Language lateralization in temporal lobe epilepsy:: A comparison between fMRI and the wada test
Language lateralization in temporal lobe epilepsy:: A comparison between fMRI and the wada test
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DOI：
10.1111/j.1528-1167.2006.00549.x
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发表时间：
2006-08-01
期刊：
影响因子：
5.6
通讯作者：
Willmes, Klaus
中科院分区：
文献类型：
--
作者：
Benke, Thomas;Koylu, Bulent;Willmes, Klaus
目的：最近的研究声称，语言功能磁共振成像（fMRI）可以识别颞叶癫痫（TLE）患者的语言偏侧化，并且基于fMRI的结果与传统的语言优势评估程序--颈动脉内异戊巴比妥试验（IAT）高度一致。为了建立语言功能磁共振成像在术前评估中检测语言偏侧化的能力，我们比较了68例慢性顽固性左右颞叶癫痫（rTLE，n = 28; lTLE，n = 40）患者的语义决策范式与标准IAT结果，这些患者连续接受了术前评估程序。患者组还包括14名（20.6%）非典型（双侧或右半球）语音受试者。四个评分员使用视觉分析程序，以确定单独为每个patient.Results的语音相关激活的偏侧性：整体一致性之间的fMRI为基础的偏侧性和偏侧商的IAT是89.3%，在rTLE和72.5%，在lTLE患者。rTLE患者的一致性最好，左侧语言。在lTLE患者中，语言fMRI在每例病例中识别出不典型的右半球言语优势，但在17.2%的病例中遗漏了左半球言语优势。额叶激活与IAT的一致性高于颞顶或联合感兴趣区域（ROI）的激活。由于方法学的问题，识别的双边语音是困难的。结论：这些数据提供的证据表明，语言功能磁共振成像在本研究中使用的IAT的相关性有限，特别是在患者与lTLE和混合语音优势。进一步完善的范例和分析程序，将需要提高术前评估的语言功能磁共振成像的贡献。
Purpose: Recent studies have claimed that language functional magnetic resonance imaging (fMRI) can identify language lateralization in patients with temporal lobe epilepsy (TLE) and that fMRI-based findings are highly concordant with the conventional assessment procedure of speech dominance, the intracarotid amobarbital test (IAT).Methods: To establish the power of language fMRI to detect language lateralization during presurgical assessment, we compared the findings of a semantic decision paradigm with the results of a standard IAT in 68 patients with chronic intractable right and left temporal lobe epilepsy (rTLE, n = 28; lTLE, n = 40) who consecutively underwent a presurgical evaluation program. The patient group also included 14 (20.6%) subjects with atypical (bilateral or right hemisphere) speech. Four raters used a visual analysis procedure to determine the laterality of speech-related activation individually for each patient.Results: Overall congruence between fMRI-based laterality and the laterality quotient of the IAT was 89.3% in rTLE and 72.5% in lTLE patients. Concordance was best in rTLE patients with left speech. In lTLE patients, language fMRI identified atypical, right hemisphere speech dominance in every case, but missed left hemisphere speech dominance in 17.2%. Frontal activations had higher concordance with the IAT than did activations in temporoparietal or combined regions of interest (ROIs). Because of methodologic problems, recognition of bilateral speech was difficult.Conclusions: These data provide evidence that language fMRI as used in the present study has limited correlation with the IAT, especially in patients with lTLE and with mixed speech dominance. Further refinements regarding the paradigms and analysis procedures will be needed to improve the contribution of language fMRI for presurgical assessment.