Stereoelectroencephalographic language mapping of the basal temporal cortex predicts postoperative naming outcome
Stereoelectroencephalographic language mapping of the basal temporal cortex predicts postoperative naming outcome
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DOI：
10.3171/2020.8.jns202431
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发表时间：
2021-11-01
影响因子：
4.1
通讯作者：
Maillard, Louis
中科院分区：
文献类型：
--
作者：
Abdallah, Chifaou;Brissart, Helene;Maillard, Louis
目的：在耐药颞叶癫痫（TLE）患者中，作者根据立体脑电图（SEEG）时皮质刺激识别的基底颞叶语言区（BTLA）的切除情况，评估优势颞叶切除（TLR）后视觉物体命名能力下降的早期和晚期结果。方法20例耐药TLE患者行SEEG治疗，符合纳入标准。在语言映射过程中，当两个连续接触的刺激在两个远程会话中引起至少一个命名障碍时，一个位点被认为是积极的。在BTLA同侧TLR后，当至少一个阳性语言部位被切除时，患者被分类为BTLA+，当所有阳性语言部位都被保留时，患者被分类为BTLA-。命名和语言流畅性测试的结果采用组前和术后（术后7个月和25个月）评分和可靠变化指数（rci）评估个体水平的临床意义变化。结果BTLA+患者（n = 7）在术后1年内的命名评分明显低于BTLA-患者（n = 13），但在长期评价中无明显差异。在语言流畅性测试中没有观察到差异。使用rci时，18例患者中有5例（28%）在术后1年内出现命名下降（对应于57%的BTLA+患者和9%的BTLA-患者）。BTLA切除与命名能力下降之间存在显著相关性。结论：BTLA切除术与特异性和早期命名下降有关。即使这种下降是短暂的，与基线相比，BTLA+患者的命名评分往往仍然较低。SEEG图谱有助于预测显性TLR术后语言预后。
OBJECTIVE In drug-resistant temporal lobe epilepsy (TLE) patients, the authors evaluated early and late outcomes for decline in visual object naming after dominant temporal lobe resection ( TLR) according to the resection status of the basal temporal language area (BTLA) identified by cortical stimulation during stereoelectroencephalography (SEEG).METHODS Twenty patients who underwent SEEG for drug-resistant TLE met the inclusion criteria. During language mapping, a site was considered positive when stimulation of two contiguous contacts elicited at least one naming impairment during two remote sessions. After TLR ipsilateral to their BTLA, patients were classified as BTLA+ when at least one positive language site was resected and as BTLA- when all positive language sites were preserved. Outcomes in naming and verbal fluency tests were assessed using pre- and postoperative (means of 7 and 25 months after surgery) scores at the group level and reliable change indices (RCIs) for clinically meaningful changes at the individual level.RESULTS BTLA+ patients (n = 7) had significantly worse naming scores than BTLA- patients (n = 13) within 1 year after surgery but not at the long-term evaluation. No difference in verbal fluency tests was observed. When RCIs were used, 5 of 18 patients (28%) had naming decline within 1 year postoperatively (corresponding to 57% of BTLA+ and 9% of BTLA- patients). A significant correlation was found between BTLA resection and naming decline.CONCLUSIONS BTLA resection is associated with a specific and early naming decline. Even if this decline is transient, naming scores in BTLA+ patients tend to remain lower compared to their baseline. SEEG mapping helps to predict postoperative language outcome after dominant TLR.