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. 2011 Aug;95(3):246-54.
doi: 10.1016/j.eplepsyres.2011.04.007. Epub 2011 May 18.

Hippocampal activation correlates with visual confrontation naming: fMRI findings in controls and patients with temporal lobe epilepsy

Silvia B Bonelli  1 , Rob Powell, Pamela J Thompson, Mahinda Yogarajah, Niels K Focke, Jason Stretton, Christian Vollmar, Mark R Symms, Cathy J Price, John S Duncan, Matthias J Koepp
Affiliations

Hippocampal activation correlates with visual confrontation naming: fMRI findings in controls and patients with temporal lobe epilepsy

Silvia B Bonelli et al. Epilepsy Res. 2011 Aug.

Abstract

Purpose: In patients with left temporal lobe epilepsy (TLE) due to hippocampal sclerosis (HS) decreased naming ability is common, suggesting a critical role for the medial left temporal lobe in this task. We investigated the integrity of language networks with functional MRI (fMRI) in controls and TLE patients.

Experimental design: We performed an fMRI verbal fluency paradigm in 22 controls and 66 patients with unilateral mesial TLE (37 left HS, 29 right HS). Verbal fluency and naming ability were investigated as part of the standard presurgical neuropsychological assessment. Naming ability was assessed using a visual confrontation naming test.

Results: Left TLE patients had significantly lower naming scores than controls and those with right TLE. Right TLE patients performed less well than controls, but better than those with left TLE. Left TLE had significantly lower scores for verbal fluency than controls. In controls and right TLE, left hippocampal activation during the verbal fluency task was significantly correlated with naming, characterised by higher scores in subjects with greater hippocampal fMRI activation. In left TLE no correlation with naming scores was seen in the left hippocampus, but there was a significant correlation in the left middle and inferior frontal gyri, not observed in controls and right TLE. In left and right TLE, out of scanner verbal fluency scores significantly correlated with fMRI activation for verbal fluency in the left middle and inferior frontal gyri.

Conclusion: Good confrontation naming ability depends on the integrity of the hippocampus and the connecting fronto-temporal networks. Functional MRI activation in the left hippocampus during verbal fluency is associated with naming function in healthy controls and patients with right TLE. In left TLE, there was evidence of involvement of the left frontal lobe when naming was more proficient, most likely reflecting a compensatory response due to the ongoing epileptic activity and/or underlying pathology.

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Figures

Figure 1
Figure 1
FMRI results in controls. (A) Main effect for verbal fluency, Left middle and inferior frontal activation (Threshold p < 0.05, FWE correction). (B) Correlational analysis. Left hippocampal activation for verbal fluency correlates with naming scores, characterised by better naming scores in subjects with greater fMRI activation (Threshold p < 0.01, uncorrected). (C) Correlation of fMRI activation for verbal fluency and naming scores at the peak voxel in the left hippocampus. Significant regions are superimposed onto an averaged normalized mean EPI image from 30 healthy controls, 15 patients with left and 15 patients with right HS.
Figure 2
Figure 2
FMRI results in TLE patients. (A) Right TLE patients: correlational analysis. Left hippocampal activation for verbal fluency correlates with naming scores, characterised by better naming scores in subjects with greater fMRI activation (Display at threshold p < 0.01, uncorrected). (B) Left TLE patients: correlational analysis. Left middle and inferior frontal activation for verbal fluency correlates with naming scores, characterised by better naming scores in subjects with greater fMRI activation (Display at threshold p < 0.001, uncorrected). The correlations at the peak voxel are illustrated on the right. Significant regions are superimposed onto an averaged normalized mean EPI image from 30 healthy controls, 15 patients with left and 15 patients with right HS.
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