Cortical Localization in Temporal Lobe Epilepsy

描述（由申请人提供）：众所周知，颞叶在语言中介中起着关键作用。然而，颞叶区域内语言的功能解剖组织还没有得到很好的理解。对于选择手术治疗以控制癫痫发作的颞叶癫痫患者来说，这是一个重要的问题，因为这种手术切除了相当大一部分颞叶皮层。为了保留语言能力，通常进行皮层语言映射以识别“必要的”语言皮层并使这些区域免于切除。尽管如此，许多患者术后尽管有这种映射，主要是在单词查找方面下降。虽然大多数手术程序依赖于视觉对象命名，以确定“基本”的语言皮层，除了听觉命名揭示了一个独特的区域，在前颞叶皮层刺激受损的听觉，但视觉命名。初步的后续测试表明，保留这些听觉命名网站保留字的发现，而切除这些网站的结果下降（不影响癫痫发作的结果）。有趣的是，一些患者在听觉和视觉命名方面都有所下降，尽管事实上只有“纯听觉”部位被切除，而所有视觉命名部位都被保留。在本研究中，我们将在颞叶切除前后使用心理语言学任务来研究前颞叶皮层在词汇及其意义的通达中的作用。类似的任务将在映射过程中使用，以在其他方法无法达到的分析水平上描绘语言相关的结构-功能关系。持续的术后随访将评估初步结果的可靠性，并确定缺陷是否持续存在。还将监测癫痫发作结果。主要目标是：1）确定在哪些患者中，去除听觉命名部位会导致单词发现下降的频率; 2）为了确定涉及单词选择和获得词义的过程在解剖学上不同的程度，以及这些过程在神经解剖学上的表现，3）确定为什么似乎支持模态特异性的皮层切除（听觉）命名可以导致一般的词发现下降; 4）确定是否保留听觉命名的网站从切除影响癫痫发作的结果。结果承诺更深入地了解语言的神经功能组织，可能提供更好的治疗和语言技能的保护，不仅对癫痫手术患者，而且对其他神经学语言障碍的患者。

DESCRIPTION (provided by applicant): It is well established that the temporal lobe plays a critical role in language mediation. Yet, the functional-anatomical organization of language within the temporal lobe region is not well understood. This is a significant concern for temporal lobe epilepsy patients who elect surgical treatment for seizure control, because a substantial portion of temporal cortex is removed with this procedure. To preserve verbal abilities, cortical language mapping is often performed to identify "essential" language cortex and spare these areas from resection. Nonetheless, many patients decline post-operatively despite such mapping, primarily with respect to word finding. Although most surgery programs rely on visual object naming to identify 'essential' language cortex, the addition of auditory naming revealed a distinct region in anterior temporal cortex where stimulation impaired auditory but not visual naming. Preliminary follow-up testing suggests that sparing these auditory naming sites preserves word finding whereas resecting these sites results in decline (without affecting seizure outcome). Interestingly, a number of patients declined on both auditory and visual naming, despite the fact that only "pure auditory" sites were resected, and that all visual naming sites were spared. In the proposed studies, psycholinguistic tasks will be used before and after temporal lobe resection to study the role of anterior temporal cortex in the access of words and their meaning. Similar tasks will be used during mapping to delineate language-related structure-function relations at a level of analysis that is not attainable with other methods. Continued post-operative follow-up will assess the reliability of the preliminary findings, and determine whether deficits persist. Seizure outcome will be monitored as well. Primary goals are: 1) To determine how often, and in which patients, removing auditory naming sites results in word finding decline; 2) To determine the extent to which processes involved in word selection and access to word meaning are anatomically distinct, and where these process are represented neuroanatomically, 3) Determine why resection of cortex that appears to support modality-specific (auditory) naming can result in general word finding decline; 4) Determine whether sparing auditory naming sites from resection affects seizure outcome. Results promise deeper understanding of the neuro-functional organization of language, potentially offering improved treatment and preservation of language skills, not only to epilepsy surgery patients, but also to individuals with other neurologically based language disorders.