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      Presurgical language mapping in epilepsy: Using fMRI of reading to identify functional reorganization in a patient with long-standing temporal lobe epilepsy

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          Abstract

          We report a 55-year-old, right-handed patient with intractable left temporal lobe epilepsy, who previously had a partial left temporal lobectomy. The patient could talk during seizures, suggesting that he might have language dominance in the right hemisphere. Presurgical fMRI localization of language processing including reading of exception and regular words, pseudohomophones, and dual meaning words confirmed the clinical hypothesis of right language dominance, with only small amounts of activation near the planned surgical resection and, thus, minimal eloquent cortex to avoid during surgery. Postoperatively, the patient was rendered seizure-free without speech deficits.

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          Semantic processing in the anterior temporal lobes: a meta-analysis of the functional neuroimaging literature.

          M. Visser, E. Jefferies, M Lambon Ralph (2010)
          The role of the anterior temporal lobes (ATLs) in semantic cognition is not clear from the current literature. Semantic dementia patients show a progressive and a specific semantic impairment, following bilateral atrophy of the ATLs. Neuroimaging studies of healthy participants, however, do not consistently show ATL activation during semantic tasks. Consequently, several influential theories of semantic memory do not ascribe a central role to the ATLs. We conducted a meta-analysis of 164 functional neuroimaging studies of semantic processing to investigate factors that might contribute to the inconsistency in previous results. Four factors influenced the likelihood of finding ATL activation: (1) the use of PET versus fMRI, reflecting the fact that fMRI but not PET is sensitive to distortion artifacts caused by large variations in magnetic susceptibility in the area of the ATL; (2) a field of view (FOV) of more than 15 cm, thereby ensuring whole-brain coverage; (3) the use of a high baseline task to prevent subtraction of otherwise uncontrolled semantic activation; (4) the inclusion of the ATL as an ROI. The type of stimuli or task did not influence the likelihood of ATL activation, consistent with the view that this region underpins an amodal semantic system. Spoken words, written words, and picture stimuli produced overlapping ATL peaks. On average, these were more inferior for picture-based tasks. We suggest that the specific pattern of ATL activation may be influenced by stimulus type due to variations across this region in the degree of connectivity with modality-specific areas in posterior temporal cortex.
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            Quantitative fMRI assessment of the differences in lateralization of language-related brain activation in patients with temporal lobe epilepsy.

            J.E. Adcock, R.G. Wise, J.M. Oxbury … (2003)
            Defining language lateralization is important to minimize morbidity in patients treated surgically for temporal lobe epilepsy (TLE). Functional magnetic resonance imaging (fMRI) offers a promising, noninvasive, alternative strategy to the Wada test. Here we have used fMRI to study healthy controls and patients with TLE in order to (i) define language-related activation patterns and their reproducibility; (ii) compare lateralization determined by fMRI with those from of the Wada test; and (iii) contrast different methods of assessing fMRI lateralization. Twelve healthy right-handed controls and 19 right-handed preoperative patients with TLE (12 left- and seven right-TLE) were studied at 3T using fMRI and a verbal fluency paradigm. A Wada test also was performed on each of the patients. Greater activation was found in several areas in the right hemisphere for the left-TLE group relative to controls or right-TLE patients. Relative hemispheric activations calculated based on either the extent or the mean signal change gave consistent results showing a more bihemispheric language representation in the left-TLE patients. There was good agreement between the Wada and fMRI results, although the latter were more sensitive to involvement of the nondominant right hemisphere. The reproducibility of the fMRI values was lowest for the more bihemispherically represented left-TLE patients. Overall, our results further demonstrate that noninvasive fMRI measures of language-related lateralization may provide a practical and reliable alternative to invasive testing for presurgical language lateralization in patients with TLE. The high proportion (33%) of left-TLE patients showing bilateral or right hemispheric language-related lateralization suggests that there is considerable plasticity of language representation in the brains of patients with intractable TLE.
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              Use of preoperative functional neuroimaging to predict language deficits from epilepsy surgery.

              Maurice Swanson, Jonathan Mueller, John G L Morris … (2003)
              Left anterior temporal lobectomy (L-ATL) may be complicated by confrontation naming deficits. To determine whether preoperative fMRI predicts such deficits in patients with epilepsy undergoing L-ATL. Twenty-four patients with L-ATL underwent preoperative language mapping with fMRI, preoperative intracarotid amobarbital (Wada) testing for language dominance, and pre- and postoperative neuropsychological testing. fMRI laterality indexes (LIs), reflecting the interhemispheric difference between activated volumes in left and right homologous regions of interest, were calculated for each patient. Relationships between the fMRI LI, Wada language dominance, and naming outcome were examined. Both the fMRI LI (p < 0.001) and the Wada test (p < 0.05) were predictive of naming outcome. fMRI showed 100% sensitivity and 73% specificity in predicting significant naming decline. Both fMRI and the Wada test were more predictive than age at seizure onset or preoperative naming performance. Preoperative fMRI predicted naming decline in patients undergoing left anterior temporal lobectomy surgery.
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                Author and article information

                Contributors
                Marla J.S. Mickleborough
                Journal
                Journal ID (nlm-ta): Epilepsy Behav Case Rep
                Journal ID (iso-abbrev): Epilepsy Behav Case Rep
                Title: Epilepsy & Behavior Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 2213-3232
                Publication date PMC-release: 02 December 2015
                Publication date Collection: 2016
                Publication date (Electronic): 02 December 2015
                Volume: 5
                Pages: 6-10
                Affiliations
                [a ]Department of Psychology, 9 Campus Drive, University of Saskatchewan, Saskatoon, SK S7N 5A5, Canada
                [b ]Department of Medical Imaging, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada
                [c ]Department of Surgery, Division of Neurosurgery, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N OW8, Canada
                [d ]Department of Neurology, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N OW8, Canada
                Author notes
                [* ]Corresponding author at: Department of Psychology, 9 Campus Drive, Saskatoon, SK S7N 5A5, Canada. Tel.: + 1 306 966 6691; fax: + 1 306 966 6630.Department of Psychology9 Campus DriveSaskatoonSKS7N 5A5Canada marla.mick@ 123456usask.ca
                Article
                Publisher ID: S2213-3232(15)00043-2
                DOI: 10.1016/j.ebcr.2015.10.003
                PMC ID: 4907790
                PubMed ID: 27330987
                SO-VID: 8587786c-fe5c-4a71-a56f-430aa5234eba
                Copyright © © 2015 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 30 September 2015
                Date revision received : 25 October 2015
                Date accepted : 28 October 2015
                Categories
                Subject: Case Report

                Keywords: language,temporal lobe epilepsy,fmri,neurosurgery,reading
                Data availability:
                Keywords: language, temporal lobe epilepsy, fmri, neurosurgery, reading

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