eplepsyres.2011.12.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 12/14/2011] [Accepted: 12/20/2011] [Indexed: 10/14/2022]
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40
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Bonelli SB, Thompson PJ, Yogarajah M, Vollmar C, Powell RHW, Symms MR, McEvoy AW, Micallef C, Koepp MJ, Duncan JS. Imaging language networks before and after anterior temporal lobe resection: results of a longitudinal fMRI study. Epilepsia 2012; 53:639-50. [PMID: 22429073 PMCID: PMC4471632 DOI: 10.1111/j.1528-1167.2012.03433.x] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Summary Purpose: Anterior temporal lobe resection (ATLR) controls seizures in up to 70% of patients with intractable temporal lobe epilepsy (TLE) but, in the language dominant hemisphere, may impair language function, particularly naming. Functional reorganization can occur within the ipsilateral and contralateral hemispheres. We investigated reorganization of language in left-hemisphere–dominant patients before and after ATLR; whether preoperative functional magnetic resonance imaging (fMRI) predicts postoperative naming decline; and efficiency of postoperative language networks. Methods: We studied 44 patients with TLE due to unilateral hippocampal sclerosis (24 left) on a 3T GE-MRI scanner. All subjects performed language fMRI and neuropsychological testing preoperatively and again 4 months after left or right ATLR. Key Findings: Postoperatively, individuals with left TLE had greater bilateral middle/inferior frontal fMRI activation and stronger functional connectivity from the left inferior/middle frontal gyri to the contralateral frontal lobe than preoperatively, and this was not observed in individuals with right TLE. Preoperatively, in left and right TLE, better naming correlated with greater preoperative left hippocampal and left frontal activation for verbal fluency (VF). In left TLE, stronger preoperative left middle frontal activation for VF was predictive of greater decline in naming after ATLR. Postoperatively, in left TLE with clinically significant naming decline, greater right middle frontal VF activation correlated with better postoperative naming. In patients without postoperative naming decline, better naming correlated with greater activation in the remaining left posterior hippocampus. In right TLE, naming ability correlated with left hippocampal and left and right frontal VF activation postoperatively. Significance: In left TLE, early postoperative reorganization to the contralateral frontal lobe suggests multiple systems support language function. Postoperatively, ipsilateral recruitment involving the posterior hippocampal remnant is important for maintaining language, and reorganization to the contralateral hemisphere is less effective. Preoperative left middle frontal activation for VF was predictive of naming decline in left TLE after ATLR.
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Affiliation(s)
- Silvia B Bonelli
- Epilepsy Society MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
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41
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Language mapping in temporal lobe epilepsy in children: special considerations. EPILEPSY RESEARCH AND TREATMENT 2012; 2012:837036. [PMID: 22957246 PMCID: PMC3420711 DOI: 10.1155/2012/837036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 11/06/2011] [Indexed: 02/01/2023]
Abstract
Temporal lobe epilepsy (TLE) in children is a slightly different entity than TLE in adults not only because of its semiology and pathology but also because of the different approach to surgical treatment. Presurgical investigations for eloquent cortex, especially language, must take these differences into account. Most diagnostic tests were created for adults, and many of the assessment tools need to be adapted for children because they are not just small adults. This paper will highlight the specific challenges and solutions in mapping language in a pediatric population with TLE.
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42
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Helmstaedter C, Witt JA. Clinical neuropsychology in epilepsy: theoretical and practical issues. HANDBOOK OF CLINICAL NEUROLOGY 2012; 107:437-459. [PMID: 22938988 DOI: 10.1016/b978-0-444-52898-8.00036-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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43
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Politi K, Kivity S, Goldberg-Stern H, Halevi A, Shuper A. Selective mutism and abnormal electroencephalography (EEG) tracings. J Child Neurol 2011; 26:1377-82. [PMID: 21596703 DOI: 10.1177/0883073811406731] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Epileptic discharges are not considered a part of the clinical picture of selective mutism, and electroencephalography is generally not recommended in its work-up. This report describes 6 children with selective mutism who were found to have a history of epilepsy and abnormal interictal or subclinical electroencephalography recordings. Two of them had benign epilepsy of childhood with centro-temporal spikes. The mutism was not related in time to the presence of active seizures. While seizures could be controlled in all children by medications, the mutism resolved only in 1. Although the discharges could be coincidental, they might represent a co-morbidity of selective mutism or even play a role in its pathogenesis. Selective mutism should be listed among the psychiatric disorders that may be associated with electroencephalographic abnormalities. It can probably be regarded as a symptom of a more complicated organic brain disorder.
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Affiliation(s)
- Keren Politi
- Department of Pediatric and Adolescent Neurology, Schneider Children's Medical Center of Israel, Petah Tiqwa, Israel
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44
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Hamberger MJ, Cole J. Language organization and reorganization in epilepsy. Neuropsychol Rev 2011; 21:240-51. [PMID: 21842185 PMCID: PMC3193181 DOI: 10.1007/s11065-011-9180-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 07/31/2011] [Indexed: 10/17/2022]
Abstract
The vast majority of healthy individuals are left hemisphere dominant for language; however, individuals with left hemisphere epilepsy have a higher likelihood of atypical language organization. The cerebral organization of language in epilepsy has been studied with invasive procedures such as Wada testing and electrical cortical stimulation mapping (ESM), and more recently, with noninvasive neuroimaging techniques such as functional magnetic resonance imaging (fMRI). Investigators have used these techniques to explore the influence of unique clinical features inherent in epilepsy that might contribute to the reorganization of language, such as location of seizure onset, age of seizure onset, and extent of interictal epileptiform activity. In this paper, we review the contribution of these and other clinical variables to the lateralization and localization of language in epilepsy, and how these patient-related variables affect the results from these three different, yet complementary methodologies. Unlike the abrupt language changes that occur following acute brain injury with disruption of established language circuits, converging evidence suggests that the chronic nature of epileptic activity can result in a developmental shift of language from the left to the right hemisphere or re-routing of language pathways from traditional to non-traditional areas within the dominant left hemisphere. Clinical variables have been shown to contribute to cerebral language reorganization in the setting of chronic seizure disorders, yet such factors have not been reliable predictors of altered language networks in individual patients, underscoring the need for language lateralization and localization procedures when definitive identification of language cortex is necessary for clinical care.
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Affiliation(s)
- Marla J Hamberger
- The Neurological Institute, Columbia University Medical Center, 710 West 168th Street, 7th floor, New York, NY 10032, USA.
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45
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Atypical language lateralisation associated with right fronto-temporal grey matter increases--a combined fMRI and VBM study in left-sided mesial temporal lobe epilepsy patients. Neuroimage 2011; 59:728-37. [PMID: 21839176 DOI: 10.1016/j.neuroimage.2011.07.053] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 06/09/2011] [Accepted: 07/18/2011] [Indexed: 12/30/2022] Open
Abstract
By combining language functional magnetic resonance imaging and voxel-based morphometry in patients with left-sided mesial temporal lobe epilepsy and hippocampal sclerosis, we studied whether atypical language dominance is associated with temporal and/or extratemporal cortical changes. Using verbal fluency functional magnetic resonance imaging for language lateralisation, we identified 20 patients with left-sided mesial temporal lobe epilepsy with hippocampal sclerosis and atypical language lateralisation. These patients were compared with a group of 20 matched left-sided mesial temporal lobe epilepsy patients who had typical language lateralisation. Using T1-weighted 3D images of all patients and voxel-based morphometry, we compared grey matter volumes between the groups of patients. We also correlated grey matter volumes with the degree of atypical language activation. Patients with atypical language lateralisation had increases of grey matter volumes, mainly within right-sided temporo-lateral cortex (x=59, y=-16, z=-1, T=6.36, p<.001 corrected), and less significantly within frontal brain regions compared to patients with typical language lateralisation. The degree of atypical fronto-temporal language activation (measured by lateralisation indices and relative functional magnetic resonance imaging activity) was correlated with right-sided temporal and frontal grey matter volumes. Patients with atypical language lateralisation did not differ in terms of language performance from patients with typical language dominance. Atypical language lateralisation in patients with left-sided mesial temporal lobe epilepsy was associated with increased grey matter volume within the non-epileptic right temporal and frontal lobe. Grey matter increases associated with atypical language might represent morphological changes underlying functional reorganisation of the language network. This hard-wired reorganised atypical language network seems to be suitable to support language functions.
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Perlaki G, Orsi G, Kovacs N, Schwarcz A, Pap Z, Kalmar Z, Plozer E, Csatho A, Gabriel R, Komoly S, Janszky I, Janszky J. Coffee consumption may influence hippocampal volume in young women. Brain Imaging Behav 2011; 5:274-84. [DOI: 10.1007/s11682-011-9131-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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47
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Kalmar Z, Kovacs N, Perlaki G, Nagy F, Aschermann Z, Kerekes Z, Kaszas B, Balas I, Orsi G, Komoly S, Schwarcz A, Janszky J. Reorganization of Motor System in Parkinson’s Disease. Eur Neurol 2011; 66:220-6. [DOI: 10.1159/000330658] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 06/22/2011] [Indexed: 11/19/2022]
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Kovac S, Möddel G, Reinholz J, Alexopoulos A, Syed T, Koubeissi M, Schuele S, Lineweaver T, Busch R, Loddenkemper T. Visual naming performance after ATL resection: Impact of atypical language dominance. Neuropsychologia 2010; 48:2221-5. [DOI: 10.1016/j.neuropsychologia.2010.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2009] [Revised: 03/05/2010] [Accepted: 03/09/2010] [Indexed: 11/29/2022]
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Warren JE, Crinion JT, Lambon Ralph MA, Wise RJS. Anterior temporal lobe connectivity correlates with functional outcome after aphasic stroke. ACTA ACUST UNITED AC 2010; 132:3428-42. [PMID: 19903736 PMCID: PMC2792371 DOI: 10.1093/brain/awp270] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Focal brain lesions are assumed to produce language deficits by two basic mechanisms: local cortical dysfunction at the lesion site, and remote cortical dysfunction due to disruption of the transfer and integration of information between connected brain regions. However, functional imaging studies investigating language outcome after aphasic stroke have tended to focus only on the role of local cortical function. In this positron emission tomography functional imaging study, we explored relationships between language comprehension performance after aphasic stroke and the functional connectivity of a key speech-processing region in left anterolateral superior temporal cortex. We compared the organization of left anterolateral superior temporal cortex functional connections during narrative speech comprehension in normal subjects with left anterolateral superior temporal cortex connectivity in a group of chronic aphasic stroke patients. We then evaluated the language deficits associated with altered left anterolateral superior temporal cortex connectivity in aphasic stroke. During normal narrative speech comprehension, left anterolateral superior temporal cortex displayed positive functional connections with left anterior basal temporal cortex, left inferior frontal gyrus and homotopic cortex in right anterolateral superior temporal cortex. As a group, aphasic patients demonstrated a selective disruption of the normal functional connection between left and right anterolateral superior temporal cortices. We observed that deficits in auditory single word and sentence comprehension correlated both with the degree of disruption of left-right anterolateral superior temporal cortical connectivity and with local activation in the anterolateral superior temporal cortex. Subgroup analysis revealed that aphasic patients with preserved positive intertemporal connectivity displayed better receptive language function; these patients also showed greater than normal left inferior frontal gyrus activity, suggesting a possible ‘top-down’ compensatory mechanism. These results demonstrate that functional connectivity between anterolateral superior temporal cortex and right anterior superior temporal cortex is a marker of receptive language outcome after aphasic stroke, and illustrate that language system organization after focal brain lesions may be marked by complex signatures of altered local and pathway-level function.
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Affiliation(s)
- Jane E Warren
- Cognitive Neuroimaging Group, MRC Cyclotron Unit, Hammersmith Hospital, London W120NN, UK.
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50
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Toth V, Fogarasi A, Karadi K, Kovacs N, Ebner A, Janszky J. Ictal affective symptoms in temporal lobe epilepsy are related to gender and age. Epilepsia 2009; 51:1126-32. [DOI: 10.1111/j.1528-1167.2009.02396.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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