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Drane DL, Acerbo E, Rogers A, Pedersen NP, Williamson A, Stern MA, Dickey AS, Howard BM, Bearden DJ, Okada N, Staikova E, Gutekunst CA, Alwaki A, Gershon T, Jirsa V, Gross RE, Loring DW, Kheder A, Willie JT. Selective Posterior Cerebral Artery Wada Better Predicts Good Memory and Naming Outcomes Following Selective Stereotactic Thermal Ablation for Medial Temporal Lobe Epilepsy Than Internal Carotid Artery Wada. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.24.24304488. [PMID: 38585976 PMCID: PMC10996748 DOI: 10.1101/2024.03.24.24304488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
The conventional intracarotid amobarbital (Wada) test has been used to assess memory function in patients being considered for temporal lobe epilepsy (TLE) surgery. Minimally invasive approaches that target the medial temporal lobe (MTL) and spare neocortex are increasingly used, but a knowledge gap remains in how to assess memory and language risk from these procedures. We retrospectively compared results of two versions of the Wada test, the intracarotid artery (ICA-Wada) and posterior cerebral artery (PCA-Wada) approaches, with respect to predicting subsequent memory and language outcomes, particularly after stereotactic laser amygdalohippocampotomy (SLAH). We included all patients being considered for SLAH who underwent both ICA-Wada and PCA-Wada at a single institution. Memory and confrontation naming assessments were conducted using standardized neuropsychological tests to assess pre- to post-surgical changes in cognitive performance. Of 13 patients who initially failed the ICA-Wada, only one patient subsequently failed the PCA-Wada (p=0.003, two-sided binomial test with p 0 =0.5) demonstrating that these tests assess different brain regions or networks. PCA-Wada had a high negative predictive value for the safety of SLAH, compared to ICA-Wada, as none of the patients who underwent SLAH after passing the PCA-Wada experienced catastrophic memory decline (0 of 9 subjects, p <.004, two-sided binomial test with p 0 =0.5), and all experienced a good cognitive outcome. In contrast, the single patient who received a left anterior temporal lobectomy after failed ICA- and passed PCA-Wada experienced a persistent, near catastrophic memory decline. On confrontation naming, few patients exhibited disturbance during the PCA-Wada. Following surgery, SLAH patients showed no naming decline, while open resection patients, whose surgeries all included ipsilateral temporal lobe neocortex, experienced significant naming difficulties (Fisher's exact test, p <.05). These findings demonstrate that (1) failing the ICA-Wada falsely predicts memory decline following SLAH, (2) PCA-Wada better predicts good memory outcomes of SLAH for MTLE, and (3) the MTL brain structures affected by both PCA-Wada and SLAH are not directly involved in language processing.
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Reindl C, Walther K, Allgäuer AL, Lang JD, Welte TM, Stritzelberger J, Gollwitzer S, Schwarz M, Trollmann R, Madzar D, Knott M, Doerfler A, Seifert F, Rössler K, Brandner S, Rampp S, Schwab S, Hamer HM. Age of epilepsy onset as modulating factor for naming deficit after epilepsy surgery: a voxel-based lesion-symptom mapping study. Sci Rep 2023; 13:14395. [PMID: 37658152 PMCID: PMC10474263 DOI: 10.1038/s41598-023-40722-4] [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: 05/13/2023] [Accepted: 08/16/2023] [Indexed: 09/03/2023] Open
Abstract
Age at onset of epilepsy is an important predictor of deterioration in naming ability following epilepsy surgery. In 141 patients with left hemispheric epilepsy and language dominance who received epilepsy surgery at the Epilepsy Centre Erlangen, naming of objects (Boston naming test, BNT) was assessed preoperatively and 6 months postoperatively. Surgical lesions were plotted on postoperative MRI and normalized for statistical analysis using voxel-based lesion-symptom mapping (VBLSM). The correlation between lesion and presence of postoperative naming deterioration was examined varying the considered age range of epilepsy onsets. The VBLSM analysis showed that volumes of cortex areas in the left temporal lobe, which were associated with postoperative decline of naming, increased with each year of later epilepsy onset. In patients with later onset, an increasing left posterior temporobasal area was significantly associated with a postoperative deficit when included in the resection. For late epilepsy onset, the temporomesial expansion also included the left hippocampus. The results underline that early onset of epilepsy is a good prognostic factor for unchanged postoperative naming ability following epilepsy surgery. For later age of epilepsy onset, the extent of the area at risk of postoperative naming deficit at 6 months after surgery included an increasing left temporobasal area which finally also comprised the hippocampus.
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Affiliation(s)
- Caroline Reindl
- Epilepsy Center Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Katrin Walther
- Epilepsy Center Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Anna-Lena Allgäuer
- Epilepsy Center Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Johannes D Lang
- Epilepsy Center Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Tamara M Welte
- Epilepsy Center Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Jenny Stritzelberger
- Epilepsy Center Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Stephanie Gollwitzer
- Epilepsy Center Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Michael Schwarz
- Epilepsy Center Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Regina Trollmann
- Department of Neuropaediatrics, University Hospital Erlangen, Erlangen, Germany
| | - Dominik Madzar
- Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Michael Knott
- Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
| | - Arnd Doerfler
- Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
| | - Frank Seifert
- Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Karl Rössler
- Department of Neurosurgery, University Hospital Vienna (AKH), Vienna, Austria
| | - Sebastian Brandner
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany
| | - Stefan Rampp
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany
- Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
- Department of Neurosurgery, University Hospital Halle (Saale), Halle, Germany
| | - Stefan Schwab
- Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Hajo M Hamer
- Epilepsy Center Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
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Georgiou E(EZ, Prapiadou S, Thomopoulos V, Skondra M, Charalampopoulou M, Pachi A, Anagnostopoulou Α, Vorvolakos T, Perneczky R, Politis A, Alexopoulos P. Naming ability assessment in neurocognitive disorders: a clinician's perspective. BMC Psychiatry 2022; 22:837. [PMID: 36585667 PMCID: PMC9801565 DOI: 10.1186/s12888-022-04486-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Detecting impaired naming capacity is valuable in diagnosing neurocognitive disorders (ND). A. clinical practice- oriented overview of naming tests validated in ND is not available yet. Here, features of naming tests with validated utility in ND which are open access or available for purchase are succinctly presented and compared. METHODS Searches were carried out across Pubmed, Medline and Google Scholar. Additional studies were identified by searching reference lists. Only peer-reviewed journal articles were eligible. A narrative- and tabullar synthesis was used to summarize different aspects of the naming assessment instruments used in patients with ND such as stimuli type, administration time, assessment parameters and accessibility. Based on computational word frequency calculations, the tests were compared in terms of the average frequency of their linguistic content. RESULTS Twelve naming tests, relying either on visual or auditory stimuli have been validated in ND. Their content and administration time vary between three and 60 items and one and 20 minutes, respectively. The average frequency of the words of each considered test was two or lower, pointing to low frequency of most items. In all but one test, scoring systems are exclusively based on correctly named items. Seven instruments are open access and four are available in more than one language. CONCLUSIONS Gaining insights into naming tests' characteristics may catalyze the wide incorporation of those with short administration time but high diagnostic accuracy into the diagnostic workup of ND at primary healthcare and of extensive, visual or auditory ones into the diagnostic endeavors of memory clinics, as well as of secondary and tertiary brain healthcare settings.
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Affiliation(s)
- Eliza ( Eleni-Zacharoula) Georgiou
- grid.11047.330000 0004 0576 5395Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Savvina Prapiadou
- grid.11047.330000 0004 0576 5395Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Vasileios Thomopoulos
- grid.11047.330000 0004 0576 5395Large-Scale Machine Learning & Cloud Data Engineering Laboratory (ML@Cloud-Lab), Faculty of Computer Engineering & Informatics, School of Engineering, University of Patras, Patras, Greece
| | - Maria Skondra
- grid.11047.330000 0004 0576 5395Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Marina Charalampopoulou
- grid.11047.330000 0004 0576 5395Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Asimina Pachi
- grid.11047.330000 0004 0576 5395Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Αlexandra Anagnostopoulou
- grid.11047.330000 0004 0576 5395Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece ,General Hospital of Zakynthos “Saint Dionysios”, Zakynthos, Greece
| | - Theofanis Vorvolakos
- grid.12284.3d0000 0001 2170 8022Department of Psychiatry, Faculty of Medicine, School of Health Sciences, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Robert Perneczky
- grid.5252.00000 0004 1936 973XDivision of Mental Health in Older Adults and Alzheimer Therapy and Research Center, Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany ,grid.7445.20000 0001 2113 8111Ageing Epidemiology (AGE) Research Unit, School of Public Health, Faculty of Medicine, The Imperial College of Science, Technology and Medicine, London, UK ,grid.424247.30000 0004 0438 0426German Center for Neurodegenerative Diseases (DZNE) Munich, Munich, Germany ,grid.452617.3Munich Cluster for Systems Neurology (SyNergy), Munich, Germany ,grid.11835.3e0000 0004 1936 9262Sheffield Institute for Translational Neurosciences (SITraN), University of Sheffield, Sheffield, UK
| | - Antonios Politis
- grid.5216.00000 0001 2155 0800First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece ,grid.21107.350000 0001 2171 9311Department of Psychiatry, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins Medical School, Baltimore, USA
| | - Panagiotis Alexopoulos
- Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece. .,Global Brain Health Institute, Medical School, Trinity College Dublin, The University of Dublin, Dublin, Republic of Ireland. .,Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Faculty of Medicine, Technical University of Munich, Munich, Germany. .,Patras Dementia Day Care Center, Corporation for Succor and Care of Elderly and Disabled - FRODIZO, Patras, Greece.
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Kaestner E, Stasenko A, Ben-Haim S, Shih J, Paul BM, McDonald CR. The importance of basal-temporal white matter to pre- and post-surgical naming ability in temporal lobe epilepsy. Neuroimage Clin 2022; 34:102963. [PMID: 35220106 PMCID: PMC8888987 DOI: 10.1016/j.nicl.2022.102963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/15/2021] [Accepted: 02/07/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Emerging research highlights the importance of basal-temporal cortex, centered on the fusiform gyrus, to both pre-surgical naming ability and post-surgical naming outcomes in temporal lobe epilepsy (TLE). In this study, we investigate whether integrity of the white matter network that interconnects this basal region to the distributed language network affects naming ability and risk for post-surgical naming decline. METHODS Patients with drug-resistant TLE were recruited from two epilepsy centers in a prospective longitudinal study. The pre-surgical dataset included 50 healthy controls, 47 left TLE (L-TLE), and 41 right TLE (R-TLE) patients. All participants completed pre-surgical T1- and diffusion-weighted MRI (dMRI), as well as neuropsychological tests of auditory and visual naming. Nineteen L-TLE and 18 R-TLE patients underwent anterior temporal lobectomy (ATL) and also completed post-surgical neuropsychological testing. Pre-surgical fractional anisotropy (FA) of the white matter directly beneath the fusiform neocortex (i.e., superficial white matter; SWM) and of deep white matter tracts with connections to the basal-temporal cortex [inferior longitudinal fasciculus (ILF) and inferior frontal occipital fasciculus (IFOF)] was calculated. Clinical variables, hippocampal volume, and FA of each white matter tract or region were examined in linear regressions with naming scores, or change in naming scores, as the primary outcomes. RESULTS Pre-surgically, higher FA in the bilateral ILF, bilateral IFOF, and left fusiform SWM was associated with better visual and auditory naming scores (all ps < 0.05 with FDR correction). In L-TLE, higher pre-surgical FA was also associated with less naming decline post-surgically, but results varied across tracts. When including only patients with typical language dominance, only integrity of the right fusiform SWM was associated with less visual naming decline (p = .0018). DISCUSSION Although a broad network of white matter network matter may contribute to naming ability pre-surgically, the reserve capacity of the contralateral (right) fusiform SWM may be important for mitigating visual naming decline following ATL in L-TLE. This shows that the study of the structural network interconnecting the basal-temporal region to the wider language network has implications for understanding both pre- and post-surgical naming in TLE.
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Affiliation(s)
- Erik Kaestner
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | - Alena Stasenko
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | - Sharona Ben-Haim
- Department of Neurosurgery, University of California, San Diego, CA, USA
| | - Jerry Shih
- Department of Neurosurgery, University of California, San Diego, CA, USA
| | - Brianna M Paul
- Department of Neurology, University of California -San Francisco, San Francisco, CA, USA
| | - Carrie R McDonald
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
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McDonald CR. Removing Basal Temporal Language Cortex in Epilepsy Surgery: Short-Term Disruption or Long-Lasting Problem? Epilepsy Curr 2021; 21:329-331. [PMID: 34924825 PMCID: PMC8655261 DOI: 10.1177/15357597211025134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Bidirectional propagation of low frequency oscillations over the human hippocampal surface. Nat Commun 2021; 12:2764. [PMID: 33980852 PMCID: PMC8115072 DOI: 10.1038/s41467-021-22850-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 04/01/2021] [Indexed: 02/03/2023] Open
Abstract
The hippocampus is diversely interconnected with other brain systems along its axis. Cycles of theta-frequency activity are believed to propagate from the septal to temporal pole, yet it is unclear how this one-way route supports the flexible cognitive capacities of this structure. We leveraged novel thin-film microgrid arrays conformed to the human hippocampal surface to track neural activity two-dimensionally in vivo. All oscillation frequencies identified between 1-15 Hz propagated across the tissue. Moreover, they dynamically shifted between two roughly opposite directions oblique to the long axis. This predominant propagation axis was mirrored across participants, hemispheres, and consciousness states. Directionality was modulated in a participant who performed a behavioral task, and it could be predicted by wave amplitude topography over the hippocampal surface. Our results show that propagation directions may thus represent distinct meso-scale network computations, operating along versatile spatiotemporal processing routes across the hippocampal body.
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Aron O, Jonas J, Colnat-Coulbois S, Maillard L. Language Mapping Using Stereo Electroencephalography: A Review and Expert Opinion. Front Hum Neurosci 2021; 15:619521. [PMID: 33776668 PMCID: PMC7987679 DOI: 10.3389/fnhum.2021.619521] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/11/2021] [Indexed: 11/25/2022] Open
Abstract
Stereo-electroencephalography (sEEG) is a method that uses stereotactically implanted depth electrodes for extra-operative mapping of epileptogenic and functional networks. sEEG derived functional mapping is achieved using electrical cortical stimulations (ECS) that are currently the gold standard for delineating eloquent cortex. As this stands true especially for primary cortices (e.g., visual, sensitive, motor, etc.), ECS applied to higher order brain areas determine more subtle behavioral responses. While anterior and posterior language areas in the dorsal language stream seem to share characteristics with primary cortices, basal temporal language area (BTLA) in the ventral temporal cortex (VTC) behaves as a highly associative cortex. After a short introduction and considerations about methodological aspects of ECS using sEEG, we review the sEEG language mapping literature in this perspective. We first establish the validity of this technique to map indispensable language cortices in the dorsal language stream. Second, we highlight the contrast between the growing empirical ECS experience and the lack of understanding regarding the fundamental mechanisms underlying ECS behavioral effects, especially concerning the dispensable language cortex in the VTC. Evidences for considering network architecture as determinant for ECS behavioral response complexities are discussed. Further, we address the importance of designing new research in network organization of language as this could enhance ECS ability to map interindividual variability, pathology driven reorganization, and ultimately identify network resilience markers in order to better predict post-operative language deficit. Finally, based on a whole body of available studies, we believe there is strong evidence to consider sEEG as a valid, safe and reliable method for defining eloquent language cortices although there have been no proper comparisons between surgical resections with or without extra-operative or intra-operative language mapping.
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Affiliation(s)
- Olivier Aron
- Department of Neurology, Nancy University Hospital Center, Nancy, France
- CRAN, Université́ de Lorraine, CNRS, Nancy, France
| | - Jacques Jonas
- Department of Neurology, Nancy University Hospital Center, Nancy, France
- CRAN, Université́ de Lorraine, CNRS, Nancy, France
| | | | - Louis Maillard
- Department of Neurology, Nancy University Hospital Center, Nancy, France
- CRAN, Université́ de Lorraine, CNRS, Nancy, France
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Helmstaedter C, Sadat-Hossieny Z, Kanner AM, Meador KJ. Cognitive disorders in epilepsy II: Clinical targets, indications and selection of test instruments. Seizure 2020; 83:223-231. [PMID: 33172763 DOI: 10.1016/j.seizure.2020.09.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 12/26/2022] Open
Abstract
This is the second of two narrative reviews on cognitive disorders in epilepsy (companion manuscript: Cognitive disorders in epilepsy I: Clinical experience, real-world evidence and recommendations). Its focus is on the clinical targets, indications, and the selection of neuropsychological test instruments. Cognitive assessment has become an essential tool for the diagnosis and outcome control in the clinical management of epilepsy. The diagnostics of basic and higher brain functions can provide valuable information on lateralized and localized brain dysfunctions associated with epilepsy, its underlying pathologies and treatment. In addition to the detection or verification of deficits, neuropsychology reveals the patient's cognitive strengths and, thus, information about the patient reserve capacities for functional restitution and compensation. Neuropsychology is an integral part of diagnostic evaluations mainly in the context of epilepsy surgery to avoid new or additional damage to preexisting neurocognitive impairments. In addition and increasingly, neuropsychology is being used as a tool for monitoring of the disease and its underlying pathologies, and it is suited for the quality and outcome control of pharmacological or other non-invasive medical intervention. This narrative review summarizes the present state of neuropsychological assessments in epilepsy, reveals diagnostic gaps, and shows the great need for education, homogenization, translation and standardization of instruments.
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Affiliation(s)
- C Helmstaedter
- University Clinic Bonn, Department of Epileptology, Germany.
| | - Z Sadat-Hossieny
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, 213 Quarry Road, MC 5979, CA, 94304, USA
| | - A M Kanner
- University of Miami Health System, Uhealth Neurology, 1150 NW 14th St #609, Miami, FL 33136, USA
| | - K J Meador
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, 213 Quarry Road, MC 5979, CA, 94304, USA
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Binder JR, Tong JQ, Pillay SB, Conant LL, Humphries CJ, Raghavan M, Mueller WM, Busch RM, Allen L, Gross WL, Anderson CT, Carlson CE, Lowe MJ, Langfitt JT, Tivarus ME, Drane DL, Loring DW, Jacobs M, Morgan VL, Allendorfer JB, Szaflarski JP, Bonilha L, Bookheimer S, Grabowski T, Vannest J, Swanson SJ. Temporal lobe regions essential for preserved picture naming after left temporal epilepsy surgery. Epilepsia 2020; 61:1939-1948. [PMID: 32780878 DOI: 10.1111/epi.16643] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/10/2020] [Accepted: 07/20/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To define left temporal lobe regions where surgical resection produces a persistent postoperative decline in naming visual objects. METHODS Pre- and postoperative brain magnetic resonance imaging data and picture naming (Boston Naming Test) scores were obtained prospectively from 59 people with drug-resistant left temporal lobe epilepsy. All patients had left hemisphere language dominance at baseline and underwent surgical resection or ablation in the left temporal lobe. Postoperative naming assessment occurred approximately 7 months after surgery. Surgical lesions were mapped to a standard template, and the relationship between presence or absence of a lesion and the degree of naming decline was tested at each template voxel while controlling for effects of overall lesion size. RESULTS Patients declined by an average of 15% in their naming score, with wide variation across individuals. Decline was significantly related to damage in a cluster of voxels in the ventral temporal lobe, located mainly in the fusiform gyrus approximately 4-6 cm posterior to the temporal tip. Extent of damage to this region explained roughly 50% of the variance in outcome. Picture naming decline was not related to hippocampal or temporal pole damage. SIGNIFICANCE The results provide the first statistical map relating lesion location in left temporal lobe epilepsy surgery to picture naming decline, and they support previous observations of transient naming deficits from electrical stimulation in the basal temporal cortex. The critical lesion is relatively posterior and could be avoided in many patients undergoing left temporal lobe surgery for intractable epilepsy.
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Affiliation(s)
- Jeffrey R Binder
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jia-Qing Tong
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sara B Pillay
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lisa L Conant
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Colin J Humphries
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Manoj Raghavan
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Wade M Mueller
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Robyn M Busch
- Department of Neurology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Linda Allen
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - William L Gross
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Chad E Carlson
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mark J Lowe
- Department of Radiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - John T Langfitt
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | - Madalina E Tivarus
- Department of Imaging Sciences, University of Rochester, Rochester, New York, USA
| | - Daniel L Drane
- Department of Neurology and Pediatrics, Emory University, Atlanta, Georgia, USA
| | - David W Loring
- Department of Neurology and Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Monica Jacobs
- Department of Psychology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Victoria L Morgan
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Susan Bookheimer
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Thomas Grabowski
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Jennifer Vannest
- Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Sara J Swanson
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Swanson SJ, Conant LL, Humphries CJ, LeDoux M, Raghavan M, Mueller WM, Allen L, Gross WL, Anderson CT, Carlson CE, Busch RM, Lowe M, Tivarus ME, Drane DL, Loring DW, Jacobs M, Morgan VL, Szaflarski J, Bonilha L, Bookheimer S, Grabowski T, Phatak V, Vannest J, Binder JR. Changes in description naming for common and proper nouns after left anterior temporal lobectomy. Epilepsy Behav 2020; 106:106912. [PMID: 32179500 PMCID: PMC7195239 DOI: 10.1016/j.yebeh.2020.106912] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/10/2020] [Accepted: 01/11/2020] [Indexed: 11/28/2022]
Abstract
Numerous studies have shown that surgical resection of the left anterior temporal lobe (ATL) is associated with a decline in object naming ability (Hermann et al., 1999). In contrast, few studies have examined the effects of left ATL surgery on auditory description naming (ADN) or category-specific naming. Compared with object naming, which loads heavily on visual recognition processes, ADN provides a more specific measure of concept retrieval. The present study examined ADN declines in a large group of patients who were tested before and after left ATL surgery, using a 2 × 2 × 2 factorial manipulation of uniqueness (common vs. proper nouns), taxonomic category (living vs. nonliving things), and time (pre- vs. postsurgery). Significant declines occurred across all categories but were substantially larger for proper living (PL) concepts, i.e., famous individuals. The disproportionate decline in PL noun naming relative to other conditions is consistent with the notion that the left ATL is specialized not only for retrieval of unique entity concepts, but also plays a role in processing social concepts and person-specific features.
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Affiliation(s)
- Sara J. Swanson
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI
| | - Lisa L Conant
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI
| | | | - Megan LeDoux
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI
| | - Manoj Raghavan
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI
| | - Wade M. Mueller
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| | - Linda Allen
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI
| | - William L. Gross
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI
| | | | - Chad E. Carlson
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI
| | - Robyn M. Busch
- Department of Neurology, Cleveland Clinic, Cleveland, OH
| | - Mark Lowe
- Department of Radiology, Cleveland Clinic, Cleveland, OH
| | | | | | | | - Monica Jacobs
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN
| | - Victoria L. Morgan
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN
| | | | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, SC
| | - Susan Bookheimer
- Department of Neurology, University of California, Los Angeles, CA
| | | | - Vaishali Phatak
- Department of Neurology, University of Washington, Seattle, WA
| | - Jennifer Vannest
- Department of Neurology, University of Cincinnati, Cincinnati, OH
| | - Jeffrey R. Binder
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI
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Drane DL, Pedersen NP. Knowledge of language function and underlying neural networks gained from focal seizures and epilepsy surgery. BRAIN AND LANGUAGE 2019; 189:20-33. [PMID: 30615986 PMCID: PMC7183240 DOI: 10.1016/j.bandl.2018.12.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 09/05/2018] [Accepted: 12/19/2018] [Indexed: 05/09/2023]
Abstract
The effects of epilepsy and its treatments have contributed significantly to language models. The setting of epilepsy surgery, which allows for careful pre- and postsurgical evaluation of patients with cognitive testing and neuroimaging, has produced a wealth of language findings. Moreover, a new wave of surgical interventions, including stereotactic laser ablation and radio frequency ablation, have contributed new insights and corrections to language models as they can make extremely precise, focal lesions. This review covers the common language deficits observed in focal dyscognitive seizure syndromes. It also addresses the effects of surgical interventions on language, and highlights insights gained from unique epilepsy assessment methods (e.g., cortical stimulation mapping, Wada evaluation). Emergent findings are covered including a lack of involvement of the hippocampus in confrontation word retrieval, possible roles for key white matter tracts in language, and the often-overlooked basal temporal language area. The relationship between language and semantic memory networks is also explored, with brief consideration given to the prevailing models of semantic processing, including the amodal Hub and distributed, multi-modal processing models.
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Affiliation(s)
- Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA.
| | - Nigel P Pedersen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
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12
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Dutta M, Murray L, Miller W, Groves D. Effects of Epilepsy on Language Functions: Scoping Review and Data Mining Findings. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:350-378. [PMID: 29497749 DOI: 10.1044/2017_ajslp-16-0195] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 08/29/2017] [Indexed: 06/08/2023]
Abstract
PURPOSE This study involved a scoping review to identify possible gaps in the empirical description of language functioning in epilepsy in adults. With access to social network data, data mining was used to determine if individuals with epilepsy are expressing language-related concerns. METHOD For the scoping review, scientific databases were explored to identify pertinent articles. Findings regarding the nature of epilepsy etiologies, patient characteristics, tested language modalities, and language measures were compiled. Data mining focused on social network databases to obtain a set of relevant language-related posts. RESULTS The search yielded 66 articles. Epilepsy etiologies except temporal lobe epilepsy and older adults were underrepresented. Most studies utilized aphasia tests and primarily assessed single-word productions; few studies included healthy control groups. Data mining revealed several posts regarding epilepsy-related language problems, including word retrieval, reading, writing, verbal memory difficulties, and negative effects of epilepsy treatment on language. CONCLUSION Our findings underscore the need for future specification of the integrity of language in epilepsy, particularly with respect to discourse and high-level language abilities. Increased awareness of epilepsy-related language issues and understanding the patients' perspectives about their language concerns will allow researchers and speech-language pathologists to utilize appropriate assessments and improve quality of care.
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Affiliation(s)
- Manaswita Dutta
- Department of Speech and Hearing Sciences, Indiana University, Bloomington
| | - Laura Murray
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
| | - Wendy Miller
- School of Nursing, Indiana University, Bloomington
| | - Doyle Groves
- School of Nursing, Indiana University, Bloomington
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Krámská L, Lukavský J, Vojtěch Z. A neuropsychologist's view: Outcome after RF-ablation for mTLE. Epilepsy Res 2017; 142:167-169. [PMID: 29031865 DOI: 10.1016/j.eplepsyres.2017.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 09/28/2017] [Accepted: 10/06/2017] [Indexed: 11/18/2022]
Abstract
Concern about postoperative worsening of cognitive functions after temporal lobe epilepsy surgery is an important issue. In this article we review our data on neuropsychological outcome after radiofrequency (RF) ablation of amygdalohippocampal complex (AHC). On a group level we found initial improvement in intelligence domains and unchanged memory scores one year after the surgery. During longitudinal follow-up, we found improvement in both intellectual and memory domains. This improvement was most pronounced up to two years after surgery. On an individual level, no patient worsened in any intellectual domain and most patients improved in memory. We hypothesize that this favorable outcome may be a consequence of minimization of collateral damage and incomplete destruction of target structures. We also summarize our experience with psychiatric complications of the procedure.
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Affiliation(s)
- Lenka Krámská
- Na Homolce Hospital, Epilepsy Center, Prague, Czech Republic; University of New York in Prague, Londýnská 41, 120 00 Prague 2, Czech Republic.
| | - Jiří Lukavský
- Institute of Psychology, Academy of Sciences of the Czech Republic, Hybernská 8, 110 00 Prague 1, Czech Republic
| | - Zdeněk Vojtěch
- Na Homolce Hospital, Epilepsy Center, Prague, Czech Republic
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Yurchenko A, Golovteev A, Kopachev D, Dragoy O. Comprehension and production of nouns and verbs in temporal lobe epilepsy. Epilepsy Behav 2017; 75:127-133. [PMID: 28858722 DOI: 10.1016/j.yebeh.2017.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/07/2017] [Accepted: 07/05/2017] [Indexed: 11/24/2022]
Abstract
Previous research on linguistic performance at the single-word level in patients with temporal lobe epilepsy (TLE) has mostly been limited to the comprehension and production of nouns, and findings have been inconsistent. Results are likewise limited and controversial regarding the lateralization of the epileptogenic focus. The present study investigates comprehension and production of nouns and verbs in patients with left and right TLE (12 in each group). We designed a comprehension (word-picture matching) test and a production (naming) test, matched on a range of psycholinguistic parameters for the two word classes. The results showed impaired verb comprehension in patients with left TLE and impaired noun and verb production in both groups of patients compared to the control group. Patients with left and right TLE differed significantly on verb comprehension and noun production, whereas verb production was equally impaired in the two groups of patients. These findings suggest difficulties with single-word processing in patients with both left and right TLE, which are more prominent for verbs than for nouns in patients with left TLE. The verb production (action naming) test turned out to be the most effective tool for assessing linguistic difficulties at the single-word level in patients with TLE.
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Affiliation(s)
- Anna Yurchenko
- National Research University Higher School of Economics, Moscow, Russia.
| | | | | | - Olga Dragoy
- National Research University Higher School of Economics, Moscow, Russia; Moscow Research Institute of Psychiatry, Moscow, Russia
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15
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Ogawa H, Hiroshima S, Kamada K. Left hippocampectomy in an epilepsy patient with right hemisphere language dominance. COGENT MEDICINE 2017. [DOI: 10.1080/2331205x.2017.1364029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Hiroshi Ogawa
- Department of Neurosurgery, Asahikawa Medical University, 2-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | - Satoru Hiroshima
- Department of Neurosurgery, Asahikawa Medical University, 2-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | - Kyousuke Kamada
- Department of Neurosurgery, Asahikawa Medical University, 2-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, 078-8510, Japan
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16
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Llorens A, Dubarry AS, Trébuchon A, Chauvel P, Alario FX, Liégeois-Chauvel C. Contextual modulation of hippocampal activity during picture naming. BRAIN AND LANGUAGE 2016; 159:92-101. [PMID: 27380274 DOI: 10.1016/j.bandl.2016.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 05/17/2016] [Accepted: 05/24/2016] [Indexed: 06/06/2023]
Abstract
Picture naming is a standard task used to probe language processes in healthy and impaired speakers. It recruits a broad neural network of language related areas, among which the hippocampus is rarely included. However, the hippocampus could play a role during picture naming, subtending, for example, implicit learning of the links between pictured objects and their names. To test this hypothesis, we recorded hippocampal activity during plain picture naming, without memorization requirement; we further assessed whether this activity was modulated by contextual factors such as repetition priming and semantic interference. Local field potentials recorded from intracerebral electrodes implanted in the healthy hippocampi of epileptic patients revealed a specific and reliable pattern of activity, markedly modulated by repetition priming and semantic context. These results indicate that the hippocampus is recruited during picture naming, presumably in relation to implicit learning, with contextual factors promoting differential hippocampal processes, possibly subtended by different sub-circuitries.
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Affiliation(s)
- A Llorens
- Aix Marseille Univ, Inserm, Institut des Neurosciences des Systemes, Marseille, France; Aix Marseille Univ, CNRS, UMR7290, LPC, Marseille, France
| | - A-S Dubarry
- Aix Marseille Univ, Inserm, Institut des Neurosciences des Systemes, Marseille, France; Aix Marseille Univ, CNRS, UMR7290, LPC, Marseille, France
| | - A Trébuchon
- Aix Marseille Univ, Inserm, Institut des Neurosciences des Systemes, Marseille, France; AP-HM, Neurophysiologie Clinique, Marseille, France
| | - P Chauvel
- Aix Marseille Univ, Inserm, Institut des Neurosciences des Systemes, Marseille, France; AP-HM, Neurophysiologie Clinique, Marseille, France
| | - F-X Alario
- Aix Marseille Univ, CNRS, UMR7290, LPC, Marseille, France
| | - C Liégeois-Chauvel
- Aix Marseille Univ, Inserm, Institut des Neurosciences des Systemes, Marseille, France.
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Sepeta LN, Berl MM, Wilke M, You X, Mehta M, Xu B, Inati S, Dustin I, Khan O, Austermuehle A, Theodore WH, Gaillard WD. Age-dependent mesial temporal lobe lateralization in language fMRI. Epilepsia 2015; 57:122-30. [PMID: 26696589 DOI: 10.1111/epi.13258] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Functional magnetic resonance imaging (fMRI) activation of the mesial temporal lobe (MTL) may be important for epilepsy surgical planning. We examined MTL activation and lateralization during language fMRI in children and adults with focal epilepsy. METHODS One hundred forty-two controls and patients with left hemisphere focal epilepsy (pediatric: epilepsy, n = 17, mean age = 9.9 ± 2.0; controls, n = 48; mean age = 9.1 ± 2.6; adult: epilepsy, n = 20, mean age = 26.7 ± 5.8; controls, n = 57, mean age = 26.2 ± 7.5) underwent 3T fMRI using a language task (auditory description decision task). Image processing and analyses were conducted using Statistical Parametric Mapping (SPM8); regions of interest (ROIs) included MTL, Broca's area, and Wernicke's area. We assessed group and individual MTL activation, and examined degree of lateralization. RESULTS Patients and controls (pediatric and adult) demonstrated group and individual MTL activation during language fMRI. MTL activation was left lateralized for adults, but less so in children (p's < 0.005). Patients did not differ from controls in either age group. Stronger left-lateralized MTL activation was related to older age (p = 0.02). Language lateralization (Broca's and Wernicke's) predicted 19% of the variance in MTL lateralization for adults (p = 0.001), but for not children. SIGNIFICANCE Language fMRI may be used to elicit group and individual MTL activation. The developmental difference in MTL lateralization and its association with language lateralization suggests a developmental shift in lateralization of MTL function, with increased left lateralization across the age span. This shift may help explain why children have better memory outcomes following resection compared to adults.
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Affiliation(s)
- Leigh N Sepeta
- Children's National Health System, Washington, District of Columbia, U.S.A.,National Institute of Neurological Disorders & Stroke (NINDS), NIH, Bethesda, Maryland, U.S.A.,George Washington University, Washington, District of Columbia, U.S.A
| | - Madison M Berl
- Children's National Health System, Washington, District of Columbia, U.S.A.,National Institute of Neurological Disorders & Stroke (NINDS), NIH, Bethesda, Maryland, U.S.A.,George Washington University, Washington, District of Columbia, U.S.A
| | - Marko Wilke
- University Children's Hospital, Tübingen, Germany
| | - Xiaozhen You
- Children's National Health System, Washington, District of Columbia, U.S.A.,National Institute of Neurological Disorders & Stroke (NINDS), NIH, Bethesda, Maryland, U.S.A.,George Washington University, Washington, District of Columbia, U.S.A
| | - Meera Mehta
- George Washington University, Washington, District of Columbia, U.S.A
| | - Benjamin Xu
- National Institute of Neurological Disorders & Stroke (NINDS), NIH, Bethesda, Maryland, U.S.A
| | - Sara Inati
- National Institute of Neurological Disorders & Stroke (NINDS), NIH, Bethesda, Maryland, U.S.A
| | - Irene Dustin
- National Institute of Neurological Disorders & Stroke (NINDS), NIH, Bethesda, Maryland, U.S.A
| | - Omar Khan
- National Institute of Neurological Disorders & Stroke (NINDS), NIH, Bethesda, Maryland, U.S.A
| | - Alison Austermuehle
- National Institute of Neurological Disorders & Stroke (NINDS), NIH, Bethesda, Maryland, U.S.A
| | - William H Theodore
- National Institute of Neurological Disorders & Stroke (NINDS), NIH, Bethesda, Maryland, U.S.A
| | - William D Gaillard
- Children's National Health System, Washington, District of Columbia, U.S.A.,National Institute of Neurological Disorders & Stroke (NINDS), NIH, Bethesda, Maryland, U.S.A.,George Washington University, Washington, District of Columbia, U.S.A
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18
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Berberian AP, Hopker C, Mazzarotto I, Cunha J, Guarinello AC, Massi G, Crippa A. Aspects of Oral Language, Speech, and Written Language in Subjects with Temporal Lobe Epilepsy of Difficult Control. Int Arch Otorhinolaryngol 2015; 19:302-8. [PMID: 26491475 PMCID: PMC4593911 DOI: 10.1055/s-0035-1547524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 01/26/2015] [Indexed: 11/16/2022] Open
Abstract
Introduction About 50 million people have epilepsy and 30% of them have epilepsy that does not respond to properly conducted drug treatment. Objective Verify the incidence of language disorders in oral language, speech, and written language of subjects with difficult to control temporal lobe epilepsy (TLE) and compare the occurrence of these disorders in subjects before and after surgery. Methods Cross-sectional study with quantitative analysis, exploratory type. A questionnaire for data collection was administered covering the following aspects: oral language, speech complaints, and writing production and comprehension. Criteria for inclusion of subjects were a diagnosis of TLE refractory to drug treatment and at least 4 years of schooling. Results The sample of 63 patients with TLE was divided into two groups: presurgical (n = 31) and postsurgical (n = 32). In the postsurgical group, there was a higher frequency of left lobectomy (75%) than right (25%). Conclusion Statistical analysis was performed with the chi-square test (significance level of 0.05). Complaints related to speech-language attention were more predominant in postsurgical subjects. Analysis of oral language, speech, and written language in subjects with epilepsy who underwent temporal lobectomy or not showed findings consistent with symptoms related to transient aphasia, with the presence of paraphasias, as well as changes in speech prosody and melody. These symptoms appeared more associated with recurrence after having a temporal lobectomy.
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Affiliation(s)
- Ana Paula Berberian
- Masters and Doctorate Program in Communication Disorders, Universidade Tuiuti do Paraná, Curitiba, Paraná, Brazil
| | - Christiane Hopker
- Masters and Doctorate Program in Communication Disorders, Universidade Tuiuti do Paraná, Curitiba, Paraná, Brazil
| | - Ingrid Mazzarotto
- Masters and Doctorate Program in Communication Disorders, Universidade Tuiuti do Paraná, Curitiba, Paraná, Brazil
| | - Jenane Cunha
- Masters and Doctorate Program in Communication Disorders, Universidade Tuiuti do Paraná, Curitiba, Paraná, Brazil
| | - Ana Cristina Guarinello
- Masters and Doctorate Program in Communication Disorders, Universidade Tuiuti do Paraná, Curitiba, Paraná, Brazil
| | - Giselle Massi
- Masters and Doctorate Program in Communication Disorders, Universidade Tuiuti do Paraná, Curitiba, Paraná, Brazil
| | - Ana Crippa
- Department of Neurophysiology, Universidade Federal do Paraná, Curitiba, Brazil
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Object naming in epilepsy and epilepsy surgery. Epilepsy Behav 2015; 46:27-33. [PMID: 25599985 DOI: 10.1016/j.yebeh.2014.12.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 12/15/2014] [Accepted: 12/16/2014] [Indexed: 11/22/2022]
Abstract
The ability to express oneself verbally is critical for success in academic, occupational, and social domains. Unfortunately, word-finding or "naming" difficulty is the most common cognitive complaint among individuals with temporal lobe epilepsy (TLE), and a substantial body of work over the past several decades has documented naming impairment in left (language-dominant) TLE, with further risk to naming ability following left temporal lobe resection for seizure control. With these findings well established, this paper reviews more recent work that has aimed to identify the neuroanatomical substrates of naming, understand how adverse structural and functional effects of TLE might impinge upon these brain regions, predict and potentially reduce the risk of postoperative naming decline, and begin to understand naming difficulty in TLE from a developmental perspective. Factors that have confounded interpretation and hindrances to progress are discussed, and suggestions are provided for improved empirical investigation and directions for future research.
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20
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Affiliation(s)
- Bruce Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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21
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Surgical treatment for mesial temporal lobe epilepsy associated with hippocampal sclerosis. Rev Neurol (Paris) 2015; 171:315-25. [DOI: 10.1016/j.neurol.2015.01.561] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/01/2015] [Accepted: 01/30/2015] [Indexed: 02/07/2023]
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Lah S, Smith ML. Verbal memory and literacy outcomes one year after pediatric temporal lobectomy: a retrospective cohort study. Epilepsy Behav 2015; 44:225-33. [PMID: 25771353 DOI: 10.1016/j.yebeh.2014.12.040] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 12/28/2014] [Accepted: 12/30/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVE In children with temporal lobe epilepsy (TLE), temporal lobectomy (TL) is a treatment of choice for those children with seizure that are difficult to control with medication. Semantic memory is dependent on functional integrity of the temporal lobes and is thought to be critical for development of literacy skills. However, little is known about semantic memory and literacy outcomes post-TL in children. METHOD In this retrospective cohort study, 40 children with TLE were administered tests of memory and literacy pre-TL and 1year post-TL in one hospital between 1996 and 2011. RESULTS One year post-TL, 60% of the children became seizure-free. A significant decline was found in one aspect of semantic memory (naming) in children who underwent left TL. In addition, a significant drop was also evident in one aspect of literacy (reading accuracy), irrespective of the side of surgery. These declines were related neither to each other nor to epilepsy variables including seizure outcome. CONCLUSIONS This is the largest pediatric outcome study of memory and literacy skills to date and shows that TL is associated with a risk of a mild drop in specific aspects of semantic memory (naming, following left TL) and reading accuracy, while other areas of memory and literacy remain unchanged.
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Affiliation(s)
- Suncica Lah
- Department of Psychology, University of Sydney, Sydney, NSW, Australia; ARC Centre of Excellence in Cognition and Its Disorders, Australia.
| | - Mary Lou Smith
- ARC Centre of Excellence in Cognition and Its Disorders, Australia; Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada; Neurosciences and Mental Health Program, Hospital for Sick Children, Toronto, ON, Canada.
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Abstract
Naming or word-finding tasks are a mainstay of the typical neuropsychological evaluation, particularly with older adults. However, many older adults have significant visual impairment and there are currently no such word-finding tasks developed for use with older visually impaired populations. This study presents a verbal, non-visual measure of word-finding for use in the evaluation of older adults with possible dysnomia. Stimuli were chosen based on their frequency of usage in everyday spoken language. A 60-item scale was created and given to 131 older Veterans. Rasch analyses were conducted and differential item functioning assessed to eliminate poorly-performing items. The final 55-item scale had a coefficient alpha of 0.84 and correlated with the Neuropsychological Assessment Battery Naming test, r=0.84, p<.01, Delis-Kaplan Executive Function System (D-KEFS) Category Fluency, r=0.45, p<.01, and the D-KEFS Letter Fluency, r=0.40, p<.01. ROC analyses found the measure to have sensitivity of 79% and specificity of 85% for detecting dysnomia. Patients with dysnomia performed worse on the measure than patients with intact word-finding, t(84)=8.2, p<.001. Patients with no cognitive impairment performed significantly better than patients with mild cognitive impairment, who performed significantly better than patients with dementia. This new measure shows promise in the neuropsychological evaluation of word-finding ability in older adults with or without visual impairment. Future directions include the development of a shorter version and the generation of additional normative data.
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Distinct functional connectivity of the hippocampus during semantic and phonemic fluency. Neuropsychologia 2015; 69:39-49. [PMID: 25619848 DOI: 10.1016/j.neuropsychologia.2015.01.031] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 12/21/2014] [Accepted: 01/21/2015] [Indexed: 01/12/2023]
Abstract
Verbal fluency tasks are typically used in neuropsychological practice for assessment of language function in a variety of neurological disorders. Recently, it has been shown that the hippocampus, a region thought to be exclusive to the domain of memory, is also involved in tests of semantic fluency. The present study further explores hippocampal contribution to verbal fluency using functional Magnetic Resonance Imaging (fMRI) and examining mean activity and inter-regional functional connectivity with known task-related brain regions. Given the clear lateralization of brain areas involved in language, lateralization of hippocampal involvement in semantic and phonemic word fluency was also investigated. Different hippocampal recruitment during semantic and phonemic fluency was found: greater change in activity was seen during semantic fluency, as compared with phonemic fluency. This pattern was obtained in the right and the left hippocampus, with no lateralization effects. Functional connectivity analyses corroborate the notion of selective contribution of the hippocampus to semantic fluency. During the semantic fluency task, connectivity levels between the hippocampi and components of the semantic network did not differ from connectivity levels within the semantic network. In contrast, during the phonemic fluency task, the hippocampi were less correlated with components of the phonemic network, as compared to the within phonemic network connectivity. Importantly, hippocampal connectivity with the semantic network was task-dependent and restricted to periods of semantic fluency performance. Altogether, results suggest that the right and the left hippocampus are integral components of the brain network that selectively supports verbal semantic fluency, but not phonemic fluency.
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25
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Drane DL, Loring DW, Voets NL, Price M, Ojemann JG, Willie JT, Saindane AM, Phatak V, Ivanisevic M, Millis S, Helmers SL, Miller JW, Meador KJ, Gross RE. Better object recognition and naming outcome with MRI-guided stereotactic laser amygdalohippocampotomy for temporal lobe epilepsy. Epilepsia 2015; 56:101-13. [PMID: 25489630 PMCID: PMC4446987 DOI: 10.1111/epi.12860] [Citation(s) in RCA: 211] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Patients with temporal lobe epilepsy (TLE) experience significant deficits in category-related object recognition and naming following standard surgical approaches. These deficits may result from a decoupling of core processing modules (e.g., language, visual processing, and semantic memory), due to "collateral damage" to temporal regions outside the hippocampus following open surgical approaches. We predicted that stereotactic laser amygdalohippocampotomy (SLAH) would minimize such deficits because it preserves white matter pathways and neocortical regions that are critical for these cognitive processes. METHODS Tests of naming and recognition of common nouns (Boston Naming Test) and famous persons were compared with nonparametric analyses using exact tests between a group of 19 patients with medically intractable mesial TLE undergoing SLAH (10 dominant, 9 nondominant), and a comparable series of TLE patients undergoing standard surgical approaches (n=39) using a prospective, nonrandomized, nonblinded, parallel-group design. RESULTS Performance declines were significantly greater for the patients with dominant TLE who were undergoing open resection versus SLAH for naming famous faces and common nouns (F=24.3, p<0.0001, η2=0.57, and F=11.2, p<0.001, η2=0.39, respectively), and for the patients with nondominant TLE undergoing open resection versus SLAH for recognizing famous faces (F=3.9, p<0.02, η2=0.19). When examined on an individual subject basis, no SLAH patients experienced any performance declines on these measures. In contrast, 32 of the 39 patients undergoing standard surgical approaches declined on one or more measures for both object types (p<0.001, Fisher's exact test). Twenty-one of 22 left (dominant) TLE patients declined on one or both naming tasks after open resection, while 11 of 17 right (nondominant) TLE patients declined on face recognition. SIGNIFICANCE Preliminary results suggest (1) naming and recognition functions can be spared in TLE patients undergoing SLAH, and (2) the hippocampus does not appear to be an essential component of neural networks underlying name retrieval or recognition of common objects or famous faces.
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Affiliation(s)
- Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, U.S.A; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, U.S.A; Department of Neurology, University of Washington School of Medicine, Seattle, Washington, U.S.A
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Bartha-Doering L, Trinka E. The interictal language profile in adult epilepsy. Epilepsia 2014; 55:1512-25. [PMID: 25110150 DOI: 10.1111/epi.12743] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to systematically review the literature on the interictal language profile in adult patients with epilepsy. METHODS An extensive literature search was performed using MEDLINE, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, PASCAL, and PSYNDEXplus databases. Key aspects of inclusion criteria were adult patients with epilepsy, patient number >10, and in-depth qualitative investigations of a specific language modality or administration of tests of at least two different language modalities, including comprehension, naming, repetition, reading, writing, and spontaneous speech. RESULTS Our search strategy yielded 933 articles on epilepsy and language. Of these, 31 met final eligibility criteria. Most included articles focused on temporal lobe epilepsy; only three studies were interested in the language profile of patients with idiopathic generalized epilepsies, and one study on frontal lobe epilepsy met inclusion criteria. Study results showed a pronounced heterogeneity of language abilities in patients with epilepsy, varying from intact language profiles to impairment in several language functions. However, at least 17% of patients displayed deficits in more than one language function, with naming, reading comprehension, spontaneous speech, and discourse production being most often affected. SIGNIFICANCE This review underscores the need to evaluate different language functions-including spontaneous speech, discourse abilities, naming, auditory and reading comprehension, reading, writing, and repetition-individually in order to obtain a reliable profile of language functioning in patients with epilepsy. Moreover, our findings show that in contrast to the huge scientific interest of memory functions in epilepsy, the examination of language functions so far played a minor role in epilepsy research, emphasizing the need for future research activities in this field.
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Affiliation(s)
- Lisa Bartha-Doering
- Department of Pediatrics and Adolescent Medicine, Medical University, Vienna, Austria
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Frisch C, Helmstaedter C. Object location performance: detection of functional impairment in right temporal lobe epilepsy. Epilepsy Behav 2014; 35:28-33. [PMID: 24792097 DOI: 10.1016/j.yebeh.2014.03.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/25/2014] [Accepted: 03/27/2014] [Indexed: 10/25/2022]
Abstract
A prominent role of the right temporal lobe in nonverbal memory and visuospatial memory is widely accepted. A variety of neuropsychological tests have been shown to be sensitive to functional deficits related to right temporal lobe epilepsies mainly after surgical interventions, whereas preoperative deficits were seldom used to demonstrate test sensitivities. Furthermore, compensation processes or additional cognitive deficits related to left temporal or extratemporal dysfunctions are often not adequately taken into account. We used a modified object location task to demarcate preoperative visuospatial memory deficits of right temporal origin against such processes in patients with clinically verified right temporal, left temporal, or extratemporal lobe epilepsies. Healthy subjects served as controls. By using 8 "unnameable" objects, the positional memory accuracy of patients with right temporal lobe epilepsy was significantly lower than the positional memory performance of patients with left temporal and extratemporal lobe epilepsies, while object location memory performance differentiated patients with right temporal and extratemporal lobe epilepsies from patients with left temporal lobe epilepsy. Our version of a classical object location task might be a useful tool to detect mnestic deficits specifically related to right temporal lobe dysfunction. Future studies should focus on the refinement of testing conditions in order to detect differences induced by more distinct structural or functional deficits.
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Affiliation(s)
- Christian Frisch
- University of Bonn Medical Center, Department of Epileptology, Sigmund Freud-Straße 25, 53105 Bonn, Germany.
| | - Christoph Helmstaedter
- University of Bonn Medical Center, Department of Epileptology, Sigmund Freud-Straße 25, 53105 Bonn, Germany
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Kucukboyaci NE, Kemmotsu N, Leyden KM, Girard HM, Tecoma ES, Iragui VJ, McDonald CR. Integration of multimodal MRI data via PCA to explain language performance. NEUROIMAGE-CLINICAL 2014; 5:197-207. [PMID: 25068109 PMCID: PMC4110349 DOI: 10.1016/j.nicl.2014.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 05/07/2014] [Accepted: 05/09/2014] [Indexed: 11/16/2022]
Abstract
Objective/methods Neuroimaging research has predominantly focused on exploring how cortical or subcortical brain abnormalities are related to language dysfunction in patients with neurological disease through the use of single modality imaging. Still, limited knowledge exists on how various MRI measures relate to each other and to patients' language performance. In this study, we explored the relationship between measures of regional cortical thickness, gray–white matter contrast (GWMC), white matter diffusivity [mean diffusivity (MD) and fractional anisotropy (FA)] and the relative contributions of these MRI measures to predicting language function across patients with temporal lobe epilepsy (TLE) and healthy controls. T1- and diffusion-weighted MRI data were collected from 56 healthy controls and 52 patients with TLE. By focusing on frontotemporal regions implicated in language function, we reduced each domain of MRI data to its principal component (PC) and quantified the correlations among these PCs and the ability of these PCs to explain the variation in vocabulary, naming and fluency. We followed up our significant findings by assessing the predictive power of the implicated PCs with respect to language impairment in our sample. Results We found significant positive associations between PCs representing cortical thickness, GWMC and FA that appeared to be partially mediated by changes in total brain volume. We also found a significant association between reduced FA and increased MD after controlling for confounding factors (e.g., age, field strength, total brain volume). Reduced FA was significantly associated with reductions in visual naming while increased MD was associated with reductions in auditory naming scores, even after controlling for the variability explained by reductions in hippocampal volumes. Inclusion of FA and MD PCs in predictive models of language impairment resulted in significant improvements in sensitivity and specificity of the predictions. Conclusions Quantitative MRI measures from T1 and diffusion-weighted scans are unlikely to represent perfectly orthogonal vectors of disease in individuals with epilepsy. On the contrary, they exhibit highly intercorrelated PCs in their factor structures, which is consistent with an underlying pathological process that affects both the cortical and the subcortical structures simultaneously. In addition to hippocampal volume, the PCs of diffusion weighted measures (FA and MD) increase the sensitivity and specificity for determining naming impairment in patients with TLE. These findings underline the importance of combining multimodal imaging measures to better predict language performance in TLE that could extend to other patients with prominent language impairments. We integrate structural and diffusion MRI data from TLE patients and controls. We use PCA to characterize disease-related volumetric and tract-based changes. Increased left hemisphere FA is associated with worse visual naming. Decreased left hemisphere MD is associated with worse auditory naming. Using diffusion-based MRI metrics improves prediction of language function in TLE.
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Affiliation(s)
- N E Kucukboyaci
- Department of Psychiatry, University of California San Diego, CA, USA ; Multimodal Imaging Laboratory, University of California San Diego, CA, USA ; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - N Kemmotsu
- Department of Psychiatry, University of California San Diego, CA, USA ; Multimodal Imaging Laboratory, University of California San Diego, CA, USA
| | - K M Leyden
- Multimodal Imaging Laboratory, University of California San Diego, CA, USA
| | - H M Girard
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - E S Tecoma
- Department of Neurosciences, University of California San Diego, CA, USA
| | - V J Iragui
- Department of Neurosciences, University of California San Diego, CA, USA
| | - C R McDonald
- Department of Psychiatry, University of California San Diego, CA, USA ; Multimodal Imaging Laboratory, University of California San Diego, CA, USA
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Emerton BC, Gansler DA, Sandberg EH, Jerram M. Functional anatomic dissociation of description and picture naming in the left temporal lobe. Brain Imaging Behav 2013; 8:570-8. [DOI: 10.1007/s11682-013-9281-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Naming outcomes of anterior temporal lobectomy in epilepsy patients: a systematic review of the literature. Epilepsy Behav 2012; 24:194-8. [PMID: 22569529 DOI: 10.1016/j.yebeh.2012.04.115] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 04/02/2012] [Accepted: 04/03/2012] [Indexed: 11/22/2022]
Abstract
Anterior temporal lobectomy (ATL) is the standard surgical treatment for medically intractable temporal lobe epilepsy (TLE). While seizure outcome is favorable, cognitive outcomes are a concern, particularly in respect of memory and naming. A systematic review of the literature on the naming outcomes of ATL is presented in this article. Searches were conducted on PubMed and PsycInfo, yielding a total of 93 articles, 21 of which met inclusion criteria. Declines in visual naming are common following ATL in the dominant hemisphere, and particularly, for naming living stimuli or famous faces. The Boston Naming Test (BNT) declines by a mean of 5.8 points, exceeding the Reliable Change Index (RCI). There are no reports of deficits in auditory naming following ATL, despite the fact that auditory naming has shown to be a more sensitive measure of dysnomia than the BNT in TLE patients. The absence of structural hippocampal pathology and late-onset epilepsy are the strongest predictors of naming decline. Recommendations are made for further study.
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31
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Pure left hippocampal stroke: a transient global amnesia-plus syndrome. J Neurol 2011; 259:989-92. [DOI: 10.1007/s00415-011-6296-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 10/12/2011] [Accepted: 10/15/2011] [Indexed: 11/27/2022]
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Friedman D, Nessler D, Kulik J, Hamberger M. The brain's orienting response (novelty P3) in patients with unilateral temporal lobe resections. Neuropsychologia 2011; 49:3474-83. [PMID: 21906606 DOI: 10.1016/j.neuropsychologia.2011.08.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 07/29/2011] [Accepted: 08/24/2011] [Indexed: 10/17/2022]
Abstract
The brain's orienting response is a biologically primitive, yet critical cognitive function necessary for survival. Though based on a wide network of brain regions, the lateral prefrontal cortex and posterior hippocampus are thought to play essential roles. Indeed, damage to these regions results in abnormalities of the novelty P3 or P3a, an event-related potential (ERP) sign of the orienting response. Like other ubiquitous markers of orienting, such as the galvanic skin response, the P3a habituates when novel events are repeated. Here, we assessed habituation of the P3a in patients who had undergone unilateral anteromedial resection of the medial temporal lobe (AMTL), including the entire hippocampus, for relief of pharmacologically intractable epilepsy. Eight left- and 8 right-AMTL patients and 16 age- and education-matched controls heard frequent standard tones, infrequent targets (requiring reaction times) and equally infrequent, unique novel, environmental sounds. The novel sounds repeated 2 blocks after their first presentation. In controls, novel repetition engendered a reduction in P3a amplitude, but this was not the case in either left- or right-AMTL patients. We conclude that bilaterally intact hippocampi are necessary for the brain to appreciate that a repetition of a novel sound has occurred, perhaps due to disruptions in ipsilateral hippocampal-prefrontal pathways and/or between the left and right hippocampi.
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Affiliation(s)
- David Friedman
- Cognitive Electrophysiology Laboratory, Division of Cognitive Neuroscience, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY 10032, USA.
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Lesser RP, Crone NE, Webber WRS. Subdural electrodes. Clin Neurophysiol 2010; 121:1376-1392. [PMID: 20573543 PMCID: PMC2962988 DOI: 10.1016/j.clinph.2010.04.037] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 04/21/2010] [Accepted: 04/27/2010] [Indexed: 10/19/2022]
Abstract
Subdural electrodes are frequently used to aid in the neurophysiological assessment of patients with intractable seizures. We review the indications for these, their uses for localizing epileptogenic regions and for localizing cortical regions supporting movement, sensation, and language.
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Affiliation(s)
- Ronald P Lesser
- Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA; Department of Neurosurgery, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
| | - Nathan E Crone
- Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA
| | - W R S Webber
- Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA
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