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. 2009 Aug 18;73(7):518-25.
doi: 10.1212/WNL.0b013e3181b2a48e.

Cortical reorganization following anterior temporal lobectomy in patients with temporal lobe epilepsy

S W H Wong  1 , L Jong, D Bandur, F Bihari, Y-F Yen, A M Takahashi, D H Lee, D A Steven, A G Parrent, S E Pigott, S M Mirsattari
Affiliations

Cortical reorganization following anterior temporal lobectomy in patients with temporal lobe epilepsy

S W H Wong et al. Neurology. .

Abstract

Background: Functional MRI was used to study the impact of temporal lobe epilepsy (TLE) and anterior temporal lobectomy (ATL) on the cortical language network in patients with medically refractory TLE.

Methods: Nineteen patients with medically refractory TLE and 11 healthy control subjects were enrolled in this study. Ten patients underwent left ATL (mean age 35.2 +/- 3.8 years), and 9 underwent right ATL (mean age 35.9 +/- 2.6 years). The subjects silently generated verbs in response to a series of visually presented nouns inside the scanner. Correlation analysis was performed between the subjects' performance on the clinical language tests and their neural response in the a priori cortical regions.

Results: Preoperative data revealed that the patients with TLE showed increased neural activity in the right inferior frontal gyri (IFG) and middle frontal gyri (MFG). The right TLE patients demonstrated strong correlation between their language performance and the level of cortical activation within the typical language areas. However, such a correlation was absent in the left TLE patients. After the ATL surgery, the left TLE patients showed reduced activation in the left MFG and right IFG, whereas no difference was observed in the right TLE patients. In the right TLE patients, the correlation between language performance and neural response shifted from the typical language areas to the anterior cingulate cortex.

Conclusion: This study demonstrates that the cortical language network is affected differently by the left and right temporal lobe epilepsy and is reorganized after anterior temporal lobectomy.

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Figures

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Figure 1 Activation maps before and after anterior temporal lobectomy Activation maps for the left temporal lobe epilepsy (LTLE), right temporal lobe epilepsy (RTLE), and healthy control (CTRL) groups before (left) and after (right) the anterior temporal lobectomy (p < 0.001, uncorrected).
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Figure 2 Percent signal change at the predefined regions of interest CTRL = healthy control subjects; LTLE = left temporal lobe epilepsy; pre = before anterior temporal lobectomy; post = after anterior temporal lobectomy; RTLE = right temporal lobe epilepsy; oper = pars opercularis of inferior frontal gyrus; tri = pars triangularis of inferior frontal gyrus; orb = pars orbitalis of inferior frontal gyrus; LMFG = left middle frontal gyrus; RMFG = right middle frontal gyrus.
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Figure 3 Decreased activation after anterior temporal lobectomy in the left temporal lobe epilepsy group Before anterior temporal lobectomy, left temporal lobe epilepsy (LTLE) patients showed stronger activation in the right inferior frontal gyrus, left middle frontal gyrus, and left inferior and superior parietal gyri (p < 0.001, uncorrected).
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Figure 4 Correlation between blood oxygenation level–dependent signal and language score before and after ipsilateral anterior lobectomy Correlation between blood oxygenation level–dependent signal and language score in the left temporal lobe epilepsy (LTLE) patients and the right temporal lobe epilepsy (RTLE) patients before and after an ipsilateral anterior lobectomy (ATL). Postoperative language scores were obtained from 6 of the RTLE patients, and the language score of an RTLE patient was classified as an outlier and excluded from the correlation analysis. LIFG = left inferior frontal gyrus; BNT = Boston Naming Test; RIFG = right inferior frontal gyrus.
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Figure 5 Average correlation coefficient (R2) between percent signal change at different predefined regions of interest and language scores across participants LTLE = left temporal lobe epilepsy; RTLE = right temporal lobe epilepsy; WAB = Western Aphasia Battery; LQ = Language Quotient; BDAE = Boston Diagnostic Aphasia Examination; BNT = Boston Naming Test; LIFG orb = pars orbitalis of left inferior frontal gyrus; LIFG oper = pars opercularis of left inferior frontal gyrus; LIFG tri = pars triangularis of left inferior frontal gyrus; LMFG = left middle frontal gyrus; LSFG = left superior frontal gyrus; LACC = left anterior cingulate cortex; RACC = right anterior cingulate cortex; RSFG = right superior frontal gyrus; RMFG = right middle frontal gyrus; RIFG tri = pars triangularis of right inferior frontal gyrus; RIFG oper = pars opercularis of right inferior frontal gyrus; RIFG orb = pars orbitalis of right inferior frontal gyrus.
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References

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