Lesion and lesion network localization of dysnomia after epilepsy surgery. Brain 2025 Mar 06;148(3):776-787
Date
10/18/2024Pubmed ID
39423309Pubmed Central ID
PMC11884675DOI
10.1093/brain/awae322Scopus ID
2-s2.0-86000714877 (requires institutional sign-in at Scopus site) 7 CitationsAbstract
Temporal lobe epilepsy surgery is an effective treatment option for patients with drug-resistant epilepsy. However, neurosurgery poses a risk for cognitive deficits-up to one-third of patients have a decline in naming ability following temporal lobe surgery. In this study, we aimed to better understand the neural correlates associated with reduced naming performance after temporal lobe surgery, with the goal of informing surgical planning strategies to mitigate the risk of dysnomia. We retrospectively identified 85 patients who underwent temporal lobe resective surgery (49 left temporal lobe, 36 right temporal lobe) for whom naming ability was assessed before and >3 months post-surgery using the Boston Naming Test. We used multivariate lesion-symptom mapping to identify resection sites associated with naming decline, and we used lesion network mapping to evaluate the broader functional and structural connectivity profiles of resection sites associated with naming decline. We validated our findings in an independent cohort of 59 individuals with left temporal lobectomy, along with repeating all analyses after combining the cohorts. Lesion laterality and location were important predictors of post-surgical naming performance. Naming performance significantly improved after right temporal lobectomy (P = 0.015) while a decrement in performance was observed following left temporal lobectomy (P = 0.002). Declines in naming performance were associated with surgical resection of the left anterior middle temporal gyrus (Brodmann area 21, r = 0.41, P < 0.001), along with a previously implicated basal temporal language area. Resection sites linked to naming decline showed a functional connectivity profile featuring a left-lateralized network closely resembling the extended semantic\default mode network, and a structural connectivity profile featuring major temporo-frontal association white matter tracts coursing through the temporal stem. This extends prior work by implicating the left anterior middle temporal gyrus in naming decline and provides additional support for the role of the previously identified basal temporal language area in naming decline. Importantly, the structural and functional connectivity profiles of these regions suggest they are key nodes of a broader extended semantic network. Together these regional and network findings may help in surgical planning and discussions of prognosis.
Author List
Mhanna A, Bruss J, Griffis JC, Sullivan AW, Kawasaki H, Binder JR, Pillay SB, Howard MA 3rd, Tranel D, Boes ADAuthors
Jeffrey R. Binder MD Professor in the Neurology department at Medical College of WisconsinSara B. Pillay PhD Associate Professor in the Neurology department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentAdult
Anterior Temporal Lobectomy
Brain Mapping
Drug Resistant Epilepsy
Epilepsy, Temporal Lobe
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Nerve Net
Neurosurgical Procedures
Postoperative Complications
Retrospective Studies
Temporal Lobe
Young Adult
