Cortical Localization in Temporal Lobe Epilepsy

颞叶癫痫的皮质定位

• 批准号: 8298541
• 负责人: MARLA J HAMBERGER
• 金额: $ 34.51万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 1996
• 资助国家: 美国
• 起止时间: 1996-12-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8298541
• 关键词: Address; Adult; Affect; Age; Area; Auditory; Benchmarking; Biological Preservation; Brain; Caring; Child; Childhood; Clinical; Clinical assessments; Cognitive; Comorbidity; Data; Development; Epilepsy; Evaluation; Excision; Exhibits; Frequencies; Functional disorder; Funding; Goals; Grant; Hippocampus (Brain); Image; Impaired cognition; Individual; Knowledge; Language; Language Development; Lateral; Lead; Left; Linguistics; Location; Maps; Measures; Mediating; Memory; Methods; Modality; Names; National Institute of Neurological Disorders and Stroke; Nature; Operative Surgical Procedures; Patients; Performance; Pharmacological Treatment; Postoperative Period; Prevention; Process; Psycholinguistics; Refractory; Research; Risk; Role; Seizures; Semantics; Severities; Site; Source; Structure; Temporal Lobe; Temporal Lobe Epilepsy; Testing; Visual; Visual Perception; Vocabulary; Work; age group; base; clinically relevant; cost; improved; insight; phonology; prevent; public health relevance; skills; sound; tool; visual object processing

DESCRIPTION (provided by applicant): Temporal lobe resection offers the best hope of cure for patients who suffer from refractory temporal lobe epilepsy. Unfortunately, this surgery often comes with a cost to naming ability, which is typically already compromised before surgery. Identification of naming deficits prior to surgery provides valuable information that can lateralize seizure onset. Furthermore, sparing of naming cortex identified via stimulation mapping helps prevent naming decline postoperatively. Historically, visual object naming has been the sole method both for assessing naming and for stimulation mapping to identify essential language cortex. However, visual naming has failed to reliably identify true naming deficits and has failed to consistently protect postoperative naming. The recent addition of auditory description naming has enhanced our ability to lateralize and localize cortical dysfunction associated with epileptogenic cortex. In stimulation mapping, auditory naming has improved mapping efficacy by identifying clinically relevant language cortex that otherwise would have remained undetected. Despite these considerable advances, two problems persist. First, some patients still exhibit postoperative naming decline and second, the work in auditory naming has not been extended to children. These two issues will be addressed in the two subcomponents of the proposed project: Adult Mapping and Child Naming. Regarding Adult Mapping, preliminary studies suggest two new potential sources of naming decline: 1) Hippocampal removal (the hippocampus is generally considered a memory structure without language involvement, but recent postoperative and imaging data implicate it in naming decline) and 2) Surgical disruption of lateral temporal areas that support naming-related linguistic functions (pilot mapping results reveal anatomically distinct sites that mediate semantic and phonological access, both of which are necessary for naming). To address these two possibilities, the linguistic processes that comprise naming will be tested during direct stimulation of hippocampal and lateral temporal sites to establish the role and clinical relevance of these brain areas in naming. Project goals for Adult Mapping are to determine: a) Which aspects of naming are mediated by the hippocampus, b) Whether "non-naming" lateral temporal sites mediate critical naming sub-processes, and c) Whether the nature and severity of naming decline are related to the location, type, or number of naming sites disrupted by surgery. Regarding Child Naming, we will address the absence of age appropriate naming measures for children with epilepsy. Project goals for this component of the project are to: a) Develop and standardize analogous pediatric versions of the adult auditory and visual naming tests via normative study and patient testing, and b) Determine whether auditory naming performance predicts hemispheric lateralization of seizure onset in children with lateralized epilepsy, as it does in adults. Results from the overall project promise new insights into temporal lobe organization of language, better prediction and prevention of postoperative deficits, and improvements in pediatric epilepsy care. PUBLIC HEALTH RELEVANCE: This work will lead to better understanding of temporal lobe language organization, which will improve our ability to preserve language abilities in individuals who require temporal lobe epilepsy surgery. This work will also provide a means for assessing and understanding word finding ability in children.

描述（由申请人提供）：颞叶切除术为难治性颞叶癫痫患者提供了治愈的最佳希望。不幸的是，这种手术通常会损害命名能力，而命名能力通常在手术前就已经受到损害。手术前识别命名缺陷可以提供有价值的信息，可以侧化癫痫发作。此外，通过刺激映射识别的命名皮层的保留有助于防止术后命名能力下降。从历史上看，视觉对象命名一直是评估命名和刺激映射以识别基本语言皮层的唯一方法。然而，视觉命名未能可靠地识别真实的命名缺陷，也未能始终如一地保护术后命名。最近增加的听觉描述命名增强了我们侧化和定位与致癫痫皮层相关的皮层功能障碍的能力。在刺激映射中，听觉命名通过识别临床相关的语言皮层来提高映射效率，否则这些语言皮层将无法被检测到。尽管取得了这些显着的进步，但仍然存在两个问题。首先，一些患者术后命名能力下降，其次，听觉命名的工作尚未扩展到儿童。这两个问题将在拟议项目的两个子组件中得到解决：成人映射和儿童命名。关于成人映射，初步研究表明命名下降的两个新的潜在来源：1）海马体去除（海马体通常被认为是不涉及语言的记忆结构，但最近的术后和影像数据表明它与命名下降有关）和2）支持命名相关语言功能的外侧颞区的手术破坏（试点映射结果揭示了介导语义和功能的解剖学上不同的部位） 语音访问，两者都是命名所必需的）。为了解决这两种可能性，将在直接刺激海马和外侧颞叶部位的过程中测试构成命名的语言过程，以确定这些大脑区域在命名中的作用和临床相关性。成人映射的项目目标是确定：a) 命名的哪些方面是由海马体介导的，b) “非命名”外侧颞叶部位是否介导关键的命名子过程，以及 c) 命名下降的性质和严重程度是否与手术破坏的命名部位的位置、类型或数量有关。关于儿童命名，我们将解决癫痫儿童缺乏适合年龄的命名措施的问题。该项目这一部分的项目目标是：a) 通过规范性研究和患者测试，开发并标准化成人听觉和视觉命名测试的类似儿科版本，以及 b) 确定听觉命名表现是否可以预测偏侧性癫痫儿童的半球偏侧性癫痫发作，就像成人一样。整个项目的结果有望为语言颞叶组织提供新的见解，更好地预测和预防术后缺陷，并改善小儿癫痫护理。 公共健康相关性：这项工作将有助于更好地理解颞叶语言组织，这将提高我们保留需要颞叶癫痫手术的个体的语言能力的能力。这项工作还将提供一种评估和理解儿童找词能力的方法。