Cortical Localization in Temporal Lobe Epilepsy

颞叶癫痫的皮质定位

• 批准号: 8686964
• 负责人: MARLA J HAMBERGER
• 金额: $ 34.17万
• 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 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8686964
• 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; 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.

描述（由申请人提供）：颞叶切除术为患有难治性颞叶癫痫的患者提供了治愈的最佳希望。不幸的是，这种手术通常会带来命名能力的代价，而这种能力通常在手术前就已经受到了损害。手术前识别命名缺陷提供了有价值的信息，可以偏侧癫痫发作。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下降。从历史上看，视觉对象命名一直是唯一的方法，既评估命名和刺激映射，以确定必要的语言皮层。然而，视觉命名未能可靠地识别真正的命名缺陷，并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的能力，侧化和定位与致痫皮质相关的皮质功能障碍。在刺激映射中，听觉命名通过识别临床相关的语言皮层提高了映射效率，否则将无法检测到。尽管取得了这些重大进展，但仍然存在两个问题。首先，一些患者仍然表现出术后命名下降，第二，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次级组成部分：成人绘图和儿童绘图中处理。关于成人地图，初步研究表明命名下降的两个新的潜在来源：1）海马切除术（海马体通常被认为是没有语言参与的记忆结构，但最近的术后和影像学数据暗示它在命名下降）和2）手术破坏侧颞区，支持命名相关的语言功能（试点测绘结果揭示了解剖学上不同的网站，介导语义和语音的访问，这两者都是必要的命名）。为了解决这两种可能性，包括命名的语言过程将在海马和侧颞部位的直接刺激期间进行测试，以确定这些脑区在命名中的作用和临床相关性。成人绘图的项目目标是确定：a）哪些方面的命名是由海马介导的，B）“非命名”侧颞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。关于儿童癫痫，我们将解决缺乏适合癫痫儿童年龄的命名措施的问题。本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，开发成人听觉和视觉命名测试的类似儿科版本并使其标准化，以及B）确定听觉命名表现是否预测偏侧癫痫儿童癫痫发作的半球偏侧，就像在成人中一样。从整体项目的结果承诺新的见解颞叶组织的语言，更好地预测和预防术后缺陷，并改善小儿癫痫护理。