Improving language assessment in bilinguals with epilepsy using advanced neuroimaging and culturally-sensitive neuropsychological measures

项目概要/摘要 语言障碍在颞叶癫痫（TLE）中很常见，并且通常与癫痫发作的程度相关。 前颞叶的病理变化语言缺陷也可以通过手术切除关键的 语言结构在语言主导的一面。大多数癫痫研究都是单语，母语 这是一个问题，因为双语人数迅速增长， 数据显示，双语与单语大脑处理语言的方式不同。双语者是众所周知的 1）在语言测试中表现得比单语者差，特别是那些为 单语者--受文化和语言偏见的影响，2）表现出更多的双语 表示.这表明，目前对双语者术前语言数据的临床解释可能 导致假阳性（即，将患者分类为受损并错误地假设颞叶病理， 语言结构完好）或对术后语言衰退的预测不准确。我们假设 通过使用文化和语言，手术前语言评估的临床实用性将得到提高 针对双语者的敏感措施。迄今为止的研究只测试了一种语言的双语者和/或使用自我- 报告的语言能力评级，这是众所周知的不太可靠。此外，缺乏研究 将神经心理学数据与神经影像学相结合，以评估神经系统的功能和结构完整性。 双语者的颞叶在目标1中，我们评估一种新颖的、量身定制的方法， 两种语言的语言熟练程度和命名是上级的传统方法，评估 熟练程度仅通过自我报告和测试命名与单语规范的措施。量身定制的方法 将确保根据双语者的主导语言来定义障碍。在目标2中，我们检查 语言表型是否会因使用功能性MRI和扩散张量的方法而不同 成像，以及双语语言因素（例如，熟练程度、习得年龄）影响偏侧性。目标3 确定定制的方法是否预测术后语言能力下降， 这些因素与术后结果有关。我们利用多站点、回顾性和前瞻性数据集 从三个大的加州大学癫痫中心获得。实现这些目标将提高精确度 并阐明双语和TLE对语言网络重组的综合影响， 同时为申请人提供多模式成像和临床研究方面的培训， 人口这将导致K奖和职业生涯作为一个研究神经心理学家在成像训练， 特别关注双语能力，这通常与美国的少数民族地位有关。

PROJECT SUMMARY/ABSTRACT Language impairment is common in temporal lobe epilepsy (TLE) and often correlated with the amount of pathology in the anterior temporal lobe. Language deficits can also be exacerbated by surgical removal of critical language structures on the language-dominant side. The majority of epilepsy research is with monolingual, native English speakers, which is a problem given the rapidly growing number of bilingual individuals and considerable data showing that language is processed differently in the bilingual vs monolingual brain. Bilinguals are known to 1) perform worse than monolinguals on language measures—in particular on those designed for monolinguals—which suffer from cultural and linguistic biases and 2) show more bilateral language representation. This suggests that current clinical interpretation of a bilingual's presurgical language data may lead to false positives (i.e., classifying a patient as impaired and falsely assuming temporal lobe pathology when language structures are intact) or inaccurate prediction of post-operative language decline. We hypothesize that the clinical utility of pre-surgical language assessment would improve with the use of culturally and linguistically sensitive measures tailored to bilinguals. Studies to date tested bilinguals in only one language and/or used self- reported language proficiency ratings which are known to be less reliable. Further, there is a lack of studies combining neuropsychological data with neuroimaging to evaluate the functional and structural integrity of the temporal lobes in bilinguals. In Aim 1, we evaluate whether a novel, tailored approach that objectively measures language proficiency and naming in both languages is superior to a conventional approach that assesses proficiency only by self-report and tests naming with monolingual-normed measures. The tailored approach would ensure that impairment is defined based on a bilingual's dominant language. In Aim 2, we examine whether language phenotypes will differ as a result of approach using functional MRI and diffusion tensor imaging, and whether bilingual language factors (e.g., proficiency, age of acquisition) influence laterality. Aim 3 determines whether the tailored approach predicts post-operative language decline and if bilingual language factors are related to post-operative outcomes. We leverage a multisite, retrospective and prospective dataset obtained from three large University of California epilepsy centers. Fulfillment of these aims will improve precision medicine and shed light on the combined effects of bilingualism and TLE on language network re-organization, while providing the applicant with training in multimodal imaging and clinical research with a neurosurgical population. This will lead to a K-award and career as a research neuropsychologist trained in imaging, with a special focus on bilingualism, which is often correlated with minority status in the USA.