Cortical Localization in Temporal Lobe Epilepsy

描述(由申请者提供)：众所周知，颞叶在语言调节中起着关键作用。然而，关于语言在颞叶区域内的功能解剖组织还没有被很好地理解。对于选择手术治疗以控制癫痫发作的颞叶癫痫患者来说，这是一个重要的担忧，因为通过这种手术可以切除大部分的颞叶皮质。为了保护语言能力，经常进行皮质语言标测，以确定“必要的”语言皮质，使这些区域免于切除。尽管如此，尽管有这样的映射，许多患者术后还是下降了，主要是在单词查找方面。尽管大多数手术程序依靠视觉物体命名来识别“基本的”语言皮质，但听觉命名的增加揭示了前颞叶皮质中一个明显的区域，在那里刺激损害了听觉命名，而不是视觉命名。初步的后续测试表明，保留这些听觉命名位置可以保留单词查找，而切除这些位置会导致单词减少(不会影响癫痫发作结果)。有趣的是，许多患者的听觉和视觉命名能力都下降了，尽管事实上只切除了“纯听觉”部位，而且所有视觉命名部位都幸免于难。在拟议的研究中，将使用心理语言学任务在颞叶切除前后来研究前颞叶皮质在词汇及其意义通达中的作用。在映射过程中将使用类似的任务，以在其他方法无法达到的分析水平上描绘与语言有关的结构-功能关系。术后继续随访将评估初步结果的可靠性，并确定赤字是否持续存在。还将监测癫痫发作的结果。主要目标是：1)确定移除听觉命名站点的频率以及在哪些患者中，移除听觉命名站点会导致单词查找能力下降；2)确定在多大程度上涉及单词选择和词义获取的过程在解剖学上是不同的，以及这些过程在神经解剖学上的表现；3)确定为什么切除似乎支持通道特定(听觉)命名的皮质会导致一般单词查找能力下降；4)确定不切除听觉命名站点是否会影响癫痫发作的结果。结果预示着对语言的神经功能组织有更深入的理解，不仅对癫痫手术患者，而且对患有其他神经学语言障碍的个人，可能提供更好的治疗和语言技能的保存。

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.