Epileptic activity influences the speech organization in medial temporal lobe epilepsy
Epileptic activity influences the speech organization in medial temporal lobe epilepsy
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DOI：
10.1093/brain/awg193
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发表时间：
2003-09-01
期刊：
影响因子：
14.5
通讯作者：
Ebner, A
中科院分区：
文献类型：
--
作者：
Janszky, J;Jokeit, H;Ebner, A
影响非典型言语偏侧化的因素在理解高级认知功能的组织和重组方面具有理论意义，同时在脑外科和神经康复方面具有实际意义。非典型（右侧或双侧）语言表征在局灶性癫痫中比健康人更常见。这种差异被认为与儿童早期的大脑损伤有关，这些损伤位于语言中心附近。癫痫活动对言语偏侧化的影响尚未被研究，尽管许多数据表明癫痫活动可能干扰高级脑功能。它只能在具有相同部位的相同病变类型的同类癫痫人群中进行评估。基于这些原因，我们调查了184例单侧海马硬化（HS）引起的内侧颞叶癫痫（MTLE）患者，但没有其他癫痫性病变。所有患者术前均进行了全面评估。在MTLE中，脑损伤即初始诱发性损伤（IPI）发生时年龄的影响可以与其他时间因素分开评估。在进行Wada测试的100例患者中，76%的左侧MTLE患者出现左侧言语，100%的右侧MTLE患者出现左侧言语（P < 0.05）。为了进一步评估，我们只纳入了83例左侧MTLE患者。癫痫发作的平均年龄为10.1±7.8岁（范围1-37岁）；平均年龄为35.7±9.8岁。根据Wada测试，63例患者出现左侧语言，而20例（24%）患者的Wada测试显示非典型语言优势。我们发现，左颞叶非典型言语表征与较高的尖峰频率相关（P < 0.05），与代表外侧颞结构的感觉光环相关（P < 0.01）。提示边缘癫痫扩散的精神光环与左侧MTLE左侧语言优势显著相关（P < 0.05）。癫痫发作年龄和IPI年龄均与左侧MTLE的非典型言语无关。综上所述，我们发现局灶性癫痫患者，除了已知的因素，如脑损伤发生的年龄及其定位，还有癫痫活动本身，如间歇放电和发作扩散，都可能影响言语重组。我们的研究结果还表明，不仅结构因素，而且功能因素对大脑的语言组织有影响。
Factors influencing atypical speech lateralization have theoretical importance in understanding the organization and reorganization of higher cognitive functions, as well as having practical implications, especially in brain surgery and neurorehabilitation. Atypical (right-sided or bilateral) language representation is more frequent in focal epilepsy than in healthy people. This difference is thought to be related to early childhood brain injuries localized in the neighbourhood of speech centres. The effect of epileptic activity on speech lateralization has not been investigated, although much data suggest that epileptic activity may interfere with higher brain functions. It can only be evaluated in a homogeneous human population with epilepsy having the same lesion type in the same localization. For these reasons, we investigated 184 patients with medial temporal lobe epilepsy (MTLE) due to unilateral hippocampal sclerosis (HS), but without other epileptogenic lesions. All patients underwent comprehensive presurgical evaluation. In MTLE, the influence of age at the time of brain damage, i.e. the initial precipitating injury (IPI), could be evaluated separately from the other timing factors. Of 100 patients in whom a Wada test was performed, left-sided speech occurred in 76% of the left-sided and in 100% of the right-sided MTLE patients (P < 0.05). For further evaluation, we included only the 83 left-sided MTLE patients. The mean age at seizure onset was 10.1 +/- 7.8 years (range 1-37 years); the mean age at evaluation was 35.7 +/- 9.8 years. Based on the Wada test, left-sided speech was present in 63 patients, while in 20 (24%) patients the Wada test revealed atypical speech dominance. We found that atypical speech representation in left MTLE was associated with higher spiking frequency (P < 0.05) and with sensory auras representing an ictal involvement of the lateral temporal structures (P < 0.01). Psychic auras suggesting limbic seizure spread showed a significant association with left-sided speech dominance in left MTLE (P < 0.05). Neither age at epilepsy onset, nor age at IPI was associated with atypical speech in left MTLE. Conclusively, we found that in patients with focal epilepsy, not only the known factors, i.e. the age at which the brain injury occurred and its localization, but also the epileptic activity itself, i.e. interictal discharges and seizure spread, may influence speech reorganization. Our findings also suggest that not only structural elements but also functional factors have an effect on the language organization of the brain.