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Temporal lobe regions essential for preserved picture naming after left temporal epilepsy surgery. Epilepsia 2020 09;61(9):1939-1948

Date

08/12/2020

Pubmed ID

32780878

Pubmed Central ID

PMC7722029

DOI

10.1111/epi.16643

Scopus ID

2-s2.0-85089258019   12 Citations

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 7A 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 4-6A 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.

Author List

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, fMRI in Anterior Temporal Epilepsy Surgery (FATES) study

Authors

Christopher Todd Anderson MD Associate Professor in the Neurology department at Medical College of Wisconsin
Jeffrey R. Binder MD Professor in the Neurology department at Medical College of Wisconsin
Chad Carlson MD Professor in the Neurology department at Medical College of Wisconsin
Lisa L. Conant PhD Associate Professor in the Neurology department at Medical College of Wisconsin
William Gross MD, PhD Assistant Professor in the Anesthesiology department at Medical College of Wisconsin
Wade M. Mueller MD Professor in the Neurosurgery department at Medical College of Wisconsin
Sara B. Pillay PhD Assistant Professor in the Neurology department at Medical College of Wisconsin
Manoj Raghavan MD, PhD Professor in the Neurology department at Medical College of Wisconsin
Sara J. Swanson PhD Chief, Professor in the Neurology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Anomia
Anterior Temporal Lobectomy
Brain Mapping
Drug Resistant Epilepsy
Epilepsy, Temporal Lobe
Female
Functional Neuroimaging
Hippocampus
Humans
Language Tests
Magnetic Resonance Imaging
Male
Middle Aged
Postoperative Complications
Temporal Lobe
Young Adult