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

项目摘要/摘要 语言障碍在颞叶癫痫(TLE)中很常见，通常与语言障碍的程度有关 前颞叶的病理学。语言缺陷也可能因手术切除关键的 语言占主导地位的语言结构。大多数癫痫研究是以单一语言、母语为基础的 说英语的人，这是一个问题，因为双语个人的数量迅速增长，相当大的 数据显示，语言在双语和单语大脑中的处理方式不同。精通两种语言的人都知道 1)在语言测试上比只会说一种语言的人表现得更差--特别是在那些为 单语者--他们受到文化和语言偏见的困扰，2)表现出更多的双边语言 代表权。这表明，目前对双语者手术前语言数据的临床解释可能 导致假阳性(即，将患者归类为受损并在以下情况下错误地假设颞叶病理 语言结构完整)或对术后语言衰退的预测不准确。我们假设 术前语言评估的临床实用性将随着文化和语言的使用而提高 为双语者量身定做的敏感措施。到目前为止的研究只测试了双语者的一种语言和/或使用了自我 报告的语言水平评级，已知不太可靠。此外，还缺乏研究。 结合神经心理学数据和神经成像评估关节功能和结构的完整性 双语者的颞叶。在目标1中，我们评估一种新的、量身定做的方法是否客观地衡量 两种语言的语言熟练程度和命名都优于传统的评估方法 只有通过自我报告和测试命名才能熟练使用单一语言规范的测量方法。量身定做的方法 将确保根据双语者的主要语言来定义损伤。在目标2中，我们检查 使用功能磁共振成像和扩散张量的方法是否会导致语言表型不同 以及双语语言因素(如熟练程度、习得年龄)是否影响偏侧。目标3 确定量身定制的方法是否预测术后语言能力下降，以及是否使用双语 这些因素与手术后的结果有关。我们利用多站点、回溯性和前瞻性数据集 从加州大学的三个大型癫痫中心获得。这些目标的实现将提高精度 医学和揭示了双语和TLE在语言网络重组中的联合作用， 同时为申请者提供神经外科多模式成像和临床研究方面的培训 人口。这将导致获得K奖，并成为一名受过成像培训的研究神经心理学家，拥有 特别关注双语能力，这通常与美国的少数族裔地位有关。

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.