Imaging language networks before and after anterior temporal lobe resection: results of a longitudinal fMRI study.
Imaging language networks before and after anterior temporal lobe resection: results of a longitudinal fMRI study.
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DOI：
10.1111/j.1528-1167.2012.03433.x
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发表时间：
2012-04
期刊：
影响因子：
5.6
通讯作者：
Duncan JS
中科院分区：
文献类型：
--
作者：
Bonelli SB;Thompson PJ;Yogarajah M;Vollmar C;Powell RH;Symms MR;McEvoy AW;Micallef C;Koepp MJ;Duncan JS
前颞叶切除术(ATLR)可以控制高达70%的顽固性颞叶癫痫(TLE)患者的癫痫发作，但在语言占优势的大脑半球，可能会损害语言功能，特别是命名。功能重组可发生在同侧和对侧大脑半球。我们调查了左半球占优势的患者在ATLR前后的语言重组；术前功能磁共振成像(FMRI)是否预测术后命名能力下降；以及术后语言网络的效率。我们在3T GE-MRI扫描仪上对44例单侧海马硬化所致的TLE患者(左侧24例)进行了研究。所有受试者均于术前和术后4个月进行语言功能磁共振和神经心理测试。术后左侧TLE患者双侧额叶中/下部的fMRI激活程度和左侧额叶下/中回至对侧额叶的功能连接性较术前增强，而右侧TLE患者则未见此变化。术前，在左侧和右侧TLE中，更好的命名与更大的术前左海马区和左侧额叶激活的语言流利性(VF)相关。在左侧TLE患者中，术前左侧额叶中段较强的VF激活预示着ATLR后命名功能的较大下降。术后，在临床上有显著命名下降的左侧TLE中，右侧额叶中段VF的激活程度越大，术后命名效果越好。在没有术后命名下降的患者中，更好的命名与剩余左侧后部海马区的更大激活相关。在右侧TLE中，命名能力与术后左侧海马区及左右额叶VF激活相关。在左侧TLE中，术后早期对侧额叶的重组表明多个系统支持语言功能。术后，同侧重新启动涉及后海马区的残留物对维持语言很重要，而重新组织到对侧大脑半球的效果较差。术前左侧额叶中段VF的激活预示着ATLR术后左侧TLE命名功能的下降。
Anterior temporal lobe resection (ATLR) controls seizures in up to 70% of patients with intractable temporal lobe epilepsy (TLE) but, in the language dominant hemisphere, may impair language function, particularly naming. Functional reorganization can occur within the ipsilateral and contralateral hemispheres. We investigated reorganization of language in left-hemisphere–dominant patients before and after ATLR; whether preoperative functional magnetic resonance imaging (fMRI) predicts postoperative naming decline; and efficiency of postoperative language networks. We studied 44 patients with TLE due to unilateral hippocampal sclerosis (24 left) on a 3T GE-MRI scanner. All subjects performed language fMRI and neuropsychological testing preoperatively and again 4 months after left or right ATLR. Postoperatively, individuals with left TLE had greater bilateral middle/inferior frontal fMRI activation and stronger functional connectivity from the left inferior/middle frontal gyri to the contralateral frontal lobe than preoperatively, and this was not observed in individuals with right TLE. Preoperatively, in left and right TLE, better naming correlated with greater preoperative left hippocampal and left frontal activation for verbal fluency (VF). In left TLE, stronger preoperative left middle frontal activation for VF was predictive of greater decline in naming after ATLR. Postoperatively, in left TLE with clinically significant naming decline, greater right middle frontal VF activation correlated with better postoperative naming. In patients without postoperative naming decline, better naming correlated with greater activation in the remaining left posterior hippocampus. In right TLE, naming ability correlated with left hippocampal and left and right frontal VF activation postoperatively. In left TLE, early postoperative reorganization to the contralateral frontal lobe suggests multiple systems support language function. Postoperatively, ipsilateral recruitment involving the posterior hippocampal remnant is important for maintaining language, and reorganization to the contralateral hemisphere is less effective. Preoperative left middle frontal activation for VF was predictive of naming decline in left TLE after ATLR.
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